Criterion #3 Does the story adequately explain/quantify the harms of the intervention?

All healthcare interventions carry potential harms. When reading a news story about a new treatment, readers should find out what is known about the harms. 

potential harms in health news

63% of the stories we’ve reviewed were rated Not Satisfactory when it came to discussing potential harms.

When a story is about a treatment (new drug, surgery, therapy lifestyle change, etc) or screening test, we expect it to include a discussion of harms and side effects, as well any measured “adverse events” in a study.

There are tradeoffs involved in any health care decision. No matter what you choose to do, you stand to gain something and you stand to lose something. All treatments have potential harms, side effects, and complications.

Also, there is no such thing as a simple blood or screening test. They carry the risk of a false-positive or false-negative result, which can result in missed diagnosis or overtreatment, and anxiety.

Ideally, stories discuss both frequency of side effects and severity of side effects, and discuss both major and minor side effects. What might be minor to one person could be major to another.  

Preliminary animal studies or otherwise early research: It’s also important to remember that we often have no idea what the true impact of a drug is until it’s been used in a large number of people (and not mice and not cells in a lab), so it’s always a good idea for journalists to point out that some harms may be unknown–especially when the research is far from ready for prime time.

Many stories emphasize or exaggerate potential benefits while minimizing or completely ignoring potential harms. They may:

  • Fail to mention potential harms.
  • Fail to quantify potential harms.
  • Fail to describe the severity of potential harms.
  • Fail to account for “minor” side effects that could have a significant impact on a patient’s life.
  • Rely too heavily on a patient anecdote about safety.
  • Rely too heavily on a researcher’s comment that an approach “appears to be safe” – without supporting data.

John R. Finnegan, PhD is a Professor and Dean of the School of Public Health at the University of Minnesota:

Satisfactory examples

AP doesn’t sugar coat harms of CAR-T therapy for lymphoma.
In this story, reviewers praised the story’s dissection of adverse events. The reviewers said “it makes it clear CAR-T treatment is not without major risks which include: treatable anemia, brain toxicity, and a “dangerous condition where the immune system overreacts in fighting the cancer” (likely, ‘cytokine release syndrome’). Deaths directly caused by CAR-T therapy in this and other trials are mentioned.”

HealthDay story wisely includes harms of nocturia drug for older adults
The story includes the potential harms of using this drug in the elderly, and mentions that it is already on a list of drugs not to be given to the elderly.  The story also discusses incidents of low blood sodium levels that sometimes occur with this drug. It’s not often that we see stories address harms so thoroughly.

LA Times strikes the right balance by reporting evenly on both harms and benefits of ‘magic mushrooms’ for cancer patients
This story went the extra step to quantify the harms measured in a study. It explained: “In the two trials, about 15% of subjects experienced nausea or vomiting when getting a high dose, and about 1 in 3 experienced some form of transient psychological discomfort. Many subjects’ heart rates and blood pressure rose, but none to a dangerous extent.”

Not Satisfactory examples

ABC story on stroke surgery: More needed on costs, harms, conflicts of interest
Every surgery comes with potential harms, yet this story about surgery to remove blood clots didn’t discuss any. A stroke can be devastating, but so can complications from brain surgery. Readers need to know what the potential harms can be.

Potential harms missing in coverage of Color Genomics cancer test
All screening tests present potential harms–notably, the risk of incorrect or inaccurate results. New tests in particular may have an iffy risk profile. While this Bloomberg News story on a genetic test for cancer does acknowledge the possibility of ambiguous results, there is no specific discussion of possible harms from the new test such as false positive results that can lead to anxiety and stress, additional testing and potential surgeries — and of false negatives which can indicate no problem when the risks are actually quite high.

Stem cell brain implants–what could go wrong? Guardian doesn’t say
The story made it clear that this was mouse-level research and has several hurdles to go before it’s ever tested in people. But the story makes no mention of the potential harms that might arise from this approach. Since this has never been tested in humans, we have no idea what the potential harms are. The story needed to point this out.

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