We received some interesting feedback in response to our last Publisher’s Note, “Too Brief To Matter - Part Two: The benefits/harms of briefs & digests,” and wanted to share some of it with you. We are planning a revision to our site that would provide a better place to host such discussions online in the future. More on that when we’re ready to roll out the changes. For now, here are some of your comments:

From Andrew Holtz:

“I agree with what the HealthNewsReview findings indicate: if a story isn't worth devoting adequate space (or time) to, then it probably isn't worth reporting at all. And as a reader/viewer, I don't want my news cluttered with bits of partial information that are not useful. The issue reminds of the old sports news joke: “We have this partial score for you... Stanford 7.” A medical story that reports just benefits, for example, without including harms or alternatives is like a sports update that reports the score for only one team in the game. Without context, the information is worthless.”

From Robert Dacey:

“As a former consumer/patient representative on FDA expert panels (CDRH), I am acutely aware of the deluge of advertising disguised as news that saturates the news media on a daily basis. Added to the saturation is the DTC (direct-to-consumer) advertising. The purpose of consumer/patient information and education is to facilitate intelligent medical decisions. The purpose of DTC advertising and advertising disguised as news is to sell something. Your news review services are important. I share them with consumers, patients, and medical professionals.”

From William Bennett:

“Generally, I am NOT in favor of health news briefs, digests, health headline sections, and televised sound bites. Without complete information, these can be very misleading, and lead to incorrect conclusions regarding one's health. If health teasers are displayed in magazines, only enough information should be given to draw the reader to their website, and the URL should be prominently displayed.”

From Josh Fischman:

“I'm glad, in your publisher’s note, you finally recognized that you have a basic objection to the brief format in health reporting, and not with individual briefs. It seemed silly to complain that short-form stories were short-form stories. I'm curious why you think editors and publishers have fallen in love with the brief. They don't seem to deliver a good story to readers most of the time. So why do publications dote on them?”

From Joseph Pallas:

“Maybe this is an area where the traditional media really cannot match the capabilities of the online media. The problem is that the traditional media cannot easily point to the long form of the story, so they must either condense it or ignore it. This does not serve their readers/viewers well, and the question for responsible journalists is whether there is a way to tell people enough of the story to let them know that there is a story, while at the same time making it clear that they don't have the whole story. Oh, and they have to do that without annoying their editors and publishers, because the straight-forward approach will inevitably resemble ‘You're wasting your time reading this.’ Quite a challenge.”

From Ira Allen:

“In discussing the fallibility of news briefs and digests on health findings, I think it is important to recognize that a newspaper or magazine itself is a digest. At any length, a news story about a medical finding will be incomplete, which is why wider access to original journal articles is necessary. To paraphrase the old joke, now that we know how important a health news story is, we are just quibbling about length. The more information about risks and caveats of a particular treatment the better. But at some point, whether it is blind faith or printing boilerplate that reminds readers of a study's limitation, we have to give consumers credit for using their common sense and sorting through the information relevant to each of them. I suspect that because health is the No. 1 topic of non-celebrity, non-pornographic Internet searches, readers have already shown themselves to be savvy enough to go get the details elsewhere. You are absolutely correct that space is available. It’s a matter of editorial decision-makers choosing how to allocate it. However, that choice is generally based on what an editor believes the readers are interested in, and long may it be so! If you add 200 words to a medical story, it will not come at the expense of Jennifer Lopez's hoodie. It will come at the expense of another health story. And therein may lie a solution: print fewer health stories of greater length. But doing that may rob a reader of important cues. I can read accounts of 100 new studies, but the one about a condition that affects me will cause me to read it more carefully and seek more information. The news article, however skimpy, thus serves the same purpose as the headline -- encouraging you to read more. The day the newspaper or news magazine is assumed to be the last word on anything is the day journalism dies.”

(I know Ira and consider him a friend. So I don’t think he’ll mind if I point out that he used 320 words to respond to our note about the harms of stories of less than 300 words. A thoughtful response, Ira, and we post it in its entirety.)

We’ve just posted a review of a CBS News story on an osteoporosis drug. It contained 60 words and consumed about 15 seconds of airtime. It is one of only 8 stories (out of more than 420 reviewed) that we’ve given our lowest zero-star score.

And a new U.S. News & World Report story, “Prostate drug shows safer side,” ran 163 words and was reviewed with only a one-star score.

We welcome other comments on this or other topics related to the practice of health and medical journalism.

Australian journalism Melissa Sweet, in a piece entitled, "The ties that bind: how big pharma buys a good press," in the Australian online magazine Crikey (subscription required but free trial available), writes:

"The media is often quick to get on its high horse about the pharmaceutical industry’s wining and dining of doctors, but is much less upfront about the lucre that journalists accept from drug companies and other health organisations.

These take the form of journalism prizes -- the booty for the Pfizer Eureka Prize for Health and Medical Research is a hefty $10,000 -- and sponsored trips to attend conferences or other such events.

Organisations as august as the National Press Club take sponsorship for health journalism awards from groups with clear vested interests, such as the pharmaceutical industry lobby group, Medicines Australia, and the drug company, Pfizer Australia.

Indeed, so many vested interests are involved in medical journalism awards that it’s verging on the ridiculous. Roche funds an international award for obesity journalism, and is also one of the companies behind an international osteoporosis journalism award. My personal favourite is the Embrace Award, jointly sponsored by Eli Lilly and Boehringer Ingelheim, for "accurate, responsible and sensitive reporting on urinary incontinence".

Other awards are funded by professional or advocacy groups eager to promote themselves or their issues. The Australasian Society of Clinical Immunology and Allergy has an award "to recognise outstanding medical and health reporting on allergic and immune diseases in Australia and New Zealand". The Royal Australian and New Zealand College of Ophthalmologists gets up to 30 entries each year for its awards - two of $3,000 each - for journalism promoting "understanding of eye care issues specifically related to the work of Australian and/or New Zealand ophthalmologists".

Organisations such as the National Press Club stress the independence of their awards and the judging process, and just about everyone involved in such awards emphasises that their aim is to support and encourage good journalism. That may be the case but of course there are also other agendas, whether generating positive corporate PR, building relationships with key journalists and organisations, or promoting particular issues/products. The Embrace Award at least is upfront about this, saying it aims to "empower women to seek help" - presumably from one of the sponsors’ products."

The Statement of Principles of the Association of Health Care Journalists includes a clause: "...weigh the potential benefits of accepting awards from organizations sponsored by an entity with a vested interest in health care against our need for credibility."

On our HealthNewsReview.org website, we've posted a new Publisher's Note to foster discussion about what's missing in so many of those "health news briefs" or "health watch" digests or "medical minutes."

In the 17 months that we’ve been reviewing stories from about 60 major U.S. news organizations, we have given our top five-star score to only one story of less than 300 words.

We’re coming to the conclusion that such “briefs��? may do more harm than good. Almost by default they oversimplify medical research stories. They generally fail to adequately explain how big is the potential benefit of the idea being discussed, or how big is the potential harm. They fail to scrutinize costs, conflicts of interest, or the quality of the evidence.

A case in point is a 191-word story, “Keep an ovary, preserve a brain,��? by Katie Hobson, senior editor, health/medicine, for U.S. News & World Report magazine. We rated the story as unsatisfactory on four of our ten criteria.

Katie wrote to us and allowed us to publish her comments:

“Thanks for your site, and for updating reporters on when our articles are reviewed. I have absolutely no quibble with the need for your site and for more stringent reporting standards for health, medicine and science.

That said, I do have a quibble with reviewing less-than-200-word items done for our HealthWatch page, which is a quick digest of the week's health news. These items -- including the one by me that you just reviewed -- are almost always condensed versions of far longer stories that appear first on our website, during the week. So first, it seems fair to review the original article rather than the brief summary (in my case, the larger piece might have answered some of your questions, might not have, since it was a Q&A). More broadly, why review briefs at all? There are plenty of long stories in the magazine and on the site which definitely merit review and your criteria should be applied to them to see how they hold up. But given that your list of criteria is literally almost as long as the items themselves, it doesn't seem appropriate to expect a health digest to be comprehensive; there simply isn't room. It's as if you went through the front section of the NYT and criticized the regional briefs for not giving the complete history of a conflict and not consulting outside experts.

Certainly, there's a larger question as to whether a digest section should even exist, since it's impossible to include all the facets of a study in that tiny space. But shouldn't that issue be debated, rather than applying standards that seem more suitable to longer (even over 300-word) articles, rather than quick news hits?

Thanks for reading,

Katie��?

Katie and I have exchanged some thoughts in a followup e-mail and she welcomes an open discussion about some of the issues she raises.

Our stance:

Not all USN&WR readers use the USN&WR website; all they see is the magazine. That’s why we think it’s fair and legitimate to review what’s in the magazine.

To the question “Why review briefs at all?��? we are clearly countering with the question “Why publish briefs at all?��? Katie writes about the limitations of addressing our criteria – “there simply isn’t room…in that tiny space.��? But the magazine has decided these stories are only worth a tiny space; they could easily find more space. It’s an editorial decision we’re trying to change.

And that’s the larger question Katie and I (and probably many other journalists) think should be discussed and debated openly. Clearly, you can’t fault the writers and reporters who do their best to cover topics when assigned to write a brief or digest. But editors and publishers should take a hard look at the issues we raise about what’s left out – perhaps to the harm of the reader – for the sake of brevity.

And this is not just a magazine phenomenon. Network TV news health stories – across the board – get weaker reviewers than any other medium in our first 17 months. And self-imposed time limits are usually at the root of the weak review. Yet time is found in many newscasts for Anna Nicole Smith, for Lindsay Lohan, etc.

And newspapers? Last week my local Star Tribune had a full-page (except for a 10��? X 13��? ad) of eight news briefs on one page – none reported locally, all from wire services. Five were health stories - None more than 225 words. Even a “New York Fashion Week��? story on page A2 got more words than that – complete with description of Jennifer Lopez’ design of “denim boy shorts with a sparkling brown hoodie.��?

Space is available. It’s a matter of editorial decision-makers choosing how to allocate it.

Yesterday we profiled a Wall Street Journal column about the statistical flaws in some studies. Today we point out a Los Angeles Times column that gives readers a better understanding of the strengths and weaknesses of epidemiologic studies. Excerpts:

"(Critics say that) far too many of these epidemiological studies -- in which the habits and other factors of large populations of people are tracked, sometimes for years -- are wrong and should be ignored.

In fact, some of these critics say, more than half of all epidemiological studies are incorrect.

The studies can be influential. Often, in response to them, members of the public will go out and dose themselves with this vitamin or that foodstuff.

And the studies also influence medical practice -- doctors, the critics note, encouraged women to take hormones after menopause long before their effects were tested in randomized clinical trials, the gold standard of medical research.

Some of epidemiology's critics are calling for stricter standards before such studies get reported in medical journals or in the popular press.

(One) of the foremost critics argues that epidemiological studies are so often wrong that they are coming close to being worthless. "We spend a lot of money and we could make claims just as valid as a random number generator," he says.

Epidemiology's defenders say such criticisms are hugely overblown.

They are "quite simplistic and exaggerated," says Dr. Meir Stampfer, a professor of epidemiology and nutrition at the Harvard School of Public Health and a professor of medicine at Harvard Medical School.

...The debate is unlikely to be resolved any time soon. "If you put five epidemiologists and five statisticians in a room and have this debate," (one critic) says, "and try to get each one to convince the other side, at the end of the day it will still be five to five."

The important thing for journalists and for readers to understand is that there is a hierarchy of evidence - and that not all studies hold equal weight or power to point to a conclusion. Both the Wall Street Journal and Los Angeles Times stories are important in reminding us of that.

Just watched John Stossel's special, "Whose Body Is It Anyway? Sick in America," on the ABC News 20/20 program.

Wow.

Simplistic. Superficial. Shallow. Superfluous.

Just one example: he used laser eye surgery and cosmetic surgery as two examples of how the competitive marketplace can bring health care costs under control. No discussion of quality. No discussion of evidence. No discussion of overuse.

No discussion about some of health care's true challenges: management of diabetes, chronic heart or lung disease, care for the elderly, care for anyone with multiple chronic conditions.

I wasted an hour.

We want to re-open a discussion we first started earlier this year in a note called “Too Brief To Matter” about the value of health news briefs, digests, “health headline” sections and the like.

In the 17 months that we’ve been reviewing stories from about 60 major U.S. news organizations, we have given our top five-star score to only one story of less than 300 words.

We’re coming to the conclusion that such “briefs” may do more harm than good. Almost by default they oversimplify medical research stories. They generally fail to adequately explain how big is the potential benefit of the idea being discussed, or how big is the potential harm. They usually fail to scrutinize costs, conflicts of interest, or the quality of the evidence.

A case in point is a 191-word story, “Keep an ovary, preserve a brain,” by Katie Hobson, senior editor, health/medicine, for U.S. News & World Report magazine. We rated the story as unsatisfactory on four of our ten criteria.

Katie wrote to us and allowed us to publish her comments:

“Thanks for your site, and for updating reporters on when our articles are reviewed. I have absolutely no quibble with the need for your site and for more stringent reporting standards for health, medicine and science.

That said, I do have a quibble with reviewing less-than-200-word items done for our HealthWatch page, which is a quick digest of the week's health news. These items -- including the one by me that you just reviewed -- are almost always condensed versions of far longer stories that appear first on our website, during the week. So first, it seems fair to review the original article rather than the brief summary (in my case, the larger piece might have answered some of your questions, might not have, since it was a Q&A). More broadly, why review briefs at all? There are plenty of long stories in the magazine and on the site which definitely merit review and your criteria should be applied to them to see how they hold up. But given that your list of criteria is literally almost as long as the items themselves, it doesn't seem appropriate to expect a health digest to be comprehensive; there simply isn't room. It's as if you went through the front section of the NYT and criticized the regional briefs for not giving the complete history of a conflict and not consulting outside experts.

Certainly, there's a larger question as to whether a digest section should even exist, since it's impossible to include all the facets of a study in that tiny space. But shouldn't that issue be debated, rather than applying standards that seem more suitable to longer (even over 300-word) articles, rather than quick news hits?

Thanks for reading,

Katie”

Katie and I have exchanged some thoughts in a followup e-mail and we welcome an open discussion about some of the issues she raises.

Our stance:

Not all USN&WR readers use the USN&WR website; all they see is the magazine. That’s why we think it’s fair and legitimate to review what’s in the magazine.

To the question “Why review briefs at all?” we counter with the question “Why publish briefs at all?” Katie writes about the limitations of addressing our criteria – “there simply isn’t room…in that tiny space.” But the magazine has decided these stories are only worth a tiny space; they could easily find more space. It’s an editorial decision we’re trying to change.

And that’s the larger question Katie and I (and probably many other journalists) think should be discussed and debated openly. Clearly, you can’t fault the writers and reporters who do their best to cover topics when assigned to write a brief or digest. But editors and publishers should take a hard look at the issues we raise about what’s left out – perhaps to the harm of the reader – for the sake of brevity.

And this is not just a magazine phenomenon. Network TV news health stories – across the board – get weaker reviewers than any other medium in our first 17 months. Self-imposed time limits are usually at the root of the weak review. Yet time is found in many newscasts for Anna Nicole Smith, for Lindsay Lohan, etc.

And newspapers? This week my local Star Tribune had a full-page (except for a 10” X 13” ad) of eight news briefs on one page – none reported locally, all from wire services. Five were health stories - none more than 225 words. Even a “New York Fashion Week” story on page A2 got more words than that – complete with description of Jennifer Lopez’s design of “denim boy shorts with a sparkling brown hoodie.”

Space is available. It’s a matter of editorial decision-makers choosing how to allocate it.

Meantime, kudos to the Los Angeles Times for a series published in August on the influence of drug marketing.

Several excerpts from that series:

"In a nation that consumed $279-billion worth of prescription medications in 2006 - spending 80% of that on brand name drugs – (drug marketing) efforts appear to be paying off. Americans filling a prescription choose brand-name products 37% of the time, even though three quarters of all prescription drugs in the U.S. are available in cheaper generics."

"Each day in the United States, an army of roughly 100,000 pharmaceutical company sales reps storms the waiting rooms and offices of the nation's 311,000 office-based physicians."

"The drug industry, according to estimates by the Center for Public Integrity, has spent $758 million on lobbying - more than any other industry - since 1998."

A series of stories – thousands of words. Reporter Melissa Healy wrote to me that she was overwhelmed by public response to the effort. Good in-depth health journalism is not only the right thing to do – it may improve the bottom line.

Johns Hopkins University president William Brody, in a speech at the National Press Club on Friday, said journalists are not asking presidential candidates the right questions about health care reform.

“If you’re only reporting cost and coverage issues, you‘re missing a big part of the story,� Brody said.

Brody said that almost no one -- candidates or reporters -- is addressing equally essential elements of the health care puzzle: the quality and consistency of care; the complexity of medical practice today; and the role of chronic disease, the treatment of which threatens to monopolize health care resources. These “three C’s� of health care -- consistency, complexity and chronic disease -- need to be front and center in any reform efforts, Brody said.

“The fact is, cost and coverage solutions alone will not solve our problems,� Brody said. “We can’t provide health insurance for all unless we control the spiraling costs of health care. But we won’t control costs until we deal with these other issues.�

Brody said he will help get the right questions on the table by participating in a planned series of televised conversations with presidential candidates. Brody said that Johns Hopkins is working with the nationally distributed Retirement Living TV network and the National Coalition on Health Care to produce and air Presidential Spotlight on Healthcare ’08: Which Way Forward? during the primary season. In half-hour discussions, Brody will provide the presidential candidates a platform to explain their health care proposals in terms that address all age groups of Americans.

Brody urged reporters and voters to question presidential candidates closely on how they propose to bring rationality and order to what he described as the industrialized world’s most inefficient medical system.

“At The Johns Hopkins Hospital, we have to bill more than 700 different payers/insurers, such as HMOs, PPOs, Medicare and Medicaid,� he said. “Each one has its own set of rules regarding what services are covered, the level of reimbursement, and what kind of documentation and pre-approval is required. Nationally, this kind of inefficiency costs patients billions of dollars every year.�

Ben Goldacre, in this week's BMJ writes:

I was surprised last week by an email circular I received from a science writers' mailing list. It was from the Aspirin Foundation, a group funded by the drug industry, and it was offering—on behalf of Bayer Healthcare—to pay expenses for journalists to attend the European Society of Cardiology's conference in Vienna.

Now aspirin is without doubt an excellent and cheap drug. But in my naivety I had no idea such things went on. I pinged off a few emails to friends and colleagues. Most poked fun at my innocence—quite rightly—but some were helpful. Not only is it extremely common for journalists to take money from drug companies, but there have been some astonishing cases in recent history, including one memorable case where a PR company invited journalists to "an exclusive preview" of new laser eye technology, with the offer to "discuss free treatment in return for editorial features."

"I organise the media programmes for a number of medical conferences run by scientific societies," said one person who, without wishing to be melodramatic, has asked to remain anonymous, "and I reckon at least 50% of the journalists present are paid for by drug companies. They get pretty well looked after too—first class travel, five star hotels, posh dinners, etc. Some of them indulge in double dipping, where they are paid by the day by the drug company and then by the publication that takes whatever they have written. Sometimes they don't even use the press room, spend all their time in company hospitality suites, and just go to company sponsored satellite sessions and press conferences."

Perhaps I'm naive, but I don't buy Ben's claim that it's "extremely common for journalists to take money from drug companies." But the points he makes about pharma's pervasive and troublesome influence on some journalists and news organizations is worth noting. He wrote:

"...There are real dangers in being too close to PR people: lovely though they may be, their trade is, by definition, manipulation. Drug companies are businesses, with responsibilities to their shareholders, and they wouldn't pay for journalists to attend their events if they didn't think it would affect media coverage of their product. After all, a journalist's article is far more credible than a paid advertisement, for anybody's money, and more likely to be read by potential consumers. ...

It's much easier to get someone to take your calls when they've taken your money. And I, for one, will in future read outraged media reports of academic conflicts of interest with a wry smile indeed."