The first part of a two-part, two-weekend interview appeared on Indiana Public Radio this weekend.

The guest: me.

The topic: health journalism.

Some good things are happening in health news coverage.

Of the first 12 stories reviewed in 2009 on HealthNewsReview.org, five have received the top five-star score.

In the three years of the project, there have never been so many highly-rated stories in such a sport span. In fact, only 13% of all 712 stories reviewed so far have received five-star scores.

Next week in a talk at the Foundation for Informed Medical Decision Making's Policy & Research Forum in Washington, DC, I'll also be presenting some new data that shows small - but I think significant - improvement on some of our criteria on which journalists have traditionally done most poorly.

This is especially significant, in my view, given the terrible times in newsrooms these days.

• bottom line pressure hurting the quality of health news.
• lack of training
• impact of layoffs and cutbacks
• shrinking news hole for health care news overall
• weakened newsrooms more vulnerable to PR and ad pressures

Many people continue to work hard every day to report health news in depth, emphasizing evidence, context and integrity. We applaud them.

At the same time, network television health news pieces continue to disappoint. Look at the thumbnail below of two recent ABC Good Morning America segments. One got zero stars, the other two.

The Milwaukee Journal Sentinel has done it again.

This tough "medium market" (if I can call it that) newspaper faces tough economic times by scrapping to do more tough journalism. Just two weeks ago we blogged about one of their stellar health journalism efforts.

Yesterday they published a 1,700-word story (that's rare these days) raising more conflict of interest questions at the University of Wisconsin medical school. It begins:

The conclusions were clear: Women who took hormone therapy drugs were at increased risk for breast cancer, heart disease, stroke and blood clots.

The findings were so strong that researchers stopped a clinical trial in 2002, five years early, because it would have been unethical to continue giving the drugs to women.

But that same year, the University of Wisconsin-Madison's School of Medicine and Public Health began a medical education program for doctors that promoted hormone therapy, touted its benefits and downplayed its risks.

For the next six years, thousands of doctors from around the country took the online course that was funded entirely by a $12 million grant from Wyeth Pharmaceuticals, which makes the hormone therapy drugs used in the study, Prempro and Premarin.

The university received $1.5 million of that total, and university faculty received money as well.

Even after the course was no longer available, the Web site and course material remained on the Internet, accessible to consumers and doctors. The university dropped the site Jan. 15, one day after the Journal Sentinel began questioning UW officials about the propriety of the program.

The influence of drug companies on doctors - and, by extension, medical schools - is coming under increased scrutiny, with critics saying programs like the UW one are essentially marketing exercises.

Of the first 710 stories reviewed on HealthNewsReview.org, only 88 – or 12% have received our top five-star score.

But in one recent 8-day span, a record of four stories were given a five-star review by three independent reviewers – using the same ten standardized criteria we apply to all stories.

Here are those four:

• An Associated Press story, “Fewer clogged arteries need heart stents, study finds; blood-flow test can show which ones do.”

• A Cleveland Plain Dealer story, “Early Cesareans put babies at risk, study finds.”

We said: “Good job describing the current study and quantifying the results and quoting multiple experts who provide different perspectives. Valuable information for readers – and in only about 500 words.”

• An Associated Press story, “Alzheimer's drugs double death risk in elderly.”

We said: “In fewer than 450 words, this story gives good details on study methods, comments from two independent experts, and context about previous research and current treatment. Nice job.”

• A Milwaukee Journal Sentinel story, “Deep in brain, shocks help Parkinson's symptoms.”

We said: “Solid job balancing positive study findings with negative ones, providing opportunity for a skeptic to air concerns. Good to see a newspaper devote more than 1,000 words to a story these days!”

Is HealthNewsReview.org making a difference? Is it helping journalists do a better job?

We can’t be sure of the impact we’ve had, but a recent analysis of many of the first stories we reviewed back in the Spring of 2006 compared with some of the most recent stories we reviewed in the Winter of 2008 suggests that the quality of health journalism is improving – despite all of the difficult economic times in newsrooms across the country.

More on this data in weeks to come.

Meantime, congratulations to those working so hard to maintain and improve the quality of health care news coverage in this country.

The Milwaukee Journal - a paper facing all the struggles (and maybe some more) that any news organization faces - continues to shine through it all with its health news coverage.

Reporter John Fauber has a two-part series this week on "doctors moonlighting for drug companies." Excerpt:

It's a practice that increasingly is drawing criticism because of concerns that it can influence patient care and raise the cost of treatment, in addition to blurring the line between research and marketing.

The deans of the state's two medical schools say they would like to ban the practice or severely limit it.

"I am very bothered by our faculty using our school's name in giving non-academic promotional, marketing talks," said Robert Golden, dean of the UW medical school. "It's a major issue we are talking about now."

In October, the Wisconsin Medical Society, as part of its recommendations for ethical behavior, said doctors should not serve as speakers. The group has no authority to regulate or stop the practice.

See part one.

And part two.

While I was on vacation last week, many web surfers found my name when searching for articles on Sanjay Gupta's work after the announcement that he was being considered for the Surgeon General position.

Because of a failure in search engine functioning, some surfers weren't able to find what they were searching for and asked me to provide an index. Here's some of what I've written:

• on non-evidence-based screening test advice for men

• on an "unquestioning - almost cheerleading - approach to health news"

• about a journal article that pointed out his involvement in a doctor's office waiting room video program that "overtly offers sponsors, including drug companies, the chance to boost sales of their products."

• about the political newsletter CounterPunch and the Chicago Tribune asking readers:"Do you trust CNN's Dr. Sanjay Gupta?"

• about Trudy Lieberman's article describing ineptitude by CNN and Gupta in coverage of health policy news.

• about Gupta vs. Michael Moore regarding "Sicko"

• about the waste of air time speculating over the cause of death of Anna Nicole Smith.

• about a one-sided view of the controversy over mammography for women in their 40s.

• about a Pfizer ad for Pfizer's sponsorhip of the "Paging Dr. Gupta" program.

• about some laughable, some dangerous coverage on Gupta's "Housecall" program

• about bad judgment employed in his live TV news coverage of Raelian cloning news conference.

Two of his stories were reviewed on HealthNewsReview.org:

• about disease-mongering of wrinkles on CNN

• a review of his CBS story about a treatment for addiction to painkillers that got one of our lowest scores.

One of the smartest pieces I saw was by Sandy Szwarc on her Junkfood Science blog.

My summary:

1. What does the President want from a Surgeon General? Is it just PR & glitz? Then let's stop the charade and abandon the position. Like ending the Pony Express - a once good idea whose usefulness is past.

2. What does the American public need from a Surgeon General? I suggest "Nothing."

3. The prevention & wellness messages that Gupta so often promoted on CNN can go too far - pushing screening tests outside the boundaries of evidence and ignoring that such screening may cause more harm than good. If that is the message that he would promote as Surgeon General, I would consider that a non-evidence-based abuse of the bully pulpit. And a huge mistake by the Obama administration. See Gilbert Welch's pre-election essay in the NYT on the overpromotion of screening/prevention by both Obama and McCain.

4. The industry conflict of interest questions that have arisen are cause for concern. Usually where there's smoke, there's fire.

5. On the air at CNN he too often acted as a doctor not as a journalist. That's because he really wasn't a journalist. He wasn't trained as one - CNN threw him into that situation. There are countless more pre-eminent doctors and countless better health communicators than Sanjay Gupta. So what's his qualification?

6. Presumably Surgeon General Gupta would work closely with new HHS secretary Tom Daschle. Several passages from Daschle's book, "Critical: What We Can Do About the Health Care Crisis," raise questions in my mind about the Gupta appointment. Daschle wrote about "using evidence-based guidelines and cutting down on inappropriate care" as effective ways to control rising health-care costs. But Gupta's reporting, as noted in the entries above, often didn't reflect a great appreciation for evidence-based health care. Daschle also wrote, "It is relatively easy to misinform the public and stoke fears, no matter how strong the desire for reform." Promoting screening outside the boundaries of evidence is fear-mongering. These are potentially troublesome disconnects for an Obama health care team.

Can't I just have a few days away without feeling the need to comment on health care/health journalism news?

I've been away from the mainland for two days and now I hear that:

1. CNN's Sanjay Gupta may be picked as Surgeon General.

2. One of the best health news bloggers in the U.S. - Ed Silverman of the Star Ledger of New Jersey's Pharmalot.com blog, has taken a buyout and will no longer run that blog.

I'm shocked by both pieces of news.

In this economy I don't begrudge anyone's ability to make a buck. There are companies that make a lot of bucks selling "breakthrough" TV health news segments to TV stations to fill air time. Presumably the stations don't think they need their own fulltime health reporter, can't afford to hire one, and/or find it cheaper to pay for this "off the shelf" TV health news product from an out-of-town provider.

The Grade The News website gave a thorough description of the practice with one company. Excerpt:

"The company, Ivanhoe Broadcast News, allows local reporters to put their names on stories they didn't report, film or write -- without mentioning Ivanhoe. Stations also are permitted to omit geographical information, giving viewers the false impression that the stories were locally produced and the patients and doctors quoted in the stories could be their neighbors."

The company's signature product is called "Medical Breakthroughs reported by Ivanhoe." More power to entrepeneurs like Ivanhoe who make money (actually a lot of money) doing this. That's a business decision.

Shame on the stations that take this "quick and dirty" route to health news coverage. That's a journalism ethics decision.

I wrote recently about a local TV health reporter who blogged about this practice - only to discover that the station news director hijacked the reporter's blog and deleted the blog entry. Pretty clearly this is not something stations are proud of - nor should they be.

Well Ivanhoe is back in the news and this time it's with the blessing of the entire TV news industry's professional group - the Radio-Television News Directors Association, which announces:

"In celebration of Ivanhoe Broadcast News' 30th anniversary, Ivanhoe and The Radio and Television News Directors Foundation have joined forces to provide two new training opportunities for journalists.

RTNDF and Ivanhoe are offering a post-graduate internship for a recent journalism graduate. The three-month internship will provide professional training in health reporting at Ivanhoe headquarters in Orlando, Florida, in the summer of 2009.

The second opportunity is for a working reporter or producer at a television station, who will receive a two-week fellowship to travel to the Ivanhoe headquarters to focus on health and medical reporting."

When my friend and fellow former CNN medical correspondent Andrew Holtz heard of the RTNDA-Ivanhoe partnership, he wrote to me:

"The first question that came to my mind was: What are they going to teach... how to do single source stories where only the providers of a product or service are interviewed?"

Indeed, when you look at stories on the Ivanhoe website, you find single source stories with one spokesman from one institution touting one idea. No independent analysis. In fact, the online stories post a PR contact at each institution.

So it's a win-win for almost everyone:
• The health care institution gets the publicity they covet.
• The TV station can say it covers health news - even though it really doesn't.
• Ivanhoe makes more money.

The only loser? The audience - which gets "just add water" TV news slipped into the newscast as if it is the most important news of the day for that community. And it isn't.

Why doesn't RTNDA partner with the NIH Medicine in the Media workshop or the MIT Science Journalism Fellowships or with the Association of Health Care Journalists or with our HealthNewsReview.org project? (I wrote to RTNDF three times in 2008 without getting a response.)

Any one of the above organizations could help improve the state of TV health news - and help TV reporters assess questions of evidence, of cost-effectiveness, of harms (instead of always just the benefits of a new idea), and of conflicts of interest in health care and in story sources.

The RTNDA/RTNDF deal sends the wrong message to the industry: a message that promotes "breakthroughs" instead of explaining to audiences that breakthroughs are rare and that health care news demands more careful scrutiny at the local level every day.

2008 was a bad year for TV health news, with Eau Claire, Wisconsin news director Glen Mabie quitting over a decision his station had made to partner with a local medical center for delivery of that medical center's health care news. RTNDA was mostly silent on these quite common TV station arrangements with local hospitals.

2009 could be better. It's not off to a great start.

Susan Dentzer, editor-in-chief of Health Affairs and health policy analyst for the PBS NewsHour with Jim Lehrer has a commentary in this week's New England Journal of Medicine, "Communicating Medical News — Pitfalls of Health Care Journalism." Excerpt:

"In my view, we in the news media have a responsibility to hold ourselves to higher standards if there is any chance that doctors and patients will act on the basis of our reporting. We are not clinicians, but we must be more than carnival barkers; we must be credible health communicators more interested in conveying clear, actionable health information to the public than carrying out our other agendas. There is strong evidence that many journalists agree — and in particular, consider themselves poorly trained to understand medical studies and statistics.5 But not only should our profession demand better training of health journalists, it should also require that health stories, rather than being rendered in black and white, use all the grays on the palette to paint a comprehensive picture of inevitably complex realties. Journalists could start by imposing on their work a "prudent reader or viewer" test: On the basis of my news account, what would a prudent person do or assume about a given medical intervention, and did I therefore succeed in delivering the best public health message possible?

Although the primary responsibility for improving health-related journalism must lie with journalists, clinicians and researchers can help. When interviewed by journalists about a news development, such as a new study, they should offer to discuss the broader context, point reporters to any similar or contradictory studies, refer journalists to credible colleagues with differing perspectives, and mention any study limitations or caveats about the results, as well as any potential or real conflicts of interest among the study authors. It will take many expert hands to ensure that the health news the public reads really is fit to print."

Let's not lose sight of the fact that medical journals like the New England Journal of Medicine also play a role in this picture. As Trudy Lieberman points out on the Scientific American website,

"...much of daily health reporting these days is based on findings reported in medical journals. They, too, have come under criticism recently for failing to disclose authors' potential conflicts of interest, such as their ties to companies that paid for the research (those caveats are becoming more transparent). But journals usually publish "good" news — a phenomenon detailed in several studies this year that showed how rarely pharmaceutical companies publish studies with negative findings.

The journals, Lieberman notes, have same interest as the mainstream media. "They want to build an audience and hope because the American healthcare system is built on hope and money."

Unfortunately, neither the NEJM essay nor the Scientific American article mention the HealthNewsReview.org project, which, for almost 3 years has given daily evaluations and grades of health news coverage - e-mailing journalists to help them improve. Interestingly, one of the commenters to the Scientific American article did refer readers to HealthNewsReview.org as a "great learning resource for those who want to develop their critical thinking in this important area."