The evolution of a story: hospital “selling scans” makes it into final headline

At a cost of $100, a heart scan from HeartScan Minnesota is a simple, inexpensive way to get an inside view of your heart’s health.

Who should have a heart scan?

Anyone, age 35 to 79, with one or more of these risk factors for heart disease is encouraged to call for an appointment.

• Family history
• High cholesterol
• Smoking
• High blood pressure
• Obesity
• Physical inactivity
• Diabetes

That may not sound unreasonable to the untrained, unskeptical eye and ear.  But Walsh, in his final story, quoted me as follows:

Gary Schwitzer, publisher of the blog HealthNewsReview.org, said the hospitals are appealing to “the worried well,” as they push their scanning services.

“How do they promote this? ‘You are 35 years old and you’re physically inactive,’ or ‘You are 35 years old and have just been diagnosed with mild hypertension,'” Schwitzer said. “This gets you to come in the door and, ka-ching, you’re a new health care patient.”

Two physicians to whom I referred Walsh – two docs who focus on evidence – not marketing – also weighed in with critical comments in the final story.

Based on what I saw in the Star Tribune’s video of Walsh’s story – presumably taped back on September 25 – I think we were seeing a reporter who was about to go in one direction with his story – possibly a more one-sided, “Look what they found in me…this makes sense for all my readers” story.  But that didn’t happen with the final piece on October 7.

If I were Walsh’s editor, I would have changed some things:

• First of all, out of a long conversation I had with him, he used only one little quote which probably wasn’t the most important point I made with him.  But I don’t want to be like many interviewees who second-guess interviewers.  So I’ll stop there. He asked smart questions and appeared open-minded.  I enjoyed our conversation.
• Second – actually this probably should have been first – I don’t like the idea of any reporter biting on a PR person’s offer of being scanned.  I think that sets up a dangerous scenario of possible perceptions – even if subconscious – of expectations and obligations.  Walsh, in the end, avoided much of this potential danger. But it could be argued that he crossed the line on at least three of the tenets of  the Association of Health Care Journalists’ Statement of Principles (which I drafted and shepherded through to approval). Relevant excerpts of that Statement:

We must:

• Preserve a dispassionate relationship with sources, avoiding conflicts of interest, real or perceived.

• Remember that journalists face other potential conflicts of interest. Think about questions such as: Were you a patient at a particular hospital? Do you have a relative with a specific disease that could unduly influence your handling of a story? … It is the journalist’s responsibility to recognize these conflicts and prevent them from influencing stories or story choices.

• Deny favored treatment to advertisers and special interests and resist their pressure to influence news coverage.

• The argument would be that he had at least a perceived conflict by accepting the PR person’s offer, and that this could not be defined as a “dispassionate relationship” as a result.  He reported on himself being a patient at a particular hospital and his own “diagnosis” became part of the handling of his story. He and/or the Star Tribune did not resist the hospital’s pressure to influence news coverage.
• I disagree with one of Walsh’s blog posts and the statement on the hospital website referring to such scans as “simple” or the decision about having such scans being “simple enough.”  There is not and should not be anything simple about the decision to have such scans.  The balancing perspectives Walsh finally included in his final Sunday piece made this clear.  There are, indeed, harms that can arise from a so-called simple screening test.
• How a story ends often seems to reveal the reporter’s (or editor’s) editorial leaning.  This story gave the hospital’s scan-promoting director of preventive cardiology the final word – “Whatever it takes to get people to start taking the initiative.”  Many voices in health care would question the “whatever it takes” approach.  Over and over, every day we are learning that in health care more is not always better, newer is not always better, screening doesn’t always make sense for everybody.

But I am pleased that Walsh called me.  I think it made a difference in his final story – the one most people probably saw of the 3 items he published.  It had important balancing perspectives.  He and I talked about many other things in our long conversation – much of which I won’t write about.  But I also pointed out to him that what happened in his case, with his own health history and family history, may not be relevant or applicable to many of his readers.

This is not easy stuff to get right.  Journalists who cover such issues tend to get it right when they scrutinize evidence, seek independent perspectives, question the marketing promotional statements, and frame screening decisions as complex, individual matters that should take into account the tradeoffs between potential benefits and potential harms – with actual data.  In the end, Walsh got closer to that ideal, and readers were better served by the questions that eventually made it into his coverage.