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Dissecting press release puffery – Trudy Lieberman guest post

The following is a guest post by our blog contributor, Trudy Lieberman. The longer she’s been covering health care issues, the more tuned-in she seems to be about claims she sees in health care public relations.

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Back in 2002 Dartmouth researchers Steve Woloshin and Lisa Schwartz concluded in JAMA that press releases from medical journals did not routinely highlight limitations of the studies they reported or disclosed the role of industry funding the research. In 2009 Woloshin, Schwartz, and other colleagues examined more press releases in a paper in the Annals of Internal Medicine, this time from academic medical centers. They found the centers were promoting preliminary research data while omitting important caveats the public needed to judge the relevance of the results.

Puffy press releases from the healthcare industry have now gone way beyond disclosure lapses from medical journals and academic medical centers. Increased competition for patients and exploding healthcare technology have spawned tons of releases that are perfect fodder for myriad Internet sites and traditional media looking to fill their health news holes. A sample of some 20 press releases I collected over the last few months shows how the medical business stretches the definition of “news” hoping for a mention in a blog post, news story, TV segment, or tweet that will help sell a product or service, and burnish the brand.

“My work on promotion and marketing in medicine suggests benefits are hyped and harms tend to be hidden way too often,” says Ray Moynihan, co-author of “Selling Sickness” and now a senior research fellow at Bond University in Australia. “This bias can flow from the press release straight into the media coverage, distorting public debate and painting an overly rosy picture of what healthcare can deliver.”

How rosy was what I wanted to know. My sample, albeit small and nonscientific, gives a flavor of what journalists and ultimately the public are up against.

What prompted my little analysis was the “earth-shaking” news from New York City’s Mt. Sinai Hospital that the hospital had reached 100,000 likes on Facebook, “making it the first hospital in the Tri-State Area and one of seven hospitals in the nation to achieve this milestone.” What’s more NurseJournal.org ranked it among the top five social-media friendly hospitals nationally, a distinction that may have prompted this quote from the hospital system’s chief communications officer Leonard Achan, “Mount Sinai’s social media strategy has been to offer dynamic and accessible expert content that empowers and inspires our audience to live healthier lives.” Still, why would anyone pick up such a release? I e-mailed Sid Dinsay, associate director of media relations, asking him how much pick-up the release generated. We couldn’t find any.  Dinsay didn’t respond so I turned to Earle Holland, former assistant VP for research communications at Ohio State University, and now a member of the HealthNewsReview.org editorial team, to help me peel back the hidden messages of this press release and others. “Social media is an excellent way to bring in patients,” he told me. “If 100,000 people looked at you on Facebook, that means you should join the crowd of people who think you’re good. It’s a popularity contest and says nothing about the quality and care or the capability of the medical center.”

There’s a variation on this theme: If a hospital or high-tech company announces it can attract all-star talent or make prestigious business deals, others, too, might think they’re great. Take the release from the Back to Health Center in Alexandria, Va., announcing that the practice “has welcomed several new licensed massage therapists to their team of chiropractors, acupuncture physicians and natural childbirth educators.” Those new therapists allow the practice to “meet the increasing demand” for high quality massage therapy in the area and, of course, send the message that the enterprise is so good and in demand that it can attract great staff that will reel in new customers. A release from RadNet, which calls itself the leading provider of freestanding, fixed-site diagnostic imaging services in the U.S., announced it had snagged a contract to provide national cancer screening services in Qatar. Hey, if a foreign government selects your company as a vendor, you must be awfully good, and that can only help sell more machines at home.

Promoting a hospital’s survivors also polishes the brand. Sentara Norfolk General Hospital in Norfolk, Va., highlighted its 10th annual burn survivors’ reunion. “It invigorates me to see survivors like this carrying on with their lives,” said burn surgeon Dr. Jay Collins. “It can be a long road to recovery and they’re living normal lives.”  Translation: if you were badly burned, how about coming to Sentara?

But veteran research communications pro Earle Holland said,  “If you have a celebration of survivors, it suggests you are successful and if you have that condition, you go there.  It is clever and nothing but salesmanship and marketing.”

Some releases I examined used the “we are the first to do whatever” pitch What better way to create an aura of excellence than to tell the world you’re first to use whatever new device or treatment, which comes along. The Tucson Medical Center and Stereotaxis, which bills itself a “global leader” in innovative technologies for treating cardiac arrhythmias, did just that in an early January press release announcing they teamed up to bring the first Stereotaxis Vdrive® robotic navigation system with V-Loop™ variable loop catheter manipulator to the U.S. Doctors operate the hand controls of common diagnostic and therapeutic catheters from a control room during a procedure to treat cardiac arrhythmias. “We are excited and proud to be the first to offer this impressive innovation in the U.S. and particularly to the residents of Southern Arizona,” said Dr. Darren Peress, the medical director of the electrophysiology lab at the Tucson Medical Center. But should the residents of southern Arizona run out to get the new procedure? The new system just received FDA clearance in September 2014. Holland pointed out that being first may not always be the best. “The first person to do the procedure may not do it as well as the 100th person,” Holland told me. We know one word of advice to patients has been to check on the volume of procedures a particular facility has done and how many the doctor or surgeon has performed. The theory is the more they do the better they are.

Holland had a final thought about press release puffery.  What he calls “pie in the sky” language suggests some new, hyped intervention might do something, but he cautions it might not. Case in point was a recent release from MDxHealth for a product called ConfirmMDx® for prostate cancer, an epigenetic test developed to rule out the presence of undetected cancer in men with benign prostate biopsy results. The press release announced at a recent conference that data demonstrated “the prognostic value” of its technology. “The data support the ability to predict the presence of clinically significant cancer in biopsy-negative patients based on the DNA hypermethylation of the biomarkers in the Confirm MDx test,” the release said.

It added there is an “unmet medical need for a clinically effective diagnostic test” to address the false-negative results of prostate biopsies. But the release provided no specific performance data about how well the product supposedly met that unmet need!  It simply said: “Performance of the proprietary ConfirmMDx genes and technology has been published in 45 studies on over 5,000 patients tested.”  But it provided no data from those 45 studies. And no links to those studies.

You get the picture. Press release puffery goes on and on.

Starting next month, HealthNewsReview.org will begin publishing systematic, criteria-driven reviews of health care news releases.  We think this will be an important addition to our project, and potentially, a way to improve the public dialogue about health care interventions.

(Publisher’s note:  I prefer the term “news release” to “press release.”  Maybe that’s because I didn’t come up through the ranks of journalism as a print reporter.  But broadcast and online journalists have never cranked it out on a printing press, so many of us tend to prefer the term “news release.”  I let it go as “press release” in this piece because different people in this piece used the term press release.  But, in general, I will encourage the term news release on this site.      – Gary Schwitzer, Publisher.)

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Comments (8)

Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.

Brian Reid

March 19, 2015 at 10:52 am

While it’s easy to condemn PIOs who gloss over limitations or bury important caveats, the dangers of a press release about a Facebook community or a gathering of burn survivors aren’t immediately obvious.

Outrage fails me when it comes to Mount Sinai pushing out a release about amassing 100,000 Facebook “likes.” I see the fact that the hospital has a public community of 100,000 online as something more than just trivia: a hospital on social media is showing transparent behavior of a sort, opening itself to feedback, both positive and negative.

That may be why a study published last week found a correlation between a hospital’s decision to participate on Facebook and traditional quality metrics. (This is a good time to emphasize the difference between correlation and causality, but let’s just say there is a compelling hypothesis here that deserves a deeper look.) All of that suggests that the public might be interested in a local hospital amassing a six-digit Facebook following.

Is it “news”? It may not have received pickup, but dozens of people tweeted the release, showing that–for a specific community–it was not only worth reading, but worth sharing.

I realize that Trudy’s real objection is that the release (and to the release about burn survivors) is just a Trojan horse, an opportunity to imply a certain quality level by talking about something completely different. But if we’re going to start condemning organizations for implied sins (the release has zero mentions of quality), then health groups might as well abandon public communication altogether.

    Earle Holland

    March 19, 2015 at 5:06 pm

    Brian, you wrote that “the dangers of a press release about a Facebook community or a gathering of burn survivors aren’t immediately obvious,” but that really depends on your point of view. For the med center that puts out a “news” release containing no real “news,” the consequences are a loss of credibility in the eyes of the folks receiving the release, something that can indeed be costly. In a time when the number of messages a typical American receives each day numbers in the thousands, the irritation of getting useless information only weakens the public’s trust.
    As to your point about the “six-digit following” of Facebook “likes” that is the focus of Mount Sinai’s release, you believe that it suggests public support and backing. But let’s be honest — “liking” a person or thing on Facebook only indicates one thing: that a person, at one point in time clicked on the “like” icon on a Facebook page. It doesn’t ever mean that the person is actually attending to future information on that page, retaining that information and using it for decision-making. It’s purely an indication of popularity at an instance in time. Most people will “like” something and then move on, not waiting breathlessly for the next posting.
    That’s the sad truth about social media, that “likes” and “clicks” and other mechanisms of participation actually indicate nothing about a person’s actions or perceptions, except for that instant in time. Social media definitely has a role to play in, as you say, indicating the transparency of an organization, but truthfully, I seldom ever see it used that way. More often, it’s just a vehicle for one-way transmission of messages from the sender intended to sway the recipients to a positive view of the sender, to strengthen “the brand.” When public feedback about an event or episode turns negative, all too many organizations — including med centers and universities — either cull out the complaints or generically respond in a way that their legal staffs have suggested. The reason actual transparency responses from such institutions work so well is that they are so rare in practice.
    As an aside, my local network affiliate TV station, on its newscasts, always touts its six-figure total of “likes” on Facebook, offering the illusion that this many people religiously attend to their content. But there is no evidence of that. The same with followers on Twitter and other social media vehicles. While we all value this new communication medium, there is no evidence that it actually changes public opinion, which is, after all, a prime goal of public relations.
    No, what Trudy focused on in her blog, and what she and I had discussed, was the practice by all too many in the medicine and health arenas of issuing “news releases” that contained little or no actual “news.” It’s a major impediment to the trust and confidence that the public needs to have in health professionals.__EH

Brian Reid

March 20, 2015 at 10:22 am

Earle —

Thanks for the thoughtful response.

On the narrow point as to whether Facebook “likes” mean anything, I’ll concede that’s a subject of much debate among my peers in the PR and marketing field, and the odometer effect of hitting 100,000 is not, in itself, some sort of magic milestone. That said, the release makes clear that the “like” milestone is just a concrete examine of a larger investment in social media that the hospital is making as part of a community health initiative.

Now, journalists can (and should!) assess whether online community health endeavors do any good, but I don’t think that’s a topic of such limited utility that Mount Sinai deserves scorn for talking about it.

On the broader point, about fluff and credibility and attention spans, I have great sympathy. But we’re in a media environment where the user can now control what information spills over the transom. Ironically, this happens, in part, by choosing what to “like” on Facebook. You may not like press releases, I’m not a fan of CNN stories, now on the “Health” landing page, about “superfoods” (complete with a cheesecake recipe) and hangover remedies (“don’t drink”).

Of course, that’s why I love what you and Gary are doing: it’s smarter and more effective to change the demand side of the media equation by getting people to be smarter about what media they consume, rather than serving as gatekeepers on what kind of content is beyond the pale.

    Earle Holland

    March 20, 2015 at 11:24 am

    Brian, thanks for the feedback. Honest discussion on such points is always welcome and necessary for people to understand each other.

    Yes, social media has now become an integral part of daily life, including “liking” things on Facebook and “following” people on Twitter. But just as all too many people confuse the difference between correlation and causation, it’s just too easy now for conflate social media involvement with actual attitude changes and resulting actions. Clicking an icon simply requires too little commitment.

    You’re arguing that “liking” a hospital on Facebook actually means that it “is just a concrete examine (sic, “example”?) of a larger investment in social media that the hospital is making as part of a community health initiative.” I’m not convinced that is the case. Any entity that has a public relations/marketing component now has to have a social media involvement. It is expected. How effective it actually is, however, in changing attitudes is still a big unknown. There still is no way to measure what people are thinking.

    In your original comment, you mentioned that although the Mount Sinai news release “may not have received pickup (by the news media), . . . dozens of people tweeted the release.” News releases primarily are intended to inform and convince the news media of potential stories. From a staffing standpoint, is having a dozen or so re-tweets worth the effort to produce a news release? I’d say no, based on my 40-plus years in the business.

    My main point, I guess, is this: PR and PIO folks have a greater chance now to really serve the public than ever before. Release writers can include the kind of substantive information our criteria propose, and give readers the tools they need to really understand new information. The fact that this rarely has been the norm is because the institutions that produce releases seem to be more concerned with getting their “messages” out than they are with providing the public with what they need to make their own evaluations.

    We’d like to change that, to have releases contain enough fair, honest and complete information so that a typical person could become better informed after reading. We’d like to see institutions adopt this mindset and really focus on these goals. The public will reward them with greater trust.__EH

Trudy Lieberman

March 20, 2015 at 5:28 pm

Now it’s my turn to weigh in on the discussion. I want to point out, as I did in the post, that I had tried to contact Mt. Sinai to discuss these kinds of press releases and why the hospital believes they are useful. The hospital did not respond. As all journos should know, talking to people whose work you are questioning can be extremely useful in presenting a full picture to audiences.Increasingly we are finding that government and businesses are less and less interested in talking to us. As a potential patient what I am most interested in is how the hospital performs on a number of real quality metrics such as patient satisfaction, infection control practices and so on. But sadly few institutions want to do this for obvious reasons–most aren’t performing very well. The fluff of news releases simply serves to mask the real information that groups like Health News Review, AHCJ, and many news organizations like Pro Publica and others believe consumers /patients need to know.

Christine Norton

March 22, 2015 at 9:25 am

Facebook “likes” are even more meaningless than Trudy Lieberman & Earle Holland pointed out. A company or organization can pay to increase the number of its “likes” on Facebook. I’m not stating or even implying that Mt. Sinai has done that in its efforts to get to 100,000 likes but a hospital’s number of “likes” tells me nothing of value.
As a patient, I don’t care at all how many “likes” a hospital or clinic has on Facebook. I care about their patient safety record, their quality care as measured by a reliable benchmark, their efforts to reduce avoidable re-admissions, and their attention to providing right care, not overuse or underuse of care.

Brian Reid

March 22, 2015 at 12:29 pm

I think I’m homing in on the real center of disagreement with Trudy and Earle: the idea that news releases are designed for the news media, and–therefore–that their utility is proportionate to the amount of press coverage.

The reality is that for most “press” releases, media pickup isn’t the sole goal. For many, it’s not even a primary goal.

Public relations pros may be writing for specific audiences, allowing a narrow group of stakeholders to see (and share) information of particular interest. I suspect that’s why Back to Health put out a release out its massage services. They didn’t expect the Washington Post to cover, but if their current customer base spread the news, so much the better.

In other cases, we’re putting out press releases because we know that search is king when it comes to health information. According to Pew, 72 percent of internet users have looked for health information in the past year, and more than 3 of every 4 of those investigations started at the search bar.

The traditional media still has a vital role to play in curating the real from the “fluff” for particular audiences, and you’d better bet I have ProPublica bookmarket. But PR professionals also have a wider group of audiences that we must now consider, especially in a world where traditional media forms are less effective at reaching specific audiences.

    Earle Holland

    March 22, 2015 at 6:59 pm

    Brian, there’s no argument that the information contained in the typical news release/press release has important secondary purposes of informing constituencies other than the news media. But doing a news release that isn’t really intended for the media is, frankly, disingenuous. With all the other communications vehicles available nowadays, it seems silly to focus on a release as the be-all/do-all device for talking to interested folks. Personally, I’ve always been a strong fan of releases, specifically those that both provide broad and valuable information and that fulfill the criteria of being an interesting “news” story.

    Although I know the practice is commonplace, putting out a release that stands little or no chance of media use is fundamentally misleading. PR pros (and I have been one for ages) can direct their content through a wealth of alternative pathways instead of just doing a release that serves as the one-size-fits-all device.

    There’s nothing to stop communications pros from using any means they can to tell the story they want to share. But billing it as a news release, when it either contains no real news, or is not primarily intended to interest the news media — or both — seems duplicitous. Call it a “bulletin” or some such name but if the prime target isn’t the news media, it isn’t a news release.__EH