Health fear-mongering: Could our news be making us sicker?

Alan Cassels is a drug policy researcher at the University of Victoria and a regular contributor to the blog. He is also the author, most recently, of The Cochrane Collaboration: Medicine’s Best-Kept Secret. He tweets as @AKEcassels.

health anxietyYou’ve just finished reading a news story about a common food ingredient that researchers now believe may increase your risk of cancer — maybe the type of cancer that a close relative died from a few years ago.

You’ve got chest pain. Your heart is racing. You feel nauseous and you’re sweating. The overriding feeling is one of anxiety. It’s not at all pleasant.  

Given how awful this news makes you feel and how often you read such stories day in and day out in the newspaper and in your Facebook feed, the question may naturally arise: Is alarming news coverage about health risks actually making you more susceptible to serious stress-related medical problems like heart disease?

Norwegians see a link between health anxiety and heart disease

A recent Norwegian study in BMJ Open provides some roundabout insight into that question, looking at the effects of health anxiety in a 12-year study of more than 7,000 people. It found that health anxiety — defined by the study authors as “a specific type of anxiety characterised by preoccupation of having, acquiring or possibly avoiding illness” — was associated with an increased risk of developing ischemic heart disease (IHD). There’s a catch: How those effects were characterized in the news proved to be a demonstration of the problem we’re talking about in the first place.

In this case, it comes down to how the effects were reported. According to the Evening Standard, “those who fret about their health are around 70% more likely to develop heart disease.” Shape Magazine said that “worrying, particularly about your health, increased the risk of heart disease by an astonishing 73 percent.” HealthDay led with a headline saying, “Hypochondriacs may worry themselves into heart trouble” and quoted lead researcher Dr. Line Iden Berge who said that “people with high levels of health anxiety have about a 70 percent increased risk of heart disease, after taking [into] account other known risk factors.”

Don’t sweat it, yet:  Association, causation and misleading relative risk reductions

But before we all break out in a sweat just thinking we might be worrying ourselves into early heart disease, remember the simple principle here at that association doesn’t prove causation. Any story that frames these results as showing that health anxiety “increased risk of heart disease” is off-base — the language implies a relationship that simply can’t be shown in this kind of observational study.

Moreover, relative risk increases like the “70%” figure touted in these stories are bunk. We like to see the absolute numbers which the HealthDay piece, deep into the article, eventually pointed out — but which some other stories omitted altogether. 

The absolute increase in IHD over 12 years was 3% higher in the health anxious people versus the not-so-anxious. This is a 3-in-100 increase as opposed to 70 in 100. In the study, 3% of the cohort of non-anxious Norwegians developed IHD within a 12-year period versus 6% among the anxious group. So while health anxiety isn’t good for you, it’s not like the grim reaper is standing ready to cart oodles of health anxious people away. 

But maybe there are still some dangers in worrying too much about your health…

What the study authors found is in line with other research showing that anxiety disorders are associated with an increased risk of IHD. One 2010 meta-analysis following a quarter of a million people for 11 years found that an “estimated 26% increased risk of coronary heart disease among persons with anxiety, independent of demographics, biological factors and health behaviours.”  (The 26% increase is a relative risk increase, smaller than the “doubling” or a “70%” increased risk in the Norwegian study, but still a notable trend in that direction.)

This study didn’t look directly at how news coverage of health issues may be related to risk of heart disease. But it does gives rise to a hypothesis that the way health issues are reported could have an influence on the type of health anxiety that spreads among the general population of media consumers. The BIG question we’re asking here at is, what can journalists do better to moderate, or at least not exacerbate, the news-induced anxiety that could be detrimental to our health? In other words, can we help reporters produce less fear-mongering coverage of both diseases and treatments and cover healthcare in a way that won’t lead to more overall heart disease, or other adverse health effects?   

Health fear-mongering is certainly a subject we’ve covered a lot in the past. We’ve pointed to the delightfully witty commentator Richard Lehman who, in his blog in the BMJ, blamed the media for cranking up health anxiety and said the best way to reduce it is by “shutting down certain newspapers.” Publisher Gary Schwitzer has waded into this one frequently and once called the over-testing of the “worried well” a “Great American Tragedy.” He even had the math to back him up on that one.  

What about celebrities and their role in inappropriately stoking health fears?

We’ve reported on vaccine fear-mongering carried out by celebrities such as Katie Couric, who pushed an anecdote-laden story about the dangers of the HPV vaccine. One of the problems with the blatant fear-mongering around health treatments is that legitimate questions about the dangers and risks of those treatments (in this case, the HPV vaccine) are never properly discussed. One physician, commenting on our post about the Katie Couric anti-HPV vaccine story, wrote that despite the “bizarre” and “awful” fear-mongering on her show, “appropriate criticism of this particular vaccine is also unable to find the light of day.”

We’ve certainly teased out the fear-mongering vibe in other sorts of supposedly science-y reporting, such as a Dr. Oz story that warned women not put their cellphones in their bra lest they increase their risk of breast cancer. The blogger known as Orac called Dr. Oz’s bra story a “blatant piece of fear-mongering.” But speaking of cell phones, one story we looked at focused on a rat study and leapt to a most egregious and overhyped implication: mothers who paid too much attention to their smart phones were ignoring their babies and possibly leaving them irreparably emotionally damaged.

And watch out for food fearmongering…

In addition to health or social issues that give rise to fear-mongering, there are many examples of diet studies claiming that too much (or too little) of one substance or another can lead to an early death. Just last week we highlighted such stories that stoked fears about food emulsifiers — the ingredients that make it possible for fat and water to mix in all kinds of products ranging from ice cream to mayonnaise. The problem? The study that serves as the basis for the coverage gave rodents doses of lab-created carcinogens along with the emulsifiers — and yet the emulsifiers were singled out in the coverage and blamed for causing the cancer.

Similarly, an NBC story went beyond the pale in suggesting that the average U.S diet, rich in red meat, sugar and fat “may kill prostate cancer survivors.” The big sin here is taking a smallish observational study about diet and then leaving readers with a misleading message that they could be eating themselves into an early grave.   

Ways to immunize yourself from the pernicious influence of health fear-mongerers

At the end of the day, health fear-mongering is bad for you and you should do what you can to immunize yourself from its pernicious influence. Journalists (and readers) need a better tuned fear-mongering radar to detect elements that are more likely to scare than inform readers. Some points to consider:

  • Are those risks presented in relative numbers?  If something has ‘doubled’ or ‘increased by 70%’ then ask, double what?  What is the absolute risk that went up due to the thing we are told to fear?
  • Is this a real provable effect or an observation?  Many of these fear stories are based on observational data and report associations NOT causation. Always ask: Are we seeing peanuts and elephants in the same place at the same time or did one likely cause the appearance of the other?  (i.e: how do we know whether the peanuts caused the elephants’ appearance or vice versa?)
  • What is the ‘prevalence’ of the fear-inducing thing? How likely is it to be widespread and common or rare and isolated?
  • Are we talking rodents or real people?
  • Cui Bono? Who stands to gain from stoking the fear? Are there celebrities interested in increasing viewership, a drug company keen on increasing sales or researchers trying to sell their particular view of the world behind this brand of  well-placed fear-mongering?

Overall we need to recognize that fear sells; it attracts eyeballs and clicks and there are incentives to stoke worry.  

We certainly like the fact that health anxiety is considered a subject worthy of scientific scrutiny and that these results are being covered by journalists. We don’t, however, like the irony we find when the researchers (and the journalists) end up overstating the problem and making people anxious about being anxious.

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Comments (1)

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Stephen Cox, MD

November 21, 2016 at 11:12 am

One should ignore all claims unless they clearly and simply state the results provide ABSOLUTE benefits or risks. If absolute is not in the headline or text, ignore the article.