Mary Chris Jaklevic is a freelance health reporter who joined our review team in April 2016. She tweets as @mcjaklevic.
A few years back, HealthNewsReview.org publisher Gary Schwitzer drew up a widely circulated list of seven words you shouldn’t use in medical news.
Now it’s time to add one more: “controversial.” Too often, the word is used as a crutch that allows media outlets to evade the responsibility of providing context.
Certainly there are controversies in medicine, and all media outlets–including HealthNewsReview.org–employ the word “controversial” on occasion. But the word “controversial” should be used sparingly in health news, and always with context. And it should not be applied to settled science.
Yet this cliché–and synonyms such as “contentious” or “hotly debated”–remain mainstays of the news business because these terms drive clicks and glue viewers to the screen.
“Clearly, ‘controversy’ increases the interest level of a story and may push editors to give that story more prominent play,” says Tom Linden, M.D., director of the Science & Medical Journalism Program at the University of North Carolina at Chapel Hill, via email. Problems arise when “poorly informed journalists treat health stories like political stories,” he says.
Calling something “controversial” in a headline or lead doesn’t just turn science into clickbait — it’s also potentially harmful, because it can color consumers’ perceptions before they’ve learned the facts. Further, evidence suggests that early framing of a medical topic as “controversial” undermines trust in science and encourages politicization of medical issues, which can harm public health.
A January headline from CNN called new blood pressure guidelines from primary care groups “controversial,” while a headline in STAT said the guidelines “stir immediate controversy.” Neither sheds much light on the medical significance for consumers. As the stories go on to explain, medical groups haven’t reached a consensus on how to weigh benefits and harms of treating moderately elevated blood pressure amid imperfect data. Is that really a controversy? Or just lack of consensus?
Another piece from a Fox affiliate in North Carolina ran as “Breast cancer survivors, radiologist comment on controversial mammogram study.” This puts well-regarded research in a negative light without ever explaining what it actually found. In fact, the study itself was not controversial, but there is ongoing debate over how aggressively to screen women. That debate is fueled in part by organizations and device companies that have a financial interest in the issue. You won’t find that context in the story, though.
Further, hyping controversy can feed doubt about established science.
Take recent coverage of U.S. President Donald Trump’s coziness with vaccine skeptics. This Vanity Fair story downplays science when it says the then President-elect “waded deeper into the controversy surrounding the hotly-debated anti-vaccination movement.” Given ample research showing vaccines don’t cause autism, it’s misleading to suggest there’s “controversy” about the merits of the anti-vaccination movement.
In other words, it’s not “hotly debated;” it’s simply wrong.
“The real problem occurs when science or health journalists create false equivalencies in pairing a reputable source with a questionable source,” says Linden. “Once a scientific consensus emerges on an issue, introducing ‘controversy’ into a story distorts the science and confuses the reader or viewer.”
It’s up to journalists to assess the credibility of sources and give weight to peer-reviewed findings. “Science journalists should resist falling into the trap of cherrypicking a minority of scientists who hold a contrary view to inject ‘fairness’ into their stories,” says Linden.
Controversy framing also can encourage politicization, in which scientific viewpoints get attached to ideological viewpoints rather than being discussed on their own merits.
Even when robust data becomes available, it’s apt to be disregarded because people have made up their minds. Once an issue is politicized, controversy becomes a persistent feature of media coverage.
Researchers Erika Franklin Fowler of Wesleyan University Department of Government and Sarah Gollust of the University of Minnesota School of Public Health found that coverage of political controversy around the human papillomavirus (HPV) vaccine rollout a few years ago was associated with weaker support for the vaccine and for state immunization programs. It also was linked with less confidence in doctors and government.
“When politicians weigh in on health issues, we know from our work that citizens become more likely to think about the issues in political terms and take cues from like-minded partisans rather than from scientific consensus,” Fowler and Gollust wrote in an email. “For example, in our work on the HPV vaccine and with respect to immunizations more broadly, Republicans are more likely to view vaccines as less safe following cues from several of the Republican presidential candidates who questioned their efficacy.”
Calling something “controversial” does little to promote public understanding and can even do harm. Instead, consumers need context: What does the data say? Are there unanswered questions or differing interpretations? Is there misinformation? What economic interests are affected?
This ProPublica/NPR story published last week about congressional attacks on evidence-based recommendations from the U.S. Preventative Services Task Force provides illuminating context without using the label “controversial.”
The story describes how guidelines that reduced cancer screenings “raised the ire of a much more powerful constituency: the urologists and radiologists who made billions of dollars off the testing and related procedures.” It reports that Rep. Tom Price, Trump’s HHS nominee, took in $479,000 from health professional donations in the 2016 campaign cycle, one of the largest sums to any member of Congress.
The story also examines the public health impact, quoting task force chairwoman Kirsten Bibbins-Domingo, M.D., saying the political attacks “risk misleading patients about the effectiveness of screening for patients who are not at risk and are free of symptoms.”
Strong context is vital in an era when top leaders enthusiastically disregard expert opinions.
The tepid “controversial” won’t cut it.