Diseases and cures in news and advertising

You've certainly seen some of the ads before, selling drugs that cure restless legs syndrome or erectile dysfunction. You've seen the news stories too, with credulous reporters blindly parroting news releases or self-promoting scientists without actually assessing evidence or costs. Companies have been accused of selling diseases at the same time they sell the cures, and the news media has historically done a poor job of educating the public about the true value of new advances in science and medicine. Today in PLoS Medicine, a pair of articles look at corporate and media disease-mongering, and the quality of medical reporting in general.

The first of these articles is an essay by Ray Moynihan and colleagues stating that disease mongering has entered the global health debate. Disease mongering—the creation or promotion of a diagnosis—is something you've probably suspected when watching those commercials, and it's a perfectly understandable strategy. Research into "blockbuster" drugs for major diseases often turns up medicines that fail at their intended task but have some other benefit (Viagra is a famous example of this phenomenon). Companies attempting to recoup the research investment have a substantial incentive to grow the market for these drugs. Even if there is a small group of patients for whom, say, restless leg syndrome is a significant problem, the attempt to expand this market to those for whom it is merely an occasional annoyance is disease mongering. When this tactic succeeds, people end up buying medication they don't really need, which has adverse economic consequences, not to mention the personal harm that may be suffered due to occasionally severe side effects or adverse interactions with other drugs.

The essay follows up a conference and special issue of PLoS Medicine from two years ago on this subject. The authors are pleased to report that several newspaper articles and websites are now taking notice, but this seems too optimistic to me. It is encouraging that we've seen greater awareness of disease mongering in recent years. The authors, however, are unable to point to any significant regulatory progress. A few newspaper articles and a couple of little-known websites are hardly enough to combat a pharmaceutical industry that is dedicated to selling drugs that may have a small natural audience. If we are to have a true national health care coverage program it will be essential to take regulatory steps to prevent the creation or expansion of diagnoses to justify the existence of drugs post facto. In light of the silence of regulatory bodies, even the modest optimism of the essay seems unfounded.

The other article comes from the creators of one of those little-known websites, which I hope will become better known, HealthNewsReview.org. The way the system there works is that three reviewers (one of whom is always this article's author, Gary Schwitzer), evaluate health news stories from television, newspapers, and wire services on the basis of ten criteria ranging from whether the story adequately discusses costs to whether independent sources were used. In this article, Schwitzer reports the results of a survey of 500 stories from US media sources, and the results are not particularly encouraging.

The frequency of particular criteria being met indicates a strong sensationalistic bent in American media. High percentages of articles established the novelty of the approach and discussed its availability. However, less than 40% of the articles did a satisfactory job of discussing the quality of the evidence, the existence of alternative options, or quantifying harms and benefits associated with a new treatment. Less than a quarter adequately discussed the cost of the new treatment. To my mind this speaks to a certain amount of hype. As Schwitzer notes, some of these problems are due to constraints of space and time—in a limited number of paragraphs it is far easier to convey that a novel cure has been discovered than to realistically describe the limitations of the study or the expense of the medicine. Moreover, many of the writers simply lack the expertise to interpret findings, or the resources to find experts to give a second opinion.

This is not entirely the fault of the media, however. Scientific journals, research corporations, and universities contribute by providing sensationalistic press releases that serve as the starting point (if not the entirety) of many of these stories. With commercial interests this practice is standard, though hardly worthy of celebration. In my opinion, however, it is inexcusable for universities and scientific journals to adopt this approach. The reporting of scholarship ought to be about truth, not buzz.

The presentation of results in this article seems somewhat incomplete. I would have especially liked to see a histogram showing the frequency with which a single article fulfilled multiple criteria. Do articles generally fall near the extremes, or do the results more resemble the familiar bell curve? Appropriate policy recommendations may differ significantly depending on this distribution. It would also be valuable to know the track records of particular publications: this data is not available in the article or on the website, yet it could be a valuable tool in putting pressure on editors and managers to give writers the space, resources, and training necessary to produce quality health reporting.

A further weakness of this study is that it does not address cable news or alternative media outlets such as websites and blogs, from which a significant proportion of Americans now get their news. This is especially incongruous in light of the fact that HealthNewsReview.org is itself an internet resource. To be fair, many news websites simply take their stories from the AP feed, which the study examined, and studying all these varied sources would have been an immense task. However, it seems obvious that a comprehensive evaluation of all media was never an achievable goal. Knowing that, it would have made more sense to select the broadest spectrum of types of sources, rather than intensively scanning several very similar sources. It is to be hoped that HealthNewsReview.org will expand its examination into these areas soon.

Sensationalism and sloppiness in scientific reporting represent a failure of journalism because they create a misinformed public. Moreover, overhyping of predictions and results that are often quite equivocal in reality contributes to mistrust of scientists and doctors. Scientists and journalists both must do a better job of communicating the real limits and implications of scientific findings, rather than casting all results in the most positive or revolutionary light. Hopefully HealthNewsReview.org and similar initiatives in other countries will help them do that.

PLoS Medicine is an open access journal, so you can check these articles out for free. Also check out the commentary from the PLoS Medicine editors.