Sick about health care

FROM U OF M ALUMNI NEWS

Sitting on an airplane this past January, Gary Schwitzer pulled down the tray table and—plop!—right there in his lap was yet another health care message, this one an electric orange-colored ad for Zicam Gel Swabs for head colds. Passengers sitting around him gasped.

With his iPhone, Schwitzer snapped a photo of the tray table ad, posted it to his blog, and added a characteristically entertaining observation on what he called a “sneak attack” by a pharmaceutical company.

Schwitzer, an associate professor in the School of Journalism and Mass Communication at the University of Minnesota, can’t do much about health care ads, but he is working diligently to do something about inaccurate health care reporting—and those health stories that are essentially ads in disguise. He sees health care messages the way the boy in The Sixth Sense sees dead people: They’re everywhere. And they rarely adhere to the code of ethics in health care journalism he helped shape. According to his research, journalists reporting on health news typically have had no training in the subject and usually fail to address costs and insurance coverage, harms and benefits, or the quality of evidence in their stories. Worse, he believes these news stories may negatively affect consumers’ health care decisions.

Schwitzer publishes an award-winning Web site critiquing health care journalism (HealthNewsReview.org), maintains a health-related news and resource site (“Improving Health & Medical Journalism”), and is helping to train the next generation of health care journalists.

During his 30-plus years as a radio, television, interactive multimedia, and Internet journalist, Schwitzer led the medical news unit at CNN, reported in Milwaukee and Dallas, and served as founding editor-in-chief of MayoClinic.com. He came to the University of Minnesota in 2001 to launch the professional master’s program in health journalism and served as director of graduate studies for the program from its inception in 2003 until this year. A twice-elected member of the board of directors of the Association of Health Care Journalists, he authored its Statement of Principles (see page 22). Last year alone, he flew 30,000 miles promoting the Health News Review site and speaking about improving the state of health and medical coverage in American journalism.

“Gary’s work is unflinching in its quest for improving media coverage of health, medicine, and science,” says John Finnegan Jr., a professor and dean of the University of Minnesota School of Public Health, who teaches in the health journalism program. “His systematic, balanced critique is exactly what reporters, health care providers, and consumers need to cut through the fog of fragmented science, poor journalism, and public misunderstanding.”

Schwitzer sat down recently to discuss his work for Minnesota readers.

Your site HealthNewsReview.org finds stories that make therapeutic claims about drugs, treatments, and tests; has them reviewed by your multidisciplinary team of journalists and health and medical professionals; and then publishes graded critiques. Why is this critically important work? The Project for Excellence in Journalism in Washington, D.C., upon first reviewing our Web site’s criteria for articles, said our criteria could be a model for other areas of journalism. This is not a media-bashing effort. It is meant to be constructive outreach to try to improve. I do think more and better strides are being made in health journalism than in any other beat. But I’m very restless and impatient because of the odds. Industry influence is at a runaway pace, conflict of interest is around every corner in health care. God help [President Barack] Obama or anyone else who tries to institute health care reform because you’re going to see a lobbying effort like you’ve never seen. That was the problem when the Clinton administration tried it. They’re just stronger and more entrenched now.

It’s a troubling time and there isn’t time to waste space or air time or column inches on breakthroughs and cures and miracles and fluff. We’re not asking tough questions: What’s the quality of evidence? Who’s going to have access to it? What’s it going to cost? Who’s your source? What are his or her conflicts of interest? This is not only a lesson for journalists, but a lesson for consumers. These are things we should be asking of anyone who makes health care claims. Including your own caregiver.

Describe a recent story you reviewed. NBC chief medical editor Nancy Snyderman had her own coronary artery scan on the Today Show, leaving the impression that all women should have this test, unduly frightening all the women watching. If all the women in the country want this test, it would bankrupt the nation. And forget about cold, crass cash. Think of all the false positives, think of all the anxiety you would cause. You would find a few things early and help a few people, but you’re going to catch some fish you shouldn’t have caught. Ones whose lives you’re going to change unduly, and then they are labeled, anxious, find out nothing, and require more testing.

A friend at Dartmouth said you could take 15 percent of the docs in this country, move them to Africa, and improve the health care of both places. We are over-medicalized. We sell sickness. We fearmonger. We disease-monger. We are actually again being sold on the weapons of mass destruction in our lives, but these are weapons of mass destruction inside us. You’d better have a scan, although nothing is wrong with you. Under the banner of doing good we are doing harm.

You say there are seven words you shouldn’t use in medical news: Cure, miracle, breakthrough, promising, dramatic, hope, and victim. Why? Each of those words and themes was put in my head by sick people, people with health care concerns whom I had interviewed over the years. Some people look at “hope” and “victim” and say, “well, how would you deny hope to somebody?” But a woman with breast cancer put that word on my list. Like Sergeant Joe Friday, she said, “Just give me the facts. Don’t you tell me where to put my hope. I’m tired of being jerked around by false hope.”

Who’s the worst health care reporter? Hugh Downs? Sanjay Gupta? Neither, because neither is truly a health journalist. Hugh Downs certainly isn’t. I know Sanjay Gupta works and tries very hard, but at the end of the day—and this comes across in his reporting—he’s still a physician. The move from physician to journalist isn’t an easy transition. Some people applauded—I didn’t—when he was embedded in Iraq, dropped the camera and microphone, and operated on a war casualty. But then he picked up the mic and reported on himself having done this. That shows that he is constantly crossing the street back and forth from being a physician to being a journalist. When you start to look at the trend lines of his coverage, which too often fail to scrutinize medicine [or] ask the tough questions about medicine, and too often glamorizes medical advances, that sounds like, talks like, and feels like a physician on the air—not a journalist.

I worked at CNN, I was actually in charge of medical news, so I could see where people might see this as sour grapes, but it’s not. All of the things that I write about now, I was bloodying my head against the wall about then. Lately, I’ve probably been more critical of NBC’s medical news. My criticism is directed by what I see. NBC right now is cranking out of a lot of schlock. We praise good stuff when we see it, we slam schlock when we see it.

What’s it like being a watchdog of other journalists? Are you shunned at cocktail parties? Sometimes I expect it, but I can’t tell you this strongly enough: it almost never happens. I’m out there inviting input all the time. The single most recurring thing I hear is: “Why aren’t you reviewing us?” Wherever I go, someone has a nomination for somebody else I should be reviewing, and it’s usually their particular station or paper. That’s really powerful. [Either] they think they are doing a good job and they want the public recognition via our Web site, or, more likely, they know more about these topics than their editor, so they have no one to go to in their newsroom. They welcome the independent expert advice that we have to offer.

I have had journalists ask, on a number of occasions, “Could you make yourselves available pre-publication, so we can run things by you in advance?” That’s tough for us to do because no member of our team works on this full-time. But I’m intrigued by the request and we may try to offer pre-publication advice to journalists in the future.

We also added on the home page of HealthNewsReview.org a growing list of more than 100 independent experts who agree to help journalists with their stories. These experts have told us that they have no financial ties to industry.’

Why do you describe health care information as “flooding the public with a fire hose”? They are thirsty for a drink and they can’t even get a sip. We have health insurance marketing people calling their products “consumer-driven health care plans” and I could just vomit. It’s predicated on the notion that the tools will be there to put consumers in the driver’s seat. I just don’t think you can be rational and say those tools exist. There are attempts to build tools and we find over and over again that consumers don’t use them. Then you’d better find out why. They find them unusable. At a recent meeting at Consumer Reports, their ratings guru and the guy who does the US News & World Report “Best Hospitals” ratings both admitted how incomplete and flawed are their efforts.

Who covers health care the way it ought to be done? We are making progress. Things are getting better.

There are people day in and day out who do a really good job. Predictably, those are the people who sucked it up and sought training or trained themselves. Evidence-based reporters: they always start by scrutinizing results. Carla Johnson at the Associate Press in Chicago: She has gone to evidence-based journalism workshops around the country and she hasn’t even been on this beat that long, less than 10 years. A real role model. I will never forget with the Wall Street Journal next door to the Twin Towers—there was no media company as physically affected by the attack that day and they had to move their offices. Even in those days, the Wall Street Journal still beefed up its health care coverage. One guy I think very highly of is Scott Hensley, co-editor of the Wall Street Journal Health Blog with Jacob Goldstein. He’s very new-media savvy and very smart in covering these issues. And you can’t take the New York Times for granted, there is such a cast of all-stars there.

What is the biggest untold health care story in America? The biggest theme that is untold at the highest level is that we have to learn in this country that more is not automatically better. Newer is not automatically better. Thinking that way is why we spend more and don’t have the outcomes to show for it. We don’t know how to die a peaceful death in this country; we don’t know how to let go. We talk about advance directives and living wills and they almost never come into play. It’s the medical arms race.

Other countries laugh at us. We are the only industrialized country on the face of the earth that doesn’t have some form of universal, national comprehensive health insurance. It starts to beg questions about what kind of a people we are. We aren’t even getting preventive health care to 16 percent of our population.

As a journalist, I always look in the mirror first. [Journalists] have to shoulder some of the blame for the runaway spending and the “more is better, newer is better” mentality. We feed the worried well. We feed the pill-for-every-ill expectation. We are responsible, to some degree, for driving up unrealistic, unreasonable expectations of consumers about costly, unproven, and harmful treatments, tests, products, and procedures.

We just can’t afford to play around anymore in this country. We are not having a meaningful discussion on health care reform. We spend 16 percent of the gross domestic product on health care, double that of the second-place nation, and we don’t have the outcomes to show for it. Depending on which ranking you believe, we are 37th in the world in infant mortality. We spend more than anyone else and we have an obscene number of citizens who don’t know where they’re going to get health care.

What can a journalist do about that? Even if you’re going to follow our criteria of how to cover new studies and new claims, you could still be sure that every day you have that note of skepticism. Maybe all the evidence isn’t in. You could still add that note of restraint. Do we really need another cyber knife or proton beam machine? We used to have certificates of need in this state and country; you used to have to justify adding hospitals and services. That’s gone now. There are 16 to 20 MRI and CT scanning machines within a two-mile radius of Fairview Southdale. The proton beam [radiation therapy machine] is a new, multimillion dollar machine. Each treatment costs $50,000. We don’t have the evidence yet that it’s that much better, but it’s this medical arms race. We’ve got to learn to say “no” in this country.

What role should the media be playing in framing national health care discussions? There is an agenda-setting role for health care journalism that is too often abdicated. I understand what reporters are up against. Travel and training are cut, fewer people are asked to do more with less, there are multimedia tasks now [such as shooting photos and video] and most are not paid extra for that. Those are all incentives to stay in the newsroom, read today’s medical journal, never leave the newsroom, and think you’ve covered the beat. But boy, that is really a skewed view. It is clear there is a publication bias to publish only positive findings and squelch negative results, and with industry controlling more of the science, industry will publish only the positive and squelch negative results.

Instead of progress-hope-breakthroughs-cures, start embedding daily frames of “Are we scrutinizing the science?” and “48 million people are uninsured” and “more is not better.”

You can’t tell me that journalism couldn’t have tremendous impact. That’s not an advocacy stance, that’s not editorializing. That’s providing a balance that is required. Our coverage is already imbalanced by journalism that depends on the medical journals and what the commercial interests in the health care industry feed you.

And until we tackle some of those questions, and until journalism starts to accept this agenda-setting role and get us thinking about that more often—instead of getting us all hyped up about putting statins in the water supply and the latest erectile dysfunction drug—then journalism itself has to take part of the rap for the health care crisis we’re in.

What would a proud moment in health care journalism be for you? This is really radical, but I would be delighted if we stopped subscribing to medical journals in newsrooms and if AP didn’t cover those any more. There just aren’t breakthroughs and miracles on the 24-hour news cycle. There are not. We shouldn’t broaden the definition of “breakthrough.” There really are not many breakthroughs; that’s not the way science works.

What if we regularly started asking questions about where are our values? What are we getting for our investment? What do we as a people want to do for our families and selves and people we don’t know in our communities? Is health care a right or a privilege? Other countries have answered that.

If it creates a nation of skeptics, let the pendulum swing back that way.  

Pamela Hill Nettleton (B.A. ’05, M.A. ’07) is Minneapolis writer and editor and a Ph.D. candidate and instructor in the School of Journalism and Mass Communication.

Comments (1)

  1. Submitted by Nancy Hokkanen on 04/20/2009 - 11:52 am.

    Gary Schwitzer has a blind spot regarding vaccine safety concerns. He seems content to accept the CDC’s statistics-for-hire at face value, rather than dig deeper using FOIA. Or question why thousands of parents’ vaccine injury reports are not being physically investigated. These children have a paper trail of lab tests, physicians’ reports, before-and-after videos of regression and so forth.

    This afternoon is another IOM meeting from noon to 2 pm Central time — the Committee to Review Adverse Effects of Vaccines. This public meeting will be available via conference call. Dial 1-800-508-7891 and the room number *1979783* to enter the meeting. Public comment is during the second hour.

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