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6 The Media “The landscape is filled with landmarks now because so many of them have been declared.” —Peggy Peck, MedPage Today Americans use a wide range of media and most people (59 percent) obtain information from both online and offline sources. The number of outlets for medical and health news has expanded markedly, with the inception of dedicated online medical news services. Traditional news outlets—broadcast and cable networks and newspapers and news magazines—now have robust online presences that provide additional content and background to stories appearing on air or in print. A panel of journalists from national broadcast media, an online medical news source for professionals, and a patient-focused market researcher discussed the challenges facing news organizations in covering the medical research beat and provided some ideas for how journalists might respond. BALANCED COVERAGE Getting medical research stories right is vitally important, because many Americans obtain much of their health information from the media—television, radio, print, and the Internet, said Heather Won Tesoriero, Medical Producer, CBS News. Media coverage of medical advances, particularly by broadcast news, is often criticized for empha - sizing the “good news” in medical research and underreporting the “bad news”—when, for example, a previously touted advance does not pan out, she said. Media organizations are criticized for being overly enthusi - astic about the results of clinical trials, for underplaying the preliminary nature of the results or the small size of the study population, and for 49

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50 PUBLIC ENGAGEMENT AND CLINICAL TRIALS underemphasizing the long time between the trial and a marketable treat- ment, said Won Tesoriero.1 Panelists discussed that reporting on research and on clinical trials focuses on potential benefits for several reasons: the constant preoccu- pation with what is “new”; audience interest in stories that affect them, which requires reporters to extrapolate findings to a tangible end point (“what this means is that there may someday be a cure for”); researchers’ growing tendency to inflate the significance of their work; and for broad - casters, especially, the limited time (and space) for news stories, which does not allow for extensive context and caveats. Roger Sergel, Managing Editor, Medical Unit, ABC News, suggested that one approach would be for journalists to analyze studies’ confidence intervals and not report on those with weak significance levels, or report only cautiously on studies that rely on associations, since audiences likely do not understand that an association does not prove cause and effect. Particularly helpful, said Peggy Peck, Vice President and Executive Editor, MedPage Today, was including patient histories in the story pack- age presented to the news media. These personal stories engage viewers, listeners, and readers and help provide context and, at times, a more complete picture. To maintain a balance between what is “new” and what is “important,” journalists have to carefully evaluate the real significance of the medical information that comes to them. RELATIONSHIPS WITH RESEARCHERS Researchers tend to want journalists to report on what they them - selves are interested in—that is, the process of research, Sergel said—but journalists believe the public does not understand and is not very inter- ested in the research process. Instead, reporters want to know how a set of trial results will affect their audience. The panelists discussed that universities and research centers—as well as some individual researchers—have learned the value in aggres- sively promoting research results. Greater visibility enhances the pros - pects for obtaining additional grants, career advancement, and institu - tional prestige. As a result, Sergel said, news releases that an institution’s public relations department writes about a study typically suggest the results are very exciting and newsworthy. At the same time, investiga- tors have learned to speak in hyperbole and use words like “landmark,” “practice-changing,” and “grand slam,” said Peck. 1 A recent FDA user’s guide for communicating risks and benefits includes a discussion of health care news coverage and strategies for improving the accurate representation of scientific findings by the media (FDA, 2011c, Chapter 18).

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51 THE MEDIA Researchers have become “too media savvy,” Peck continued. “They’re looking to give you the perfect sound bite.” Editors and jour- nalists, she said, “have to train our colleagues to take a giant step back from language like that.” Reporters would find it helpful if researchers and institutions were more realistic about the broader significance of their findings—in terms of number of people affected or size of the advance in knowledge—when deciding to pitch a story. “But if it really could be a potential game changer down the road, that’s enough too,” said Won Tesoriero. Some editors have become cautious of stories where there seems to be too much excitement, because of the possibility that the story will be overblown. Sergel believes that researchers are responsible for making sure that news releases, public relations statements, and researchers’ own statements do not overstate the study findings or their significance. RELATIONSHIPS WITH THE AUDIENCE Unlike some other news beats, health is very “selfish.” People can be broadly interested in politics or economics with no particular stake in the coverage, Sergel said, but, for most people, a health story immediately raises the question, “How will this affect me or my family?” He further suggested that there may be too much reporting on medi- cine, including a lot of early, inconclusive, and unclear studies that fall into a gray area. Reporting could be much more selective, because the more equivocal information is likely to be lost on people. However, Amer- icans tend to want more health and science news. It might be more useful, Sergel suggested, to concentrate on stories about the care people receive, as was the news focus during the debate on health care reform. Americans’ low health and science literacy, discussed throughout the workshop, affects the way that research news is covered and health information is presented. Many in the advocacy community, for example, recognize that communications materials intended for patients, family members, and caregivers must be written at an 8th-grade level, said Joan Finnegan Brooks, Patient-Focused Market Research. CF advocates, for example, have included patient representatives on their communications committees to ensure that medical information is clear and not open to misinterpretation. Broadcast reporters, especially, try to avoid jargon, such as words like “randomized” or “placebo,” which they believe alienate viewers. Although the report might cover a study that finds interesting associa- tions, that term might not be used; instead, the limitations of that type of research finding might be described. Having to distill stories in both time

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52 PUBLIC ENGAGEMENT AND CLINICAL TRIALS and language creates some frustration for journalists who do not want to reduce them to the point they lose their meaning, said Won Tesoriero. But even if a reporter cannot use jargon, a workshop participant said, “you have to tell people the truth,” and the truth does not reside only in multisyllable words. CONFLICT OF INTEREST Journalists have an essential occupational preoccupation with the reliability of their sources. Situations that reflect on the credibility of researchers—most notably, potential conflicts of interest that arise when medical researchers receive funds from drug companies or other sources that may try to influence research outcomes—are looked at carefully by major news organizations, as Peck described. As a result, journalists may report explicitly on those conflicts or adopt other strategies to let their audiences know where financial support for a project originated. MedPage Today, for example, includes a box at the bottom of articles that includes financial disclosures. Financial disclosure—“following the money”—is crucial if people are to understand the factors that may be driving the science. However, journalists recognize that conflicts of interest are not necessarily black and white, Won Tesoriero said. Where does a conflict begin? It is not surprising when researchers receive grants from a number of corporate sources—particularly if they are field leaders. Receiving corporate sup- port for research projects is different from being part of a company’s speaker’s bureau or participating in other compensated activities. And, if there is an apparent conflict, is that affecting what the researcher says? It takes a certain level of sophistication to understand the range of conflicts before making a judgment, she said. Sergel pointed out that there are differing views even among jour- nalists about what is a conflict, and sometimes it is difficult to sort out whether a story should be dismissed simply because of a potential con- flict. It is not possible to lay down an absolute rule, inasmuch as the fund - ing of many lengthy clinical trials may have come from multiple sources over time. Although the public at large may not be interested in industry- researcher relationships, clinicians—the people who will use the informa- tion in the care of patients—should be aware when they exist, said Peck. Reporting on them alerts clinicians to look deeper. Often journalists learn about potential conflicts a scientist may have from other researchers, and, increasingly, institutional ethics commit- tees’ insistence on greater transparency gives journalists additional information.

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53 THE MEDIA From the point of view of a disease advocacy organization, having key researchers and clinicians involved with industry is a positive, if that creates the opportunity to advise biotech or pharmaceutical companies about a particular disease. Finnegan Brooks said that these industry- researcher relationships are how interest in diseases—especially diseases with relatively few patients (small markets from the pharmaceutical com- pany’s point of view)—gains traction. If conflict-of-interest rules are too stringent, it “knocks out everybody that we would want at the table,” said Finnegan Brooks.

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