Engaging The Patient

Featured Guest Blogger:  Gary Schwitzer

Gary Schwitzer

Every day for the past 6.5 years, I’ve worked with a team of great people to try to reach journalists and the public they serve to try to improve the public dialogue in the U.S. about health care.

HealthNewsReview.org has evaluated more than 1,800 stories, applying 10 criteria that we think address issues that consumers need addressed whenever they hear claims about health care interventions.

Even a casual observer should be able to see the connection with health literacy concerns in what we do. If the tsunami of stories that wash over the American public every day about claims for treatments, tests, products and procedures are not presented in a clear, understandable way with accuracy, balance and completeness, people will not be able to use that information.

But maybe the shared decision-making (SDM) link to what we do isn’t as obvious.

It was obvious to Floyd J. (Jack) Fowler, Jr., PhD, then-president of what’s now called the Informed Medical Decisions Foundation in Boston back in 2005 when he approached me about my ideas for reaching a broader audience with messages about shared decision making.  The Foundation has been a pioneer in promoting SDM and in producing SDM aides to help newly-diagnosed individuals since its inception in 1989.  I know because I had worked for the Foundation throughout the ‘90s, producing some of the early decision aids in the Foundation’s growing library.

I almost immediately told Fowler that I was envious of an Australian website called Media Doctor that had begun reviewing the quality of Australian health care news stories.  I thought that by trying to improve health care news coverage, we might try to improve public understanding of the trade-offs between benefits and harms that exist with health care interventions.  Fowler agreed and convinced his Board to support our fledgling effort, which gained the permission of the Australian team to adopt its pioneering concept.

So for 6.5 years, arguably the leading voice on SDM issues in the US has been the sole financial supporter of what is arguably the leading effort in the US to improve the quality of health care news and information on a daily basis.

Anyone who visits our site can learn from the way we evaluate health care messages.

Besides showing how to apply those 10 criteria to news stories every day, we also blog about health care public relations, news releases, advertising and marketing.  Some topics we’ve addressed recently:

• How/why journalism via news releases may not be in the public’s best interests
• How important details were included by some news organizations and excluded by others in coverage of a new Alzheimer’s drug study
• Things to think about when you hear a hospital “selling scans”
• Things consumers should consider when they hear technologies such as robotic surgery promoted
• Unbalanced stories or media messages about various screening tests may be our most common theme
• Numerous articles on overdiagnosis and on overtreatment
• Shared decision-making is one of our most common themes

In addition, we provide brief primers to help journalists and the general public understand what they read in medical studies.  Topics include:

• Surrogate markers may not tell the whole story
• Does The Language Fit The Evidence? – Association Versus Causation
• Resources for Reporting on Costs of Medical Interventions
• “Off-label” Drug Use and Marketing
• 7 Words (and more) You Shouldn’t Use in Medical News
• News from Scientific Meetings
• Absolute vs. Relative Risk
• Number Needed to Treat
• Commercialism
• Single Source Stories
• FDA Approval Not Guaranteed
• Phases of Drug Trials
• Medical Devices
• Animal & Lab Studies

We hope that what we publish may help readers become smarter health care consumers, healthier skeptics, and better critical thinkers and analysts of claims they hear.

Last year for this series, we wrote that news media emphasis or exaggeration of potential benefits of interventions, coupled with minimizing or ignoring of harms may hurt health literacy efforts.

At a very high level, in an election year, when we should be helping citizens weigh why we spend 17% of our Gross Domestic Product on health care, yet leave 17% of our neighbors uninsured, instead news stories often paint a kid-in-a-candy-store picture of U.S. health care interventions, making most of them look terrific, risk-free and without a price tag.  Nearly 70% of the 1,800 stories we’ve reviewed get unsatisfactory grades for covering costs, and for quantifying harms and benefits.

What kind of impact does such messaging have on the doctor-patient relationship? Talk to any primary care provider to hear his/her stories of the dilemmas caused by patients coming in waving news stories about things that had no relevance in their lives.

What kind of impact does such messaging have on shared decision making?  This concept is predicated on an assumption that patients are provided balanced information.  If the clinical encounter begins with an imbalance created by pre-conceived notions built up by media messages, the discussion of values and preferences may never recover.

Think about it:  if a significant percentage of consumers believe everything they hear in news stories, what influence would that have on their dealings with their doctors or on their own decision making about:

• Statins for primary prevention in low-risk people?
• Robotic surgery?
• Screening tests?
• Coronary calcium scans?
• Vaccines?
• Imaging for low back pain?
• Diets?
• Advance directives?
• “Cures…breakthroughs…dramatic…promising” interventions?

In turn, what kind of impact would health care decisions that were influenced by that kind of news coverage have on peoples’ health and outcomes?

What kind of impact does such messaging have on voters? If day after day citizens hear the wonders of health care interventions with no discussion of costs, conflicts of interest, quality of the evidence, or potential harms, civic education has failed. Some people  might oppose any candidate who supports evidence-based medicine or the idea of comparative effectiveness research if they constantly see/hear it framed as rationing  rather than rational.

Communication itself has become a major health care reform issue.  Whatever the outcome of this year’s elections, citizens will depend on balanced information from trustworthy sources.

I love what humorist Henry Wheeler Shaw wrote in the 1800s (under the pen name Josh Billings):

“I honestly believe it is better to know nothing than to know what ain’t so.”

The stakes are so high in the communication of health care information that I believe it would be better for health communicators to stop communicating than to do so in an inaccurate, imbalanced, incomplete way.  There are real harms from the current tsunami.

About the Author:

Gary Schwitzer worked in newsrooms in Milwaukee, Dallas, and at CNN/Atlanta for nearly 15 years.  He produced decision aids for what’s now the Informed Medical Decisions Foundation, was founding editor of MayoClinic.com, and launched a health journalism graduate program at the University of Minnesota.  Now he is daily publisher of HealthNewsReview.org and the Health News Watchdog blog.  The Kaiser Family Foundation published his 2009 report on the state of U.S. health journalism.   In 2010, he wrote “Covering Medical Research: A Guide For Reporting on Studies” for members of the Association of Health Care Journalists (AHCJ). His blog was voted 2009 Best Medical Blog in one competition. His articles on health journalism have appeared in many different publications, including the Columbia Journalism Review, Nieman Reports, the Poynter.org website, the Journal of the American Medical Association, BMJ, PLoS Medicine, and the newsletters and websites of the Association of Health Care Journalists and of the American Society of News Editors.  He has taught health journalism workshops at the NIH Medicine in the Media series, at the MIT Medical Evidence boot camps, at AHCJ national conferences, at AHCJ chapters in NY, Chicago, Philadelphia and San Francisco, and at National Cancer Institute workshops in Rio de Janeiro, Guadalajara and Beijing.