Author + information
- Valentin Fuster, MD, PhD∗ ()
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- ↵∗Address correspondence to:
Dr. Valentin Fuster, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York 10029.
Over the past 10 months in these Editor’s Pages, I have often encouraged my cardiologist colleagues to observe our responsibilities as teachers, leaders, and caregivers. However, in this Editor’s Page, I turn my attention to different guardians of society: the media. As physicians, we are required to take an oath to “do no harm” first and foremost. Even though journalists may seem removed from this responsibility to patients, they publish stories that could affect the health choices of hundreds or thousands of individuals. To examine this issue, a team of reviewers (many of whom were physicians) evaluated the reporting by U.S. news organizations on new medical treatments, tests, products, and procedures (1). After reviewing 1,889 stories (approximately 43% newspaper articles, 30% wire or news services stories, 15% online pieces, and 12% network television stories), the reviewers graded most stories unsatisfactory on 5 of 10 review criteria: costs, benefits, harms, quality of the evidence, and comparison of the new approach with alternatives.
Accordingly, I would like to suggest that journalists and researchers must share equally in shouldering the burden of responsibility to improve appropriate communication about basic and clinical research.
First, there is an obligation on the part of the researchers not to inflate the importance of their findings. This has been widely recognized as damaging, especially if bias is introduced in the paper (2). To address any of these concerns that are not always rectified in the peer-review process, we added 2 aspects to the Journal over the past 10 months. We now invite an independent editorial comment for every original research paper published. In addition, we have added the Clinical Perspectives section at the end of each original investigation, which is a pragmatic summary that contains a competency component (i.e., learning implications for the reader that may be applicable to the contemporary care of the patient) and a translational outlook component (i.e., anticipation of the next or future steps of research that may be applicable or developed by our research community). Incidentally, in our fall 2014 readership survey, we learned that 82% of readers of the Journal find the editorial comments extremely or very useful and 71% find the Clinical Perspectives extremely or very useful. Thus, original research in the Journal should no longer be read in isolation, without the accompaniment of its editorial comment and Clinical Perspectives. These were changes that I instituted when I took over as editor, and I stand by their importance.
Second, researchers should take some responsibility for the creation of the press release about their research, which is written by the media or press relations department at their hospital or society. Press releases are often how members of the media get introduced to a particular study, and these releases can often introduce errors or exaggerations. In fact, British researchers evaluated 462 press releases on biomedical and health-related science issued by 20 leading U.K. universities in 2011, alongside their associated peer-reviewed research papers and the news stories that followed (n = 668) (3). They found that 40% of the press releases contained exaggerated advice, 33% contained exaggerated causal claims, and 36% contained exaggerated inference to humans from animal research. When press releases contained such exaggeration, 58%, 81%, and 86% of news stories, respectively, contained further exaggeration, compared with rates of 17%, 18%, and 10% in the news when the press releases were not exaggerated. Researchers should not be excused from being part of the press release process, as the author(s) should at least review the release before it gets disseminated to the media. I would even encourage researchers to engage in the process at the writing stage and to not allow their hospital’s or society’s public relations department to extrapolate their study’s results. Ultimately, the authors and the journals in which the studies are published will be held accountable for the information that trickles into the headlines, not the public relations departments, so we must make sure that the information is accurate and representative of the study’s actual findings.
However, to return to my original recommendation: journalists and media outlets share in this obligation to properly inform the public about health research. To address this issue, the Social Media Centre, an independent public/private organization in the United Kingdom that brings together scientists and reporters for improving responsible reporting and responsible research, has proposed 10 best practice guidelines for reporting science and health stories (4) (which I have modified slightly).
1. State the source of the story (e.g., interview, conference, journal paper, a survey from a charity or trade body, and so on), ideally with enough information for readers to look it up or by including a web link.
2. Specify the size and nature of the study (e.g., who/what were the subjects, how long did it last, what was tested, or was it an observation). Importantly, mention the major limitations, usually outlined in the discussion section of the paper.
3. When reporting a link between 2 things, indicate whether or not there is evidence that one causes the other.
4. Give a sense of the stage of the research (e.g., cells in a laboratory or trials in humans—and a realistic timeframe for any new treatment or technology).
5. On health risks, include the absolute risk whenever it is available in the press release or the research paper. For example, the decrease of an event rate from 4% to 2% is often reported as a 50% decrease, which is the relative rate, but the absolute decrease is 2%. In addition, a p value that may be very significant in a study with a large population or a meta-analysis may not represent an effect when treating patients in our daily lives.
6. Especially on a story with public health implications, try to frame a new finding in the context of other evidence (e.g., does it reinforce or conflict with previous studies?). If it attracts serious scientific concerns, they should not be ignored.
7. If space allows, quote both the researchers themselves and external sources with appropriate expertise. Be wary of scientists and press releases overclaiming for studies.
8. Distinguish between findings and interpretation or extrapolation. Do not suggest health advice if none has been offered.
9. Remember patients. Don’t call something a “cure” that is not a cure.
10. Headlines should not mislead the reader about a story’s contents, and quotation marks should not be used to dress up overstatement.
To me, this last consideration of headlines can be the most damaging because of the lasting effect. We know that it is partially driven by the fast-paced online news sites, where journalists are incentivized by the amount of clicks/visits their stories receive (5). Thus, catchy headlines, even if they exaggerate the facts, tend to garner the most attention, which is termed “click bait.” Very often, these types of headlines confuse correlation with causation. Click-baiting may be an innocuous practice for some topics, but not when reporting on people’s health or decisions that may influence a person’s health choices. All health care professionals have had to dispel false information that their patients heard from a 30-s television news spot or read in a headline of a national or local paper. Personally, I tracked 10 to 12 disparate headlines about the benefits and detriments of cholesterol over a 10-year period in a very prominent national newspaper. As the headlines flip-flopped with each new study, so did my patients. Unfortunately, I started to recognize that the most recent headline/story rarely contextualized the findings of the previous study’s findings, so each finding was reported in isolation and given equal importance, which is not at all representative of how findings unfold in practice.
I recognize, however, that some journalists are not trained in statistics or clinical data; therefore, the physicians who serve as their sources need to be particularly meticulous and take the time to properly educate reporters about the data. This is the exact juncture where journalists and researchers can come together to equally share the responsibility of properly informing the public about new health research.
- American College of Cardiology Foundation
- Sumner P.,
- Vivian-Griffiths S.,
- Boivin J.,
- et al.
- ↵Social Media Centre. Publications for journalists. Available at: http://www.sciencemediacentre.org/publications/publications-for-journalists/. Accessed February 9, 2015.
- Carr D.