Medical Research and the News Media
http://www.100md.com
《新英格兰医药杂志》
Not so long ago, medical research reports were published in medical journals, to be read and evaluated primarily by physicians. If patients ever learned anything about research studies, it was from their physicians. But patterns of communication have changed. Today, the news media and the Internet are major sources of health information for the public. This shift in the flow of information has definite benefits, but it brings with it some tricky tensions for patients, physicians, researchers, and even the editors of medical journals.
Physicians may feel that they are working at cross-purposes with the health-news media, especially when news reports give patients unrealistic expectations or unnecessary anxieties. Clinicians rightly recognize the complexities of a given study, the practical problems of its application, and the trade-offs. Physicians get irritated when the press turns the release of a new study into a health crisis. They want to have time to evaluate any important report and see it in context, and they are never comfortable with basing clinical advice on the reports in the news media. They want to see the proof of time and replication. By nature and training, physicians are critical, and we are apt to recognize when the medical-news media are overselling, over-scaring, and oversimplifying. Physicians also know too well that for many medical research reports there are financial implications that may or may not align with the best interests of their patients. News reporters must work quickly and explain complex topics, and their interpretations may be vulnerable to the skilled management of the media by the pharmaceutical industry and manufacturers of devices, as well as to promotion by sponsoring institutions, disease "interest groups," and the enthusiasm of investigators who usually want as much media coverage as they can get.
The public places a lot of trust in the health-news media, in part because the reports begin with research findings from medical experts whom the public trusts even more. People want guidance, and the media produce messages that are emphatic and clear. In fact, the media have become the primary sources of health education and medical information for the public — they can certainly get a message out quickly about an event such as the sudden shortage of influenza vaccine or the withdrawal of rofecoxib from the market. And the media have certainly contributed to public awareness and acceptance of screenings for cancer and interventions to reduce the risk of coronary heart disease. At times, it may feel as if messages from the media are infringing on the practice of medicine and that a news story can trump what doctors say. But most people still want physicians they know to validate and interpret what they glean from the news, and patients often arrive at their appointments with news articles and Internet printouts in hand. Trying though such requests may be, we should see them not as direct challenges but as requests for interpretation and for help.
As health reporting has expanded, so has its quality and sophistication. In fact, physicians, too, now rely in part on the media to learn about new studies, especially those outside their own specialty areas. Physicians also want to see the news that their patients are seeing. There is a tendency for health reports to describe events as exciting, major advances or as immediate, threatening dangers. Often there is a brief, touching anecdote about one patient that the public will see as convincing proof of a highly effective new treatment or of an imminent threat. Especially in the television news, complex studies tend to be simplified into one bite-sized message. New forms of technology make for good stories; studies with negative results do not. For any report, follow-up is rare. The focus just turns to tomorrow's news and the next advance.
The articles published in this journal now lead to at least 450 original reports per month in the news media. If one counts the secondary reports based on releases from the wire services, the number of reports exceeds 1500 per month for the Journal alone. The articles that receive the most attention are those about topics that are on the minds of the public. For example, the research report that we published on the effects of combat duty on U.S. soldiers in Iraq1 led to more than 340 news articles. Articles about breast cancer, prostate cancer, osteoporosis, and coronary heart disease consistently receive wide coverage. And the public seems ever hungry for news about diet, cholesterol, obesity, and even liposuction. Members of the news media know that the public is fascinated by exotic health reports such as the fate of conjoined twins2 or of patients who have swallowed unusual objects.3 Not surprisingly, the media pay little attention to articles about uncommon diseases, genetics, and pathophysiology. There is little attention to the problems of health care costs and our health care system, and even less about world health problems such as malaria and tuberculosis. Again, the coverage in the media reflects the interests of the public, on whose attention the media themselves depend.
Knowing that the media are primed and poised to focus on what we publish only increases the responsibilities of medical journals to maintain rigorous peer review and critical examination of how researchers interpret their findings. The media and the public see publication in peer-reviewed journals as validation of the research. Diligent reviewers and careful editors can identify mistakes, provide balance, and restrain overinterpretation. At this journal we go to great lengths to provide accompanying commentary from experts who can offer critical perspective and qualification. We urge the news media to try to do the same. Ironically, physicians tend to blame the journal when the media publicizes and misinterprets a research report.
Investigators see attention in the media as a valuable professional opportunity, as do their academic institutions, their funding sources (both public and private), and even their specialty societies, not to mention the pharmaceutical and medical-device industries. For private companies, publication and a positive press have cash value, which only further increases the need for peer-reviewed journals to remain critical and for policies such as ours that ensure that editors remain free of financial ties to those whose work they publish. Journals and those who write for them should be judged by the most critical standards of the medical profession, which has a memory that endures long after the flashes in the news media have faded.
References
Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med 2004;351:13-22.
Norwitz ER, Hoyte LPJ, Jenkins KJ, et al. Separation of conjoined twins with the twin reversed-arterial-perfusion sequence after prenatal planning with three-dimensional modeling. N Engl J Med 2000;343:399-402.
Fran?ois B, Brenet O. A medical mystery. N Engl J Med 2004;350:59-59.(Edward W. Campion, M.D.)
Physicians may feel that they are working at cross-purposes with the health-news media, especially when news reports give patients unrealistic expectations or unnecessary anxieties. Clinicians rightly recognize the complexities of a given study, the practical problems of its application, and the trade-offs. Physicians get irritated when the press turns the release of a new study into a health crisis. They want to have time to evaluate any important report and see it in context, and they are never comfortable with basing clinical advice on the reports in the news media. They want to see the proof of time and replication. By nature and training, physicians are critical, and we are apt to recognize when the medical-news media are overselling, over-scaring, and oversimplifying. Physicians also know too well that for many medical research reports there are financial implications that may or may not align with the best interests of their patients. News reporters must work quickly and explain complex topics, and their interpretations may be vulnerable to the skilled management of the media by the pharmaceutical industry and manufacturers of devices, as well as to promotion by sponsoring institutions, disease "interest groups," and the enthusiasm of investigators who usually want as much media coverage as they can get.
The public places a lot of trust in the health-news media, in part because the reports begin with research findings from medical experts whom the public trusts even more. People want guidance, and the media produce messages that are emphatic and clear. In fact, the media have become the primary sources of health education and medical information for the public — they can certainly get a message out quickly about an event such as the sudden shortage of influenza vaccine or the withdrawal of rofecoxib from the market. And the media have certainly contributed to public awareness and acceptance of screenings for cancer and interventions to reduce the risk of coronary heart disease. At times, it may feel as if messages from the media are infringing on the practice of medicine and that a news story can trump what doctors say. But most people still want physicians they know to validate and interpret what they glean from the news, and patients often arrive at their appointments with news articles and Internet printouts in hand. Trying though such requests may be, we should see them not as direct challenges but as requests for interpretation and for help.
As health reporting has expanded, so has its quality and sophistication. In fact, physicians, too, now rely in part on the media to learn about new studies, especially those outside their own specialty areas. Physicians also want to see the news that their patients are seeing. There is a tendency for health reports to describe events as exciting, major advances or as immediate, threatening dangers. Often there is a brief, touching anecdote about one patient that the public will see as convincing proof of a highly effective new treatment or of an imminent threat. Especially in the television news, complex studies tend to be simplified into one bite-sized message. New forms of technology make for good stories; studies with negative results do not. For any report, follow-up is rare. The focus just turns to tomorrow's news and the next advance.
The articles published in this journal now lead to at least 450 original reports per month in the news media. If one counts the secondary reports based on releases from the wire services, the number of reports exceeds 1500 per month for the Journal alone. The articles that receive the most attention are those about topics that are on the minds of the public. For example, the research report that we published on the effects of combat duty on U.S. soldiers in Iraq1 led to more than 340 news articles. Articles about breast cancer, prostate cancer, osteoporosis, and coronary heart disease consistently receive wide coverage. And the public seems ever hungry for news about diet, cholesterol, obesity, and even liposuction. Members of the news media know that the public is fascinated by exotic health reports such as the fate of conjoined twins2 or of patients who have swallowed unusual objects.3 Not surprisingly, the media pay little attention to articles about uncommon diseases, genetics, and pathophysiology. There is little attention to the problems of health care costs and our health care system, and even less about world health problems such as malaria and tuberculosis. Again, the coverage in the media reflects the interests of the public, on whose attention the media themselves depend.
Knowing that the media are primed and poised to focus on what we publish only increases the responsibilities of medical journals to maintain rigorous peer review and critical examination of how researchers interpret their findings. The media and the public see publication in peer-reviewed journals as validation of the research. Diligent reviewers and careful editors can identify mistakes, provide balance, and restrain overinterpretation. At this journal we go to great lengths to provide accompanying commentary from experts who can offer critical perspective and qualification. We urge the news media to try to do the same. Ironically, physicians tend to blame the journal when the media publicizes and misinterprets a research report.
Investigators see attention in the media as a valuable professional opportunity, as do their academic institutions, their funding sources (both public and private), and even their specialty societies, not to mention the pharmaceutical and medical-device industries. For private companies, publication and a positive press have cash value, which only further increases the need for peer-reviewed journals to remain critical and for policies such as ours that ensure that editors remain free of financial ties to those whose work they publish. Journals and those who write for them should be judged by the most critical standards of the medical profession, which has a memory that endures long after the flashes in the news media have faded.
References
Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med 2004;351:13-22.
Norwitz ER, Hoyte LPJ, Jenkins KJ, et al. Separation of conjoined twins with the twin reversed-arterial-perfusion sequence after prenatal planning with three-dimensional modeling. N Engl J Med 2000;343:399-402.
Fran?ois B, Brenet O. A medical mystery. N Engl J Med 2004;350:59-59.(Edward W. Campion, M.D.)