The power of the health journalist’s pen

Where do you get your health and medical news? How do you know whom to trust? Should you act on news you read about health and nutrition?

The Health Correspondent Susan Dentzer recently wrote a perspective piece in the New England Journal of Medicine in which she argues that when journalists ignore complexities, or fail to provide context, the public health messages they convey are inevitably inadequate or distorted. While many seasoned reporters do a responsible, thoughtful job, she says, others-due to ignorance, an inability to interpret and convey the nuanced results of clinical studies, or a desire to hype a story to draw attention to it-deliver misleading or wrong information.

Dentzer writes:

"In my view, we in the news media have a responsibility to hold ourselves to higher standards if there is any chance that doctors and patients will act on the basis of our reporting. We are not clinicians, but we must be more than carnival barkers; we must be credible health communicators more interested in conveying clear, actionable health information to the public than carrying out our other agendas. There is strong evidence that many journalists agree-and in particular, consider themselves poorly trained to understand medical studies and statistics. But not only should our profession demand better training of health journalists, it should also require that health stories, rather than being rendered in black and white, use all the grays on the palette to paint a comprehensive picture of inevitably complex realties. Journalists could start by imposing on their work a 'prudent reader or viewer' test: On the basis of my news account, what would a prudent person do or assume about a given medical intervention, and did I therefore succeed in delivering the best public health message possible? "

I think that there's no field as prone to misinformation and misinterpretation as nutrition science.

Nutrition study is inherently hard. Isolating the effect of diet on health is difficult, and in the end gives a statistical answer, telling us what's likely. The fact is there are no certainties.

People differ from each other, eat all sorts of different foods over a lifetime, and live in different types of environments. Testing a specific food or nutrient-as opposed to testing a highly purified new drug-is impossible, as people eat in a social context, with food, lifestyle and other health influencers interacting and complicating interpretations. Many nutrition studies use study models that are not the ideal methods for obtaining proof, as there are technical and financial restraints that would make the ideal trial unattainable. Nevertheless, when the evidence of these trials is weighed together, and further, better studies are preformed, scientists can arrive at a consensus, which is the best advice that can be given at this time.

As difficult as nutrition science is, most people are very interested in learning about new developments. We all eat, and we'd all like to know how to eat best for optimal health. Therefore many scientific studies are reported in the general media.

Now, don't get me wrong: every study has value, and publishing study results in scientific papers is the way science-eventually-gets to the truth. But publishing a surprising study result using a catchy title in a popular media outlet can lead to misinterpretation and the false belief that what a study shows is the "truth."

I'll give you one recent example that really upset me.

A paper titled: "Light drinking in pregnancy, a risk for behavioural problems and cognitive deficits at 3 years of age?" was published in International Journal of Epidemiology. It was a prospective study whose results indicated that at age 3 years children born to mothers who drank up to 1-2 drinks a week during pregnancy did not seem to have clinically relevant behavioral difficulties or cognitive deficits compared with children of abstinent mothers. The authors of the study concluded:

"There is no increased risk of behavioural problems or cognitive deficits at age 3 years for children whose mother drank not more than 1 or 2 units of alcohol per week or on any given occasion. It is important to acknowledge that problem behaviours or cognitive deficits may become apparent in these children at older ages, and the evidence presented should be used to guide future research and inform policy."

Because alcohol consumption during pregnancy is a big health problem, such a study-if reported in lay media at all-must be interpreted with extreme caution.

Alcohol is a known teratogen (a chemical that can cause birth defects). Prenatal exposure to alcohol is widely accepted to be a risk factor in child development. Since it's unclear what amount, frequency and timing of alcohol consumption during pregnancy causes damage to the fetus, the current recommendation of the U.S. Surgeon General is to not drink at all during pregnancy.

However, here are a few examples of popular media headlines in stories that presented this study:

"Light Drinking During Pregnancy May Benefit Baby"

"Pregnancy: Odd Drink May Not Hurt"

"Light drinking in pregnancy may be good for baby boys, says study"

If readers got to the end of these articles, they might have learned that experts don't actually suggest an expectant mother should drink, but did anyone actually read the whole story? And did the same news reporters balance this catchy piece with all the bland but plentiful studies showing again and again that alcohol is dangerous to the fetus? I suspect not.

Unfortunately, there are many cases of this type of irresponsible reporting, in which the reader is drawn in with sexy headlines to seemingly relevant, applicable nutrition "news." Studies are interpreted with great liberty while the related scientific article may be about an animal model or a cell-culture model, and be hardly relevant to anyone but the scientific community.

Study results should never be taken as guidelines for behavior. An interesting study, especially one showing new or contradictory results, will be followed by repeated and more methodological ones, and in the end, all evidence will be weighed by experts and only then might a recommendation be made.

I'm all for good health and nutrition reporting. But people are influenced by what they read in print and watch on TV, and many will act on media stories. I therefore agree with Susan Dentzer, and hope reporters take their position as influencers very seriously. There are many excellent health reporters who do and never fail to put new studies in a bigger context, examples of great health reporting would be the New York Times Health section and Tara Parker-Pope's Well blog, and NPR's science and health programming.

What do you think of the reporting of nutrition news? Who do you trust?

Dr. Ayala