overing scientific issues for the general public is one of the biggest challenges journalism faces
today. The first difficulty is for the reporter to understand the science behind a story -- say, how a new
drug affects a certain ailment, or what side effects it may produce. It is important to grasp the
methodology of clinical trials, including some essential concepts of statistics. Even when a reporter is
completely in command of the material, the limited "news hole" 
in a newspaper or on a television
broadcast often means that the complex science must be boiled down to, say, 900 words or 90
seconds of air time. The reporter must also consider the desires of editors or producers, some of
whom will want to present the story more sensationally so as to attract readers or viewers.
Along the way, a promising treatment for a disease can become a "cure," and a statistically
insignificant side effect may be portrayed as a major health risk. Through a complex process riddled
with institutional imperatives and cross-purposes, medical journalism can on occasion fall short of its
objective -- sometimes propagating misinformation, even public panic. For an institution concerned
with teaching and upholding the professional standards of journalism, this field offers ample
opportunities for analysis and improvement.
Success has many fathers, the saying goes, but failure is an orphan. The conference "Breakthrough? The Science and Politics of
Medical Journalism"1 -- held at the Columbia Graduate
School of Journalism last March and jointly sponsored by 21stC, The Lancet, and the Horace W. Goldsmith
Foundation -- had many fathers (and mothers). Within a few weeks in the summer of 1998,
journalism dean Tom
Goldstein received letters from 21stC's co-publisher William Polf, medical journalist
Lynn Payer, and Dr. David
Frankel, North American editor of The Lancet, each proposing a conference designed
to help reporters read articles in medical journals with the same well-informed skepticism that a city
hall reporter brings to a mayoral press release. Discussions by the various participants led to a
full-day meeting that delved into the technical knowledge reporters need to assess such articles and
provided broader perspectives on the associated business pressures and journalistic challenges.
"Breakthrough?" attempted to make medical journalists writing for mainstream news outlets more
aware of some of the pitfalls endemic to the field and to provide background information that would
help them cover medical journal reports with greater confidence and accuracy. The day began with a
pair of cautionary tales about what happens when medical stories are misreported in the general
press: David Frankel told how inaccurate reports about a new oral contraceptive in Britain resulted in
a sharp rise in abortions and unwanted births, and Dr. Martin Schechter,
director of the Canadian HIV Trials Networks,
spoke about misleading coverage of a needle-exchange program in Canada, which was then cited by
conservatives in the U.S. Congress as an argument against such programs.
The most challenging
presentation was a crash course in biostatistics by Dr. Alan D.
Weinberg, assistant clinical professor at Columbia's Mailman School of Public Health, who
defined and explored confidence intervals, standard distributions, populations and samples, P values,
relative and absolute risk, and other central concepts of
statistics. In spite of the difficulty of the topic, the audience -- about 220 medical journalists,
journalism students, and others -- followed attentively, aware that these concepts are essential to
medical reporting. Dr. Bruce Dan of Medcast Networks
critiqued the design and reporting of clinical studies, with cautionary tales about gaping mistakes that
made it into print in prestigious journals. Boston University's Ellen Ruppel Shell, whose New York
Times Magazine article on the rivalry between the New England Journal of Medicine
and the Journal of the American Medical Association helped inspire the original idea for the
conference, sparked some lively debate with her interpretation of certain controversial editorial
decisions.
The day concluded with a Socratic dialogue conducted by the Fred Friendly Seminars on Media and Society,
headquartered at the Journalism School. A panel 
of experts (see sidebar) put the issues in motion by
examining a hypothetical discovery of a treatment for breast cancer -- associated with health risks of
its own -- and the interwoven responses by researchers, journal editors, mass-circulation reporters,
physicians, patient advocates, and the business world. The discussion brought to light the risks of
sensationalism, the desire to be first with a story, the role of public relations experts, and the way
news coverage affects the dialogue between doctors and patients.
Although the day's program
was long and complex, it was favorably received by the audience, and discussions are under way
toward another similar event in the spring of 2000. The authors in this special section of
21stC have taken up where the "Breakthrough?" participants left off. Columbia Journalism
School's Kenneth Goldstein looks at the history of medical journalism as a distinct profession, with
commentary on how it can best fulfill its complicated mission. Janice Hopkins Tanne provides a
working science journalist's perspective on the conference; another experienced medical writer,
Andrew Skolnick, analyzes controversies in the selection of research reports. A leading science
reporter from the broadcast media, Robert Bazell, provides a few tips for working researchers on
ways to make the most of their often troubled relationship with the media.
In an increasingly technological society, the importance of good medical and science coverage in
mainstream journalism can hardly be overstated. The "Breakthrough?" conference provided a useful
model for how to address the problems involved, and we at the Journalism School hope to organize
additional conferences along the same lines to help make both journalists and their sources more
aware of the difficulties involved in getting the story right.
