few years ago, an international financial magazine asked me to write about biotechnology
companies. No problem for an experienced medical writer, I thought. Cloning, gene chips, RNA,
DNA: a piece of cake. But then I discovered another sort of arcane language: price-to-earnings ratio,
initial public offerings, percentage growth in revenue vs. percentage growth in earnings, return on
equity, return on assets, return on investment.... I began 
to appreciate the difficulties that general
journalists face when they have to cover a heavy science story and the occasional horrors that
scientists face when a journalist asks them a few questions. (Some years ago, AIDS researcher Dr. Anthony Fauci of the National
Institutes of Health said he knew he was in trouble when the reporter asked him to spell "virus.")
At the "Breakthrough?" conference, Dr. David Frankel, the North American editor of The Lancet, pointed to the uproar that followed
in the United Kingdom when a study showed a tiny increase in venous thromboembolism among
women taking third-generation oral contraceptives. Statistics were misinterpreted, and the tiny
increase ballooned into a disaster. Headlines like "Pill Killed My Wife" ran on front pages, women
flooded their doctors with calls, many women stopped taking the pill immediately, and the number of
abortions increased.
Columbia's conference was even-handed in serving hubris, pointing out the failures of both scientists
and journalists. All of us--journal editors and journalists--are too gullible, don't read the small print,
have our skepticism genes turned off, are perhaps a bit careless, never ask quite enough questions,
and may be on deadline. Otherwise, we are a terrific bunch of folks who are trying to educate doctors
and the public whether they like it or not.
Science journalists consider themselves an elite. Some have medical or scientific degrees; most--by
hook or by crook--have acquired at least the level of knowledge possessed by a not-too-swift general
practitioner. But perhaps we view the major journals and their peer-review systems with too much
respect and not enough skepticism. We rely on them for quality control of their contents, but
sometimes they have feet of clay. We're well aware that the major journals tend to publish mostly the
good news, not what doesn't work. We know there's an old-boy network. We know the journals are
in the same business we're in--scoops, publicity, attention, readers, advertising.
We may be
skeptical about the way journals highlight their forthcoming articles, making it easy for us to cover
what they want us to cover. Under the embargo system, journals send us press releases, full-text
articles, videos, and contact numbers to reach authors about the stories that they consider important.
The embargo system gives us time to absorb a study, get comments from other experts, and report it.
One wonders what kind of peer-review process operates at the journals to identify certain papers as
important. Journalists often have to cover these stories because everybody else will.
One point that the conference didn't cover was the knowledge level of editors who edit publications
and programs for the public. I know several marvelous editors, but I have never met one with a
science degree. You, the science or medical reporter, are the only expert they've got, and it can be
difficult trying to explain the importance of a study to someone who doesn't know DNA from the
GNP. The science story will compete for space or air time with the suburban fire, the traffic disaster,
and 10 seconds of foreign news.
Misinterpretation of journal articles came up several times at the conference. Should we expect better
editing from the journal to make the studies clearer? Better press information about what a study
really means? Dr. Martin Schechter, an AIDS expert from Vancouver, B.C., published a study about
needle exchange. Many experts endorse the consensus that providing injecting drug users with clean
needles reduces the spread of HIV. In Schechter's study, patients in a clean-needle program actually
got infected more often than those who were not in the program.
Many news stories reported
that the needle exchange program increased the spread of AIDS. Opponents of the program pounced
on the study, claiming it proved their point that giving needles increased drug use and infection. The
real story, Schechter said, is that people who participated in the needle exchange program were
involved in high-risk behaviors; needle exchange reduced their risk, but not to levels seen in groups
with less risky behavior. I asked Schechter whether he would have not published the study, knowing
it might be misinterpreted. He said, "Absolutely not." But could the study and results have been
presented more clearly for the public?
A similar problem occurred when the New England
Journal of Medicine published a study1 that seemed to show doctors treated patients with chest pain
differently depending on their race and sex. The message was that blacks and women didn't receive
the best care. "Doctor Bias May Affect Heart Care," the New York Times reported.
Five months later,2 doctors at the Veterans Administration
Outcomes Group criticized
the study (also writing in the NEJM), identifying three basic problems with its data
presentation: "[T]he magnitude of the finding was overstated, the comparison reported was incorrect,
and the implicit assumption--that catheterization always represents the best care--was unwarranted.
These problems began with the way in which the authors chose to write the article, persisted despite
peer and editorial review, and were magnified in the news media.... It is tempting to place the
blame...on reporters, science writers, and editors in the media and to demand that they improve their
reporting. To a large extent, however, the media simply reported what they were told. If the research
community does not get it right, we cannot expect the media to do better."
Now that was a
journal-side problem. Alas, peer review doesn't catch all the problem papers. Dr. Bruce Dan, the
medical director of Medcast Networks, pointed out hilariously implausible papers that had passed
peer review: publications by a researcher every few days, but based on apparently massive, long-term
research; a family tree showing that the progenitor must have been fathering children at a
pre-pubertal age; "microbes" that were probably dust on the slide. Didn't anybody notice? Surely the
editors and reviewers should have caught these problems. Don't reviewers use calculators to add up
the numbers in the columns? I thought the journals should have been damned for publishing these
sloppy stories. Instead the blame fell on the authors, although they certainly deserved it.
Both medical reporters and journal editors can do a better job; the appropriate jargon is "continuous
quality improvement." The fact that several hundred medical reporters showed up on a Saturday for a
full day's intense program shows that we take our responsibilities seriously.
