On the one hand, on the other hand:
We're all guilty, at least some of the time

Janice Hopkins Tanne

A 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.

1. Schulman KA, Berlin JA, Harless W, et al. The effect of race and sex on physicians' recommendations for cardiac catheterization. N Engl J Med 1999; 340:618-26.

2. Schwartz LM, Woloshin S, Welch HG. Misunderstandings about the effects of race and sex on physicians' referrals for cardiac catheterization. N Engl J Med 1999; 341:279-83.

Related links...

  • National Association of Science Writers

  • Council for the Advancement of Science Writing

  • American Medical Writers Association

  • Council of Biology Editors

  • Science Writers in New York (SWINY)

  • Canadian Science Writers' Association

  • European Association of Science Editors

  • Science.komm, research communication resource based in Vienna, Austria

  • Society for Technical Communication

  • Resources for tech/scientific writers, inkspot.com

  • JANICE HOPKINS TANNE covers health and medicine for newspapers, magazines, and journals. Her articles have appeared in the British Medical Journal, New York magazine, Parade, American Health, and 21stC, among other publications. She has won nine awards for medical reporting.

    Photo Credits Headline: Photos / Computer Illo Howard R. Roberts