Of interest to discussions in the U.S. about health care reform is that among articles discussing new medical approaches, costs were mentioned in only 12 percent of stories, though most of these articles discussed costly drugs already on the market. Risks were also reported in only 12 percent of the articles. Benefits, in contrast, were mentioned in all the articles, typically reported in qualitative (rather than quantitative) terms. A third of the time they were quantified, but always in relative, rather than absolute, terms. But even a high relative benefit does not mean that many people overall will benefit, since the population with the problem may be very small. With relative benefit alone, patients and physicians cannot consider the full benefits and costs of a particular treatment option.

Sourcing was also a problem. Only three percent of the articles referenced books; the dominant sources (59 percent) were, instead, interviews with “expert opinion leaders,” defined as professors, researchers, head physicians, representatives of patients' associations or experts of companies. The finding here: Only six percent of the articles cited more than one source.

The problem with one-source stories in health-science communication is that they are vulnerable to conflicts of interest. And this was born out in the data analysis: Though only nine percent of the articles disclosed a financial conflict of interest, the researchers easily found similar conflicts in an additional 10 percent of stories, meaning that less than half of known conflicts were reported. They note that there may have been additional conflicts that were not straight-forward to ferret out.

Unbalanced reporting occurred in 18 percent of the articles under review; however, among those concerning new treatments, tests or products, this jumped to 45 percent. As the researchers note, “In the majority of the unbalanced stories, exaggerated or incorrect claims aimed at or had the effect to favor a new treatment, procedure, test or product.”

How does this compare to the United States? The organization HealthNewsReview.org has been engaged in an similar ongoing its evaluation of health coverage based on explicit ratings criteria. In its latest published report (also published in PLoS Medicine) on the state of U.S. health reporting, over 500 health news stories were analyzed over 22 months, and between 62 percent and 77 percent of stories “failed to adequately address costs, harms, benefits, the quality of the evidence, and the existence of other options when covering health care products and procedures.”

In contrast to Italy, the U.S. media failed to cover benefits as much or more than it did harm: only 28 percent of articles were considered to have “adequately covered benefits,” while 33 percent “adequately covered harms.” But if American journalism is more pessimistic than Italian, it boils down to the same message: the media is doing a poor job at reporting on health sciences. Perhaps journalists should take a closer look at the HealthNewsReview.org criteria for good medical reporting (see sidebar).

HealthNewsReview.org: Ratings Criteria and Explanation

1. Adequately discusses costs.
We believe that, in an era when health care spending represents 16% of the US gross domestic product, a story is incomplete if it does not address the costs of an approach, and a comparison with existing alternatives. We also think journalists should explore whether insurers are likely to pay for it.

2. Quantifies benefits.
Stories should give some sense of the size of the potential benefits of the approach being discussed. Stories (and studies, for that matter) should also explain the benefits in absolute, not just relative, terms.

3. Adequately explains and quantifies potential harms.
Stories should give a complete picture of potential harms of an approach, and quantify those potential harms in absolute terms.

4. Compares the new idea with existing alternatives.
We expect that a story would put the new approach being discussed into the context of existing alternatives, with some discussion of the possible advantages or disadvantages of the new approach compared with existing alternatives.

5. Seeks out independent sources and discloses potential conflicts of interest.
We expect, just as the Association of Health Care Journalists does, that journalists should “recognize that most stories involve a degree of nuance and complexity that no single source could provide. To reflect only one perspective of only one source is not wise; [journalists should] be vigilant in selecting sources, asking about, weighing and disclosing relevant financial, advocacy, personal or other interests of those [they] interview as a routine part of story research and interviews”[4].

6. Avoids disease mongering.
This criterion is an attempt to help journalists avoid promulgating the medicalization of normal states of or variations in health (e.g., baldness, menstruation, short stature, etc.). We also try to educate journalists about surrogate endpoints and about how risk factors are not diseases. With this criterion, we also remind them not to exaggerate the prevalence or incidence of a condition.

7. Reviews the study methodology or the quality of the evidence.
The story should reflect an understanding that not all studies are equal. If a story does not point out some of the limitations of an observational study and does not caution about interpreting uncontrolled data, for example, we will judge it unsatisfactory.

8. Establishes the true novelty of the idea
Many “new” products or procedures are not really novel. The product reported may be the sixth new member of a well-established class of drugs. It may be a device that has only been judged to be substantially equivalent to other devices already on the market. Journalists should accurately reflect the novelty (or lack thereof) of “new” products or procedures.

9. Establishes the availability of the product or procedure.
Many stories report on products or procedures that are still in clinical trials. We expect journalists to explain whether something is only available via limited access in clinical trials, whether something is FDA approved, whether insurability limits availability, etc. Many news stories seem to treat FDA approval of an investigational drug as a fait accompli, making predictions about how the drug “could be” or “should be” approved and on the market within a given time frame. Such stories would be rated as unsatisfactory.

10. Appears not to rely solely or largely on a news release.
We expect, just as the Association of Health Care Journalists does, that journalists should “Preserve journalistic independence by avoiding the use of video news releases or the use of quotes from printed news releases; label and credit the source whenever a portion of a video or printed news release is used” [4]. We expect a journalist to use a news release for background information only, and to then seek independent experts to comment on a development.”