By Ali and Julia
It’s no secret that journalists fall into many traps when covering the contradictory and sometimes convoluted area of health research. As a 2013 Columbia Journalism Review article—titled ‘Survival of the Wrongest’—summed up: “Even while following what are considered the guidelines of good science reporting, (journalists) still manage to write articles that grossly mislead the public, often in ways that can lead to poor health decisions with catastrophic consequences.”
This can take the form of reporting science out of context, misinterpreting conclusions, or missing big stories all together. So we set out to gather data on the places where health journalism goes wrong.
We had a grim starting place: We looked at the leading causes of death in America and compared that to how well the most comprehensive national newspaper—The New York Times—covered related stories. We wanted to see whether public health issues that matter to people are under-reported.
First, we gathered mortality data from the CDC’s most recent National Vital Statistics Report, which included 2010 deaths:
|Cause of death||Number of deaths||Percent of total deaths|
|Chronic lower respiratory diseases||138,080||5.6|
|Stroke (cerebrovascular diseases)||129,476||5.2|
|Accidents (unintentional injuries)||120,859||4.9|
|Nephritis, nephrotic syndrome, and nephrosis||50,476||2|
|Influenza and Pneumonia||50,097||2|
|Intentional self-harm (suicide)||38,364||1.6|
|Chronic liver disease and cirrhosis||31,903||1.3|
|Essential hypertension and hypertensive renal disease||26,634||1.1|
|Pneumonitis due to solids and liquids||17,011||0.7|
|All other causes||483,694||19.6|
Here, the leading causes of death are represented in a bubble chart; the biggest bubbles relate to America’s leading killers: Heart disease, cancer, chronic lower respiratory disease, stroke, accidents, et cetera.
Then, we did a query in The New York Times corpus of key search terms related to the top 15 causes of death in America. Here, we found the number of 2010 stories which mention those key words:
|Times stories in 2010||Keywords|
We then created an index to represent the media attention focused on America’s leading killers. We did this by dividing the number of New York Times stories by the number of deaths in America and then multiplying that number by 100,000. So: (New York Times stories/deaths)*100,000. Here’s what we found:
|Media attention index|
|Intentional self-harm (suicide)||863|
|Chronic liver disease and cirrhosis||379|
|Essential hypertension and hypertensive renal disease.||330|
|Influenza and Pneumonia||190|
|Stroke (cerebrovascular diseases)||167|
|Accidents (unintentional injuries)||151|
|Chronic lower respiratory diseases||20|
|Pneumonitis due to solids and liquids||6|
|Nephritis, nephrotic syndrome, and nephrosis||4|
As you can see, the big bubbles (Parkinson’s, suicide, diabetes, Alzheimer’s) suggest there’s a lot of coverage proportional to the number of deaths while barely visible bubbles mean these killers are under-covered by the media compared to mortality. If these data are correct, the third leading cause of death in America—COPD—is hardly covered in the newspaper nor was the fifth leading cause of death in America (accidents). Meanwhile, heart disease and cancer—the top killers—got relatively little attention when compared to Parkinson’s, Alzheimer’s, diabetes, and suicide.
So what does this mean?
The focus by the media on chronic diseases and diseases of aging—instead of, for example, accidents and COPD—probably reflects the interests of the more mature readership of the Times and the emphasis in newsrooms on “news you can use,” health journalism commentator Gary Schwitzer said.
He also offered another interpretation: “This exercise may reflect the work of advocacy campaigns. Maybe, in this sample, advocacy groups for Parkinson’s, liver disease, suicide, flu, diabetes, Alzheimer’s, et cetera, were just that much more successful in priming the pump by getting stuff in the New York Times.”
What’s more, our data might not be representative. Schwitzer noted that searching by key terms could turn up spurious correlations. For example, “Suicide showing up as a key word may mean that it comes from all sorts of general news stories. That may not be comparable to stroke showing up as a keyword from a stroke study. Yes, it’s what’s in the paper, but it’s not necessarily a comparison of what health care/medical/science journalists chose to report on.”
Of course, our data have other limitations. In addition to the potential flaws of searching for key terms, we used New York Times coverage as a proxy for health coverage. As Schwitzer pointed out, “‘What we journalists cover’ doesn’t necessarily equate to ‘what the New York Times did.’ To some degree, yes, because of copycat journalism. But to a large degree, day in and day out, not so much.” Similarly, the data only reflect one year of coverage.
Health editor and Retraction Watch blogger Ivan Oransky wondered whether the quantity of studies on a given topic drive coverage. “There may simply be more studies and press releases about the subjects that New York Times are more likely to cover,” he said. “And if that’s the case, this is another good reminder why letting journals set the agenda can skew what reporters cover.”
Andre Picard, a long-time public health reporter at Canada’s Globe and Mail, asked whether reflecting causes of mortality was truly the best measure for quality health coverage: “Should our choice of story topics be based (or influenced) by the impact of a disease/condition on the impact of the population?”
Picard’s answer was ‘sort of.’ “We should base our story choices in part, on the impact of diseases/conditions on the population. But I’m not sure mortality is the best metric for judging impact and I’m really sure that we should pay a lot more attention to the causes of illness than to illnesses themselves. We do that a bit – smoking as a cause of heart disease and lung cancer, for example. But we tend to shy away from issues that don’t have medical treatments.” He added: “I think availability of treatments, more than anything else, influences our coverage.”
What may not get a lot of attention in the health news pages, even though it drives human health more than anything, are the “causes of the causes of disease” such as poverty, Picard said. “We know that income is the single biggest determinant of health, followed by education. But I’m betting ‘poverty’ wouldn’t even show up as a tiny blip on your chart of health story topics. The poor and uneducated are many times more likely to die of heart disease, cancer, COPD, suicide, car crashes, etc., you name it.”
We were also interested in seeing whether there’s a disconnect between public investment in research spending and mortality. To look at this question, we tallied the dollar amounts of research funding by disease category at the NIH in 2010, and compared those to the data on the top causes of death in America. We then created an index for the research/death ratios. The bigger bubbles—stroke, Parkinson’s, Alzheimer’s, heart disease—are areas with relatively more research funding compared to mortality. Again, diseases related to aging attracted funding, as did those related to cardiovascular health.
In summary, our findings raised more questions than answers. This exercise gave us a chance to reflect on what other metrics we could use to measure the quality of health journalism and better identify the gaps in health reporting. Considering the limitations of our data, we plan to gather a more robust data set so that we can be more confident in our findings and recommendations to journalists.