Why we review health care news releases

Kevin LomanginoManaging Editor, HealthNewsReview.org

Center for Media Communication & HealthUniversity of Minnesota School of Public Health

@Klomangino@HealthNewsRevu

kevinlomangino@gmail.com

Association of Health Care Journalists meeting, April 2016

June 2002

• Only 23% of press releases included any mention of study limitations.

• Twenty-three studies were industry funded, yet only 22% of the releases noted this support.

• 55% provided some measure of baseline risk, the format least prone to exaggeration.

• “Press releases do not routinely highlight study limitations or the role of industry funding. Data are often presented using formats that may exaggerate the perceived importance of findings.”

September 2012

Positive “spin” was identified in about half of press releases and news stories. The main factor associated with “spin” in press releases was the presence of “spin” in the journal article abstract conclusion.

In other words, a direct link from published study news release news story.

Who thinks about the reader, the consumer, the patient…at the end of this food chain?

December 2014

“40% of the press releases contained exaggerated advice, 33% contained exaggerated causal claims, and 36% contained exaggerated inference to humans from animal research. When press releases contained such exaggeration, 58%, 81%, and 86% of news stories, respectively, contained similar exaggeration, compared with exaggeration rates of 17%, 18%, and 10% in news when the press releases were not exaggerated.”

September 2015

“A fundamental limitation of observational research—the inability to attribute causation—was rarely mentioned in journal documents or news stories and was often accompanied by a disclaimer... A possible consequence of inadequate reporting of limitations of observational research is that readers consider the reported associations to be causal, promoting health practices based on evidence of modest quality. Up to 50% of such practices prove ineffective when tested in randomized clinical trials.

September 2015

Since April 2015 we’ve been systematically reviewing health care news releases from many sources

• Academic medical centers• Universities• Government agencies• Hospitals and hospital systems• Nonprofits and advocacy groups• Drug and device companies• Journal publishers

Common flaws:news release spin

• Negative studies made to sound positive• Subgroup analysis treated as main study

outcome• Study descriptions that appear to prioritize

“clicks” over accurate, balanced discussion

• “This is the first time any therapy has been shown to stabilize memory loss over a year.”• “This promising combination therapy

(acetylcholineesterase inhibitors and Lupron Depot) warrants testing in early and late stages of Alzheimer’s disease.”

“Prostate Cancer Drug Slows Memory Loss in Women with Alzheimer's Disease”

Our reviewers weigh in

• Main findings of study uniformly negative and show no benefit

• News release findings came from a subgroup analysis—possibly biased

• Serious potential harms not discussed• Investigator conflict of interest – stock holdings in

company that owns patent

IMPACT ON NEWS COVERAGE

“There are more than 5 million people in the U.S. with Alzheimer's, whoever is first to market with this combo therapy is going to do really well.”

"The family of the last person I treated said they thought God had sent me to them to provide this drug."

Common flaws:news release hype

• Exaggerating effect size – usually by using relative risk data

• Using causal language to describe observational studies• Tyranny of the anecdote: telling success stories but

rarely profiling dropouts, dissatisfied, those who choose conservative route or lifestyle change instead of treatment

• “Breakthrough discovery” in fertility treatment• “Highly successful” in “stopping the damage from obesity

being passed onto the offspring” • Points to “a potential future therapy to restore ‘natural’

fertility in obese women, and to prevent multi-generational damage passing onto their children”

EXAMPLE NEWS RELEASE REVIEW

WHAT THE RELEASE LEFT OUT The study involved mice, not human “mothers”

Our Reviewers Weigh In:

• “The release talks about damage that can be ‘passed from a mother to her children’ — not from a MOUSE mother to her MOUSE children.’”

• The release mentions “laboratory studies.” Readers cannot be expected to know than “laboratory studies” means mice.

IMPACT ON NEWS COVERAGE “Damaging effect of obesity on a woman's eggs can now be reversed: Drug can 'restore egg quality to original level’”

“It is well established that being overweight or obese can impact on the chances of conceiving a child. However, [researchers] believe there could be an option for women who fall into this demographic.”

No mention anywhere that study involved mice

• “This is a simple dietary change that we believe most women can understand and adopt.”

• “It may have a big impact on public health without requiring complicated counting of calories or nutrients.”

EXAMPLE NEWS RELEASE REVIEW

Our reviewers weigh in

• Study had nothing to do with breast cancer; researchers looked at surrogate marker of blood glucose levels

• “may reduce” suggests causal link; not appropriate for observational study

• Very important limitations never addressed

• “Breast cancer risk was 12%-19% lower among women who ate more dietary fiber in early adulthood”

• “For each additional 10 grams of fiber intake... breast cancer risk dropped by 13%.”

• “...suggests one of the very few potentially modifiable risk factors for premenopausal breast cancer.”

February 2016

Our reviewers weigh in

• Breast cancer rates were 3.3% in the lowest vs. 3.1% in highest fiber consumers, an absolute difference of only 0.2%.

• “may reduce” suggests causal link; not appropriate for observational study

• “There’s a great potential for ‘recall bias’ in these types of questionnaire-based studies.”

Does the language fit the evidence?

Language to avoid when describing observational studies• Reduces risk• Increases risk• Prevents

• Cuts risk• Lowers risk• Improves

Does the language fit the evidence?

Accurate descriptive language• “This was an observational study, not a trial.” • “An observational study like this can’t establish cause and

effect, so using terms like ‘protective effect’ is inaccurate.” • “In this observational study some other factor might have

decreased x. That doesn’t mean that the statistical link �(association) isn’t real; it just means a study like this can’t prove that the y was the culprit.” �

Positive Feedback from Communications Officials

“Thanks for writing to us. We did read your post (we do get your alerts and find them instructive) and we are taking in your points. We have passed on the comments to other people involved in the press release process and hope never to be on your wall of shame again!”

- Comms Director at a Major Cardiology Society

Positive Feedback from Communications Officials

“Lesson: Institutions need to devote more efforts to policing news and installing journalistic standards into marketing efforts, not the other way around.” -- Comms Director at an Academic Medical Center

Positive Feedback from Communications Officials

“I wanted to make sure that we communicated a responsible message and in fact, consulted your website for a ‘check list’ of points I needed to make. So thank you for being a strong resource. I’m glad the release received a positive review and I gladly accept the criticism.”- Comms Director at an Academic Medical Center

kevinlomangino@gmail.com

@KLomangino@HealthNewsRevu

Thanks to the Laura and John Arnold Foundation for grant support