I believe that when journalists ignore complexities or fail to provide context, the public health messages they convey are inevitably inadequate or distorted. The news media need to become more knowledgeable and to embrace more fully our role in delivering to the public accurate, complete, and balanced messages about health. With some additional skills, care, and introspection — and a change in priorities — we can produce coverage more in line with our responsibilities.

Some health care journalists will say their paramount role is to report the “news” — strictly speaking, that which is new. These journalists tend to cover the findings of a new clinical study without much, if any, reference to previous relevant studies. For example, in 2006, multiple news reports on the Women's Health Initiative Randomized Controlled Dietary Modification trial concluded that a “low-fat” diet (in which fat accounted for 20% of calories) produced no benefit in terms of reduced rates of disease in women.1 Given the trial results, this was an inaccurate interpretation to begin with: breast cancer rates were 22% lower among women with sharply reduced fat intake than in the comparison group. Perhaps more problematically, almost no news story about this trial made reference to findings first reported in 2005 from the Women's Intervention Nutrition Study, which clearly showed that a low-fat diet reduced the risk of recurrent breast cancer among women who previously had the disease.2 Apparently, that study was no longer relevant by 2006, although it focused on the same topic. The “new” public health message for women was that dietary fat didn't especially matter.

More broadly, a problem that is worsening in this era of the 24/7 news cycle is the frequent failure to put new developments into any kind of reasonable context for readers or viewers. In this environment, reporters become little more than headline readers or conduct interviews that amount to a “hit and run” version of journalism. For example, a September 24, 2008, report on CBS's “Early Show” featured a 105-second discussion of transradial angioplasty. First, the interviewer incorrectly described all angioplasty as “the opening of blocked arteries through the wrist.” Then a prominent interventional cardiologist was allotted enough time to say that the transradial procedure was cheaper than traditional angioplasty and superior for most patients — but not enough time to cite the study on which his assertions were based. Completely absent was any discussion of when and why angioplasty should be done, let alone of the large, year-older study that raised important questions about whether too many angioplasties were being performed.

During congressional hearings in 2004 that unleashed a torrent of this type of coverage, a safety officer for the Food and Drug Administration (FDA), David Graham, singled out five drugs on the market whose safety should be “seriously looked at.” Some newspaper reports the next day featured graphic spreads on the “Five Most Dangerous Drugs” — the acne drug isotretinoin, the weight-loss drug sibutramine, the cyclooxygenase-2 inhibitor valdecoxib, the lipid-lowering drug rosuvastatin, and the asthma drug salmeterol. Four years later, all but one of these drugs (valdecoxib) are still on the market, although black-box warnings were strengthened or added for most and a new safety-oriented distribution system was created for isotretinoin. Few news reports at the time noted that Graham's list was just that — his own personal list of worrisome drugs, not the FDA's or anyone else's. Almost no drug on the market is without risk. Web sites such as Public Citizen's WorstPills.org feature literally hundreds of concerns about dozens of drugs. One could conclude that the news media largely ignores most drug-safety or efficacy issues until, for whatever reason, a new study appears or someone shows up at the U.S. Capitol to talk about such concerns.

But so uncertain and episodic has been past coverage of drug safety and efficacy that much of the news media now feel duty-bound to report on many drug-related findings whether reporters understand them or not. A recent high-profile example was coverage of the Ezetimibe and Simvastatin in Hypercholesterolemia Enhances Atherosclerosis Regression (ENHANCE) trial.4 Although the study in fact raised questions about whether ezetimibe yielded any benefit when added to statin therapy, its findings were almost consistently misreported. Some journalists asserted that it showed the drug had no benefits in preventing heart attacks and strokes — something it certainly did not show, since heart attacks and strokes were not end points in the trial. We will never know the cost of this misinformation in terms of panicked patients or physicians who, perhaps unnecessarily, discontinued use of the drug.