Journalists are not the end game: An interview with Gary Schwitzer
Gary Schwitzer is the founder of HealthNewsReview.org, an indispensable resource for journalists, consumers, and physicians who want to understand the science behind popular news stories. Of course, when you actually look at the science behind the headlines, you’re often disappointed with how thin the empiric backing really is. That’s what makes Mr. Schwitzer’s work so challenging but necessary.
Mr. Schwitzer graciously agreed to talk with me about how the media can improve the health information they present, and what consumers can do to improve their own health knowledge.
Read below for the complete interview.
Q: Could you tell me a little about your background, and how HealthNewsReview came to be?
GS: I started in television news right out of my undergrad education. I was lucky enough to get a job at an NBC station in Milwaukee. Just about a year in, I was tapped on the shoulder… “We’re starting a medical news beat and nobody wants to deal with doctors full time.” I didn’t have any particular interest, and certainly didn’t have any background, but it was advancement, so I had to take advantage of this.
I made the most of it, and here I am 43 years later. (That’s still the way many people get thrown into this beat, and it’s wrong.) I spent about 15 years in TV news, first Milwaukee, then Dallas, then finally at CNN, where I led the medical news unit. I got pretty disgusted and resigned that position.
I then went to work for the Foundation for Informed Medical Decision Making. Throughout the 1990’s, I produced patient-targeted decision-making programs. Then Mayo Clinic hired me to be the Editor-In-Chief of MayoClinic.com. Then University of Minnesota came calling, asking me to help them build a health journalism graduate program.
I was a tenured associate professor in the University of Minnesota School of Journalism, but resigned that in 2010 because I had launched HealthNewsReview, and this was the only way I could devote the attention to it that it required. I have an institutional home in the School of Public Health as an Adjunct Associate Professor.
My first 8 years, HealthNewsReview.org was supported by the Foundation for Informed Medical Decision Making. In 2005, FIMDM asked me for ideas, and I told them about an Australian website called Media Doctor that had started reviewing the quality of healthcare news in Australia. There was nothing like that in this country. I thought there’d be a synergy between FIMDM’s mission to improve decision-making and my interest in improving the public dialogue about health care. When FIMDM funding ended in 2013, I went 19 months without funding. Then, in 2014, the Laura and John Arnold Foundation approached me under their Research Integrity focus and awarded me a two-year grant. It’s important for me to say that I would never allow any funder to influence anything about what we what write.
Q: How does HealthNewsReview help improve medical information in the media?
GS: One of the ways that we try to help people get at this issue is we take a systematic criteria-driven approach to the review of healthcare news.
Some journalists I know have said, “Come on, this is not a journal we’re publishing, this is a news story. We can’t get into all this stuff.” For which I always say, let’s go through some of HealthNewsReview’s criteria and you tell me which of these is unimportant in a healthcare story: make some stab at discussing costs, quantify the scope of potential benefits and harms, you better evaluate the quality of the evidence, and so on.
You’re entitled to disagree with our criteria, but if you disagree, if not our criteria, then what criteria do you use?
Q: As physicians we get a lot of training in evaluating evidence in this manner. What you seem to be talking about is medical research and statistics knowledge. Do journalists have that kind of background? Are they capable of evaluating various types of scientific studies, their risks, and limitations?
GS: Journalists must. My patience runs out very quickly after all these years for organizations that do not expect, endorse, and support the training that would deliver these skills and knowledge to people covering health topics.
If you don’t know what surrogate markers are, if you don’t know the difference between relative and absolute risk, if you don’t know what DCIS is [and why breast cancer screening may pick up more cases of it], if you don’t have background or training to know these important areas of background and nuance, then you have absolutely no right to be on this beat. And your organization is at fault for thrusting you into this situation.
It’s my goal to educate journalists. For 9 straight years I have done a workshop at the Association of Healthcare Journalists annual conference. I will be doing at least four workshops each year.
If journalists don’t pay attention to what we’re trying to offer in our constructive criticism, I know we have a growing direct to consumer audience.
Q: So are you targeting everyday readers or journalists with HealthNewsReview?
GS: You could say we don’t have a primary audience. You could say it’s journalists. I’d like to help influence a few journalists who can then have an impact on others. But if that doesn’t happen, then we will have a direct to consumer message. We hope that our approach is effective enough that the general public will be able to see how to evaluate claims and hone their own critical thinking skills.
Journalists are not the end game; they are only a pathway to improving the public dialogue. If we don’t improve water cooler talk, talk at the dinner table, if we don’t improve this public dialogue, then I don’t think we stand much chance at meaningful healthcare reform.
Q: Do you think the media are just listening to who they consider an authority and not analyzing it themselves?
GS: First of all, we’re fortunate that as many of the network TV physician-journalists have turned out to do as good a job as they have. I don’t know how much physician authority enters into the decision of who is selected as TV physician-journalists — or how much good looks, “media training,” and living in Manhattan close to network studios has to do with it. And I often wonder whether any were given training in basic journalistic principles and ethics. I often don’t hold the physician accountable as much as the media organization accountable for just assuming that “Well, this is a charismatic, passionate individual in a white coat, and they use words that we don’t understand, so let’s put them on the air.” But are they told anything about how to avoid conflicts of interest, about independently vetting evidence, about weighing evidence and not offering opinions, about not becoming part of the story when they’re reporting in disaster areas, about reporting on problems in health care as much as on supposedly-promising new ideas in health care, etc.?
Q: How should journalists question and verify the information physicians are delivering in the media?
GS: I’d look for the kind of physician who can lead with their journalism chops and not what medical school they graduated from or how they look. [Certain physicians] put their pants on in the morning and they’re thinking like a journalist. That means not viewing this as a doc-in-the-box medical advice column, but rather thinking about it as a journalism career. This requires independent vetting of evidence and claims for this tsunami of stories that washes over the American public every day.
I think there are a lot of really smart, really hard-working physicians who have made this transition. But I think it would be better if when physicians are hired, they would be given a crash course in basic journalism ethics and methods.
Q: What about this dual mandate that the modern media seems to have to be both informative and entertaining?
GS: On healthcare news topics, there is a huge disconnect. What we have is a huge audience that is thirsty for just a little sip of accurate, balanced, complete information to help them navigate this healthcare system. And they often don’t get it. They don’t get it because we waste our time reporting, as we did last week, on a single case study of a woman reporting problems from wearing tight jeans.
We report on every finding from every journal and increasingly from more and more obscure journals, as if each one of them meant it was Moses coming down from the mountain top with stone tablets. You can actually distort the public’s thinking into expecting more and more of this stuff every day without actually delivering the news that people in their hearts and minds know they really need.
I do hold the bar high. If we are going to have so many physician-journalists, the one thing they could really bring is that knowledge and expertise about what the real rubber-meets-the-road issues are in delivering healthcare in America. And yet those are the kinds of stories we often cannot get, because, instead, we get fawning stories about new, unproven interventions.
Q: Have news organizations responded to you directly? Are they upset at the criticism?
GS: Whenever we publish a systematic review, we write to the reporter and send them a link to the review. I can count on one hand how many strong, defensive reactions that we have received. It’s clearly outnumbered by the number of journalists who have written to say that “This is great. I get your points. Please keep it up.”
Q: It interests me that journalists are so appreciative. You can be highly critical of articles (though not in a personal way). I wonder if maybe these journalists feel pressured by their organizations, and maybe the journalists feel limited and want to do better?
GS: I’ve had a number of journalists thank us. They say they’ve printed out our reviews and brought it to their editor and said “I told you that you shouldn’t have cut that paragraph. We got criticized for this.”
Of those who are defensive, a number have said, “You’re in your ivory tower, you have no idea what it’s like in news rooms today.” To which I say, you have no idea how much I know about the current environment. I talk with journalists all the time. I do workshops with journalists. I am sensitive and I hold your organization responsible, not the individual journalists.
For example, there were tough times for auto makers a few years ago, but that didn’t mean that consumers should expect that they drive off the show room floor and their rear axle would fall off. Businesses have to deliver a product that people need. And news organizations on this topic are often not delivering a product that consumers want and need.
Q: Besides your website, where should regular consumers go to get good health information that they can understand?
GS: This is always the hardest question for me. I will always have fond memories of what the Wall Street Journal did. After the twin towers disaster, many businesses took a hard hit in that post-9/11 economy, and in the midst of that, the WSJ expanded their health and science staff. And I think it shows a lot of days in their coverage. I think NPR is often smart and creative at addressing complex topics. I actually think that John Stewart and Stephen Colbert many times had some of the most insightful segments on healthcare topics. The Associated Press has really grown and matured on this beat in the last decade. They’re reporting on fewer studies, and it’s because they’ve got smart people who realize that this isn’t helpful to the public. They’re more discerning, which is good. MedPage Today, although it is primarily targeted at a physician audience, does a great job reporting on health care news in a way that I think many consumers would understand and appreciate. I’d be remiss to not say anything about the really smart bloggers who do work that is as good or better as the top news organizations.