Background

The news media have a crucial role in supporting health literacy, and multiple surveys have shown the extent to which the public relies on them for information about medical advances [1],[2]. However, the mainstream media are undergoing rapid and unprecedented change, with a shift from the traditional outlets (broadsheet newspapers and flagship current affairs programs) to online news services and blogs that are available free of charge. These online sources, and the more recent Web 2.0 activities (e.g., FaceBook and Twitter), still rely on the quality of the news coverage by the traditional media, which they frequently cite as information sources [3].

A number of recent studies have pointed to the poor and variable quality of many health stories in the mainstream media, particularly those covering new drugs and procedures [4],[5]. Some outlets are capable of producing excellent stories, but common flaws across all media include lack of attention to the quality of the research evidence, exaggerated estimates of benefits, inadequate coverage of potential harm, no information on the costs of new treatments and a failure to identify unbiased expert sources. Studies have revealed such deficiencies in Australia, Canada and the United States, with little evidence of improvement in reporting over the last five years [4]–[7]. The reasons for poor-quality journalism are complex, and include lack of specialised knowledge, time pressures on journalists, space limitations, the difficulty of accessing expert unbiased informants, and the desire of researchers, their institutions, and (sometimes) journals to exaggerate the significance of the research [8]–[11].

But what impact will the current financial pressures on the traditional media have on the already variable quality of medical news reporting? Should a newspaper editor faced with falling sales and advertising revenue retain the services of a specialised but more expensive medical journalist, who can interpret new scientific data and place it in a local context? Or will a non-specialist journalist do the job as well? Can medical news content be reliably imported from overseas media, or from news organisations such as Associated Press and Reuters? Here, we examine the question “does it matter who writes the stories?”

Monitoring the Quality of Medical News Stories

In recent years, sites that monitor the completeness and accuracy of medical news reporting have been established in Australia (http://www.mediadoctor.org.au), Canada (http://www.mediadoctor.ca), Hong Kong (http://www.mediadoctor.hk), and the US (http://www.healthnewsreview.org). To address the question posed in this Policy Forum, we accessed and analysed data from the Media Doctor Australia site. This site posts reviews of health news stories published in the Australian commercial and publicly funded media, including newspapers, online news, television, and radio broadcast transcripts [5],[6],[12]. The focus is on stories that make therapeutic claims about new treatments and procedures, including diagnostic tests. News stories are not limited to local content, and include “wire” stories from major news organizations and stories from overseas media outlets that are carried by Australian media. The stories are identified from regular searches of a wide range of online news Web sites, along with media releases, journal articles, and other material relevant to the stories. Two raters independently score each news story according to ten criteria (See Box 1 for a description of rating criteria and Media Doctor Australia methods).

Categorising the Authorship of Health News Reports

There has been little empirical research on the relationship between the authorship of articles and the content and quality of the stories. Anecdotally, specialist health journalists can provide lucid and succinct summaries of complex research, which can inform both the public and the researcher community. In operating the media monitoring sites, we have avoided naming specific journalists, preferring to concentrate on reporting the performance of the media outlets. We examined the provenance of 1,337 medical news stories published by the Australian mainstream media between 2004 and 2009, and subsequently rated by Media Doctor Australia. Although journalists are not named on the Web site, author information is recorded in a password-protected area of the Media Doctor database. Based on the “bylines” (who wrote the story) we placed the authors into six categories (Box 2).

Relationship between Categories of Journalists, Media Outlets, and the Quality of the Stories

The key issue was whether the more experienced specialist health journalists wrote stories of higher quality than journalists in the other categories. In making this judgement we were aware that the media outlet where the journalist worked was a potential confounder; even the best health journalist can have a story ruined by inappropriate editing or production. The 1,337 stories were published by 12 Australian media outlets between February 2004 and March 2009 (Table 1). Three hundred twenty stories had no byline. Of the remainder, 193 were written by 143 nonspecialist journalists; 415 came from four news organizations (Australian Associated Press [AAP], Associated Press [AP], Agence France Presse [AFP], and Reuters) and 39 came from 12 foreign media outlets (including ABC, BBC, Boston Globe, Guardian, The New York Times, The Telegraph UK, The Times, Los Angeles Times, Washington Post); 142 stories were written by 65 health/science journalists, and 228 stories were written by eight specialist health journalists, all based in Australia.

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Table 1. Average unadjusted scores for medical news stories written by different categories of journalists and sourced from different news organisations.

https://doi.org/10.1371/journal.pmed.1000323.t001

The media outlets that published these stories are summarised in Table 1, which also presents the mean scores by media outlet and journalist category. The mean scores were highest for the broadsheet newspapers and lowest for the human interest current affairs programs. The difference between the average scores of the highest and lowest performing media outlets was 26.1% (95% CI 19.9%, 32.2%). The variation in unadjusted scores between the highest and lowest performing categories of journalists was less—a range of 15.5% (95% CI 11.2%, 19.8%) (Table 2). To deal with potential confounding by media outlet, we adjusted the analyses that compared average scores by categories of journalists, and these are given in Table 2. Using stories published without a byline as the reference category, those with significantly higher average scores were from news organizations, science/health journalists and specialist health journalists; the latter scored highest.

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Table 2. Comparisons of Media Doctor scores for stories written by different categories of journalists.

https://doi.org/10.1371/journal.pmed.1000323.t002

Of the large news organizations examined, the company with the highest average scores was AP (Table 3). Differences between AP and other news organizations ranged from 7% to 15%, but after adjustment for multiple comparisons the only statistically significant difference was that between AP and AFP, 15.3% (95% CI 2.9% to 27.7%).

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Table 3. Comparisons of Media Doctor scores for stories sourced from different news organisations.

https://doi.org/10.1371/journal.pmed.1000323.t003

How Should We Interpret These Results?

It does matter who writes news stories that cover the benefits and harms of health care interventions. Stories written by specialist health journalists were superior to those written by other groups. These data illustrate what can be achieved in terms of high-quality health news reporting, but this ideal is seldom reached. The analyses also underscore the importance of which outlets journalists work for. Traditional broadsheet newspapers scored highest and commercial human interest programs consistently returned the poorest scores. We presume that these differences reflect not only the professional skills of journalists, but also editorial policies, which dictate the target audience, the writing style (favouring human interest over evidence), the length of the article, and the extent to which it serves particular sectoral interests (e.g., a patient support group or identifiable victims of a disease). These findings are not surprising, but some of the differences were large and likely to translate into flawed information for consumers, with an adverse effect on health literacy.

These findings are also significant because financial pressures in the industry threaten the jobs of experienced health journalists and the future of broadsheet newspapers. The internet has become a formidable rival to the more traditional forms of news [13]. Newspaper circulation has fallen and some experts envisage their end within a decade [14]. While this is speculation, there is no doubt that the traditional media are in a state of flux and there is pressure to economise. One outcome has been the downsizing of newsrooms across the world. An easy option for a pressured editor is to purchase health stories from foreign media outlets or news organisations. But the data presented here suggest that s/he should choose carefully. AP achieved fairly high and consistent ratings, whereas AFP had significantly lower average scores.

What Are the Policy Implications of These Results?

Obvious suggestions to improve health reporting include better training of all journalists about evidence-based medicine during their undergraduate education. Major outlets could invest in more specialist health journalists and rely on fewer imported health stories. However, each of these suggestions comes at a cost, which may be substantial and unsustainable for the foreseeable future.

Another solution is to demand more responsibility from researchers and their institutions when interacting with the media. Research funding bodies usually require grant applicants to describe how they will disseminate their findings. They should ensure that information given to the media through press releases and comments is accurate and balanced. This role properly lies with the principal investigators, but funding bodies, research institutions, universities, those responsible for media promotion, and journals publishing the work share the responsibility to make more balanced claims about the findings, their importance and implications. The intention has to be promotion of the findings of good science, not self-promotion by researchers, sponsors, institutions, or journals, which all stand to benefit from media coverage. The public deserves to be well-informed about the research it funds. While we may not be able to directly influence which journalist writes health stories, researchers can make it easier for less-experienced journalists to do a good job. Better collaboration of researchers and health professionals with journalists and news outlets is an important step towards more objective communication.