I was recently invited by Yale Law School's Global Health Justice Program to talk about medicine and the media. I wanted to share the text here.
My focus was on why being a health journalist is an especially effective way to lose friends and alienate people. (It's really an excuse to talk about some of the questions and themes in health journalism that I think a lot about.)
1) Health journalists thrive on the misery of others
Most of the time, we’re covering non-urgent health issues: obesity, nutrition, diabetes. These are chronic, and relatively boring, killers. It can be hard to compete for resources in the newsroom with the ISISes and Donald Trumps of the world.
Then an outbreak happens, and everything changes.
Well, not just an outbreak necessarily, but especially a scary virus that seems to be inching closer to home.
We saw this with Ebola. I had been writing about the outbreak in West Africa for months in the summer of 2014. Interest from my editors and readers seemed to wax and wane.
Then in the fall, a Liberian national named Thomas Duncan showed up in Dallas to visit his family, and he was soon diagnosed with the terrible virus.
His arrival coincided with full-scale panic in America. A media frenzy.
You’ll recall journalists chasing around Ebola health workers as if they were in an OJ Simpson police chase. This media frenzy was fueled by politicians who used Ebola to tap into people's fears and xenophobia, promising to seal up borders to keep the virus away.
As a health reporter, you could feed into the hysteria or try to calm people down. At Vox, we chose the latter.
We tried to remind people of the sad truth that Ebola thrived in broken or weakened health systems, like the ones of Guinea and Liberia and Sierra Leone, and that it was unlikely to spread very far here.
That it was also very unlikely for the virus to change how it’s transmitted and suddenly go airborne.
We tried to remind people that Ebola was actually difficult to catch and that the calls for travel bans and quarantines of health workers would be counterproductive, according to the best available evidence.
We used the outbreak to talk about the challenges of global health governance and the lack of a coordinated approach to prepare for pandemics.
The Ebola outbreak was emblematic of some of the challenges of the health beat: getting people to care about an important global health problem before it shows up on their doorsteps, and doing so without fanning the flames of fear.
2) I took on my mother’s hero
Around the time I started as a health reporter, in 2011, my mom would call me on what seemed like a weekly basis with insights from The Dr. Oz Show.
Did I get my thyroid checked? Would I consider taking omega-3 supplements or probiotics as Oz prescribed?
At the same time, I was talking to a lot of doctors for work, and kept hearing that they had to spend so much time in clinics debunking things Oz said or sorting through dozens of supplements patients were using because of Oz.
And so I looked at the evidence behind Oz’s claims, and I found that often the evidence contradicted him, or what he said wasn’t rooted in research at all.
I started to write about this. Oz was a very interesting figure because he was someone who should know better — a cardiothoracic surgeon.
Writing about his health claims, and their lack of evidence, was a good way to talk about the gap between reporting and research, to tell readers about what counts as medical evidence and what doesn’t, and why they should be skeptical of the health claims of celebrities — even celebrity doctors.
For better or worse, I have found celebrities are a great vehicle for public health education.
There’s some new research out this week in JAMA Internal Medicine about Charlie Sheen’s recent announcement that he is HIV-positive.
The researchers found that Sheen’s disclosure "corresponded with the greatest number of HIV-related Google searches ever recorded in the United States."
People weren’t just searching for gossip about the actor. They were searching for information about getting tested, about how to prevent HIV, and about condoms.
The researchers are calling Sheen’s announcement the "most significant domestic HIV prevention event in the last decade."
I’d call this a reminder of the strange opportunities celebrities, even celebrity doctors, present to educate the public about health.
3) I’ve nearly lost friends over arguments about alternative medicine
When I started reporting on health and looking into the evidence for popular dietary supplements, I was blown away.
It was stunning to me that consumers had absolutely no way of knowing if the supplements they take every day are safe and effective, and no way of knowing what’s in them, mostly because of very lax regulation that has persisted here.
I found the same sketchy evidence underpinned the amazing claims that come with reiki, detox therapies, homeopathy. … The most exhaustive review of the evidence for homeopathy from the Australian government found that the treatment doesn't work, period. The authors suggested people should stop wasting their time, their money, and potentially their health on what amounts to junk science.
When I’d tell these things to friends and family, my insights weren’t welcomed by all.
I quickly learned that alternative medicine, for many, is more a religion than a science. "Enlightening" people about the lack of evidence can actually be deeply offensive.
This caused me to think more about the role of debunking in changing people's minds, and how it can sometimes be counterproductive. Compassion seems to go a long way, though it doesn't necessarily change minds.
Incidentally, these tensions arise around vaccine coverage. Despite all the good science here, some very intelligent people are hesitant to give their children shots. As I've written, being afraid to subject a healthy baby to dozens of needles isn't necessarily irrational. It's more challenging to write about this sentiment in a nuanced way than to simply paint all anti-vaxxers as child abusers.
I still haven’t found a solution, though I do think more about how to reach people who are skeptical of science instead of always preaching to the converted. I also think about how to not only hold the peddlers of pseudoscience accountable, but also to go after the people who enable and support them.
4) I’m often giving people mundane evidence when all they want is magical cures and quick fixes
This is especially true when it comes to reporting on weight loss.
Almost every article I’ve written about a new fad diet or exercise trend comes to the same boring conclusion: This new gimmick — Bulletproof Coffee, a gluten-free diet, green coffee bean supplements — is not the quick fix for weight loss the peddlers of said fad are promising.
You won’t lose weight or dramatically change your body in the long term, but you’ll definitely thin out your pocketbook.
The conclusion of these articles is usually some version of the following: There are actually only a few things we know for sure will keep us healthy.
Eat a healthy, balanced diet.
Don’t drink too much alcohol.
Get a good amount of sleep.
I’ll also add, have a stable job and income, a good education, and strong relationships.
This is not as sexy or fun as promising magic and quick fixes. It’s definitely not what many people want to hear. But I’ll keep saying it … until someone finds the elusive holy grail of weight loss that I can share with our audience.
5) I'm a bit of a hypochondriac
I imagine health reporting must be like being in that phase of medical school where you think you have every disease you’re studying. But instead, as a health reporter, you deal with this your entire career.
Looking at medical oddities, outbreaks, and diseases every day makes you think a lot about how you want to avoid them and ensure your loved ones do too.
When you report on health every day, you become more sensitive to all the pathogens we know as well as those we don’t know about.
You see how easily health systems fail people, how much you want to avoid being sick as long as you can, and that you definitely want to stay out of hospitals, where it’s a miracle more things don’t go wrong.
Yet most of the time, we’re defenseless. We try our best to prevent illness, and there’s little you can do for that besides those boring things like washing your hands and eating fruits and vegetables.
In my time on the health beat, I think I have actually developed an allergy to medical hype.
So far, I've found breakthroughs have been the exceptions, not the rule.
Our language doesn’t always reflect that. A group of researchers in the Netherlands recently tried to quantify hype in scientific papers in the PubMed database.
They looked at how often adjectives like "unprecedented" and "amazing" were used in papers published between 1974 and 2014.
They found a ninefold increase in frequency during that period.
Of course, journalists like superlatives too. Researchers have looked at how often we use words like "game changer," "miracle," and "cure" to describe cancer drugs.
They found this practice was common — even for drugs that had never been tested in humans.
This means journalists were calling a drug a "miracle" or "cure" when it had only been tested on mice or cell cultures.
When I've asked reporters and researchers why they do this, they essentially say they're giving people what they want.
In the case of researchers, they're under enormous pressure to compete for a limited pool of funding, and inserting words like "breakthrough" that signal the research is something special seems to help.
Colleagues in the media have told me that if they just gave people meat-and-potatoes evidence all the time, they wouldn't be as popular. They wouldn't be able to sell their shows or books.
I think the danger here is that we mislead the public about how science works, how long and difficult the road to a cure can be. By emphasizing magic pills and miracle treatments, we also lose focus on the more mundane things that actually matter to health — like education, equality, and the environment.
We send people down unhelpful and potentially harmful paths that will only disappoint. That can have wide-reaching repercussions for waste in health and policy.
6) I'll keep alienating people
I have to admit something: Even if I’ve alienated friends and offended my mother, I wouldn’t have it any other way. I’d argue for evidence-based thinking over magical thinking every day, even when it’s unpopular.
Because we are living in an age of unprecedented scientific exploration.
There are now more randomized trials and systematic reviews published every day than there ever were, and the opportunities to benefit from this knowledge are greater than ever.
I think the media has an important role to play in making sense of science, sorting through it to help guide readers closer to science-based decisions and policies and away from magical beliefs.
I think we journalists have a duty to not just chase the newest embargoed study and report it out of context, and not to parrot the health claims of politicians or celebrities.
Instead, we should strive to translate the best knowledge into ways that can help people make decisions about their personal health and policy choices. To make that knowledge relevant and interesting to people.
We’re trying to do this in a small way at Vox. Unlike traditional media outlets, as a digital-only product we have endless space to explain science to people, to contextualize research.
Health pages aren’t squeezed between sports and entertainment sections. And we don’t need to hit artificial print deadlines every day.
There’s no pressure to make news out of a new study that doesn’t actually reflect the totality of research.
We’re trying to solve the problem of the single-study headlines you’re probably all familiar with. You know the flip-flopping I mean: Red wine is good for you one day; it’ll kill you the next. Same for vitamin D, chocolate, red meat…
We’ve launched a series to counteract that called Show Me the Evidence. These features tell the story of all the research on a given health question, where the disagreements and areas of consensus among scientists are, and what the big unknowns or limitations in the research look like.
Take e-cigarettes. We described all the research there and found some important limitations —for example, there are no published long-term studies of the health effects of vaping to date. We have no idea what vapor and the chemicals in e-cigs will do to the lungs or other parts of the body in the long term.
These tales of research would probably never have been published in newspapers — but they’re great for online audiences who want answers to big health questions in one concise place. We can translate these stories of research into videos, Snapchat editions, and other media to reach different audiences.
This is just one way digital journalism represents a golden era for health and science reporters.
It’s so much easier to write about science in the digital space in a way that reflects the scientific process than it was when print was our only option.
So I’ll keep doing it — even if it causes me to lose friends and alienate people.