What the heck, you may be asking, do journalists have to do with the soaring costs of pharmaceuticals or a $100 million device called the “particle accelerator” that uses protons to bombard cancerous tumors? Journalists, after all, don’t create those products or determine their price tag. We do, though, indirectly help market them by the kinds of stories we write, which can stimulate demand. Stories touting the benefits of the latest gee-whiz drug, coupled with ads by the drug maker, are powerful stuff. Consider the stats that show 82 percent of people who talk to their doctors about a drug after seeing an ad for it get a prescription.
When the public demands these “wonder drugs,” or the cutting edge diagnostic and treatment technology, someone has to pay for it—and that contributes to the nation’s $2 trillion annual health care bill. The Congressional Budget Office estimates that about half of the increase in health-care spending during the past several decades has been due to technological advances which include new drugs, devices, and services. Trouble is, not all of the technology works, and there may be little or no evidence that some of the drugs and devices so widely hyped do what the hype promises, or work better than what already exists. But that hasn’t stopped us from reporting on them without appropriate skepticism and context.
The HealthNewsReview.org project, run out of the University of Minnesota by journalism professor Gary Schwitzer, is in the business of evaluating the kinds of stories journalists are telling about these new health-care offerings. At best, those stories are incomplete; at worst, they mislead the public and help push up the nation’s health-care tab. In a study just reported in the online peer-reviewed journal PLoS Medicine, Schwitzer and his colleagues examined 500 news stories about tests, new treatments, products, and procedures published by the top fifty (by circulation) U.S. newspapers, the wire services, the three leading news magazines, and aired by the three most-watched TV networks—ABC, NBC, and CBS.
Investigators rated the stories on such criteria as whether they reviewed the strength of the evidence, whether costs were adequately discussed, whether potential harms explained and quantified, and whether the new technology was compared with existing alternatives that may be cheaper and work as well. Over a twenty-two-month period, some two-thirds of those stories failed to adequately discuss costs, harms, benefits, or the quality of the evidence and other options. We at CJR have also raised that question and concluded that the media are falling way short.
Schwitzer’s project is particularly relevant in light of the presidential campaign. Its substantial database of stories, illustrating the need for better information about the pros and cons of such medical interventions, offers a fresh opening for reporters to dig into a larger issue that has barely emerged so far in the campaign: Should there be an independent agency established by the government to review the evidence for new medical technology and judge whether it is worth the money being spent on it? In other words, should there be an agency that makes sure we get our money’s worth?
And should such an agency help inform the public, something the media haven’t done very well? With all the talk about medical care consuming 16 percent of GDP, you’d think it would be a no-brainer, both in terms of candidate interest and media investigation.
Barack Obama’s health-care boilerplate says that he supports an “independent institute to guide comparative effectiveness reviews,” but he hasn’t said much, if anything, about it on the campaign trail. McCain’s Web site is silent on the matter. There’s a model for such an agency, the UK’s National Institute for Health and Clinical Excellence, or NICE, which reviews the evidence for drugs that Britain’s National Health Service will pay for. It systematically looks at the cost/benefit equation—something the U.S. doesn’t do. And yes, it does step on toes when it determines that a company that’s eager to market a drug has produced weak evidence to support that drug. And sometimes, NICE says no to patients who want a drug of dubious value.
Earlier this year, at a meeting of the Association of Health Care Journalists in London, Andrew Dillon, the head of NICE, explained how the agency works. An American journalist asked if Dillon had heard from the U.S. presidential candidates. He had not. The candidates may not be calling, but journalists certainly should.
Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.