Journalists and the media regularly cop a bagging for how we cover health. We exaggerate the benefits of medicines and other interventions, focus narrowly on health as a function of genetics or behaviour, spread fear, and fail to disclose the commercial interests of our sources.
If you’re interested in more details of our failings, I’m happy to supply a list of references as long as your arm. Or you can keep an eye on the HealthNewsReview blog, run by University of Minnesota journalism academic Gary Schwitzer.
Interestingly, the very publications that publish so much of the critique of health journalism — medical journals — are coming under fire for their own contributions to journalism that misleads and misinforms.
The Lancet recently issued a mea culpa of sorts for publishing now discredited research by Andrew Wakefield which triggered widespread alarm about the vaccine for measles, mumps and rubella.
But this is really just a pimple compared with much bigger problems in medical publishing. As Adelaide psychiatrist Dr Peter Parry wrote yesterday, medical journals have often come to resemble one of the many arms of pharma marketing. They have, as a senior editor once said, become “information laundering operations for the pharmaceutical industry”.
Medical journals have also been criticised for failing to ensure that researchers report their results accurately and appropriately, and for how they promote themselves and the research they publish.
Two researchers who have been at the forefront of scrutinising how medical journals and other medical institutions shape media coverage are doctors Steven Woloshin and Lisa Schwartz from the Centre for Medicine and the Media at the Dartmouth Institute for Health Policy and Clinical Practice in New Hampshire.
In one study, they analysed press releases issued by several of the world’s leading medical journals and found many deficiencies, including that they often failed to mention the limitations of studies, and the conflicts of interests of researchers or editorialists. “We think that journals can and should do more to enhance the quality of medical reporting,” they concluded.
Following the recent fracas about the media’s misreporting of a study on homebirths, I asked them to assess the press release and editorial that accompanied the study’s publication in the Medical Journal of Australia. Their response, posted in full at Crikey‘s medical blog Croakey, is critical of both the release and editorial.
I also asked Schwitzer to comment. You can read his lengthy critique at Croakey but the short version is that he thought the press release was “awful”.
After I raised similar concerns in Crikey earlier this year, both the journal’s editor, Dr Martin Van Der Weyden and the AMA president, Dr Andrew Pesce, strongly defended the release and journal processes.
The editor seemed to suggest that journalists were the only ones with anything to learn from this case. It now seems, however, that there are others who see some lessons for journals themselves.
These are not only issues for the MJA, of course, but apply more broadly to all serious journals (as distinct from those set up by pharma as promotional vehicles). Then again, the MJA does have a particular responsibility as it regularly generates a whack of media coverage.
If journals cannot get their own houses in order, then it seems not only unfair but also unrealistic to expect journalists and the general media to lift our standards of health reporting.
At least the BMJ was this week prepared to publish an article from me on the MJA and the homebirth study, raising questions that might have been a tad too close to home for comfort.
The issue of medical research being biased due to pharmaceutical companies’ financial interests is a big one but an underreported one.
The book “The Anti-Depressant Fact Book” by Peter Breggin is a great summary of the lies and propaganda for just one class of medications.
Breggin had unprecedented access to pharmaceutical research as he was expert psychiatrist in a number of trials where pharma companies were sued because of the damage their drugs caused. The book is an eye-opener and raises questions about our whole system of medicine.
Melissa- any chance you could give us a breakdown of costs for homebirth and private hospital, obstetrician supported births.
Could this include fees per ante- natal visit and fees per delivery ( attended and toolate).
This would help us understand what and where the vested interests lie in the home birth debate.
Hi Pamela, sorry I don’t have that sort of information to hand but perhaps other Crikey readers might?….
As a simple bean counter, without delving into the details of the statistical analysis, it would appear that homebirth is a more risky activity than having a birth in hospital. If medical spin doctors exaggerate the risks for commercial advantage this is to be regretted.
However while homebirth advocates are indulging themselves with homebirth, who is looking after the interests of the unborn child? As some of the consequential but avoidable birth abnormalities require community support for the whole of the child’s lifetime, the issue is broader than “the woman’s right to decide”. A woman placing her own body at risk under such circumstances is no different from a scuba diver or downhill skier taking personal risks, but the unborn child has nobody as an advocate.
It is therefore vitally important that mothers undertaking homebirth acknowledge the higher risks and indemnify the community, including emergency health care providers, concerning the avoidable consequences of their self focused action, by being required to formally acknowledge retention of responsibility for this increase risk exposure for both themselves and their unborn child.
Hi Pamela
It was reported last September that the highest earning 10 per cent of obstetricians now earn $1.8 million a year – $1.1 million of which comes from Medicare.
Currently when a woman employs a private midwife to birth at home she pays for all the cost out of her own pocket. There is no Medicare funding for homebirth currently. The average fee is $3000-$5000 which includes all her antenatal visits and the midwife attending her during the labour and birth and postnatal visits for up to 6 weeks. Private obstetricians charge up to $8000.
A midwife might be able to tell you the average hours she spends with a client for that amount but from personal experience I can assure you it is many many times more than an obstetrician would ever spend with one of his clients.
Here is a report into the costs of obstetric services from the Menzies Health Policy Institute
http://www.menzieshealthpolicy.edu.au/other_tops/pdfs_hpa/increasingcost.pdf
Hi Greg
Can you please point out the source of your fairly sensational claims that homebirths cause “avoidable birth abnormalities that require community support for the whole of the child’s lifetime?”
More than 40% of Australian women now have an operative birth which includes caesareans and instrumental deliveries (forceps/vacuum extraction) – these carry high risks to the baby and the mother and can be very traumatic for both.
Caesarean births impact a woman for the rest of her reproductive live and put her (and her future babies) at a higher risk of a number of serious complications caused by the previous caesarean. They also cost the Government and the tax payers thousands of dollars more for each birth.
What these figures show is that the obstetric model is broken.
Let’s please focus more on the thousands of babies dying during childbirth in the hospital system being cared for under the obstetric model instead of comparing homebirthing mothers to scuba divers.