Journalists as change agents in medicine and health care.

PHYSICIANS AND SCIENTISTS HAVE CRITICIZED JOURNALISTS FOR misleading the public about important medical issues. For example, a 1997 survey of scientists found that the majority of them believed that reporters do not understand statistics well enough to explain new scientific findings, do not understand the nature of science and technology, and are more interested in sensationalism than in scientific truth. These concerns may have been bolstered by misleading reports in the popular press. For instance, sensationalized reports on the hazards of calcium channel blockers may have led some patients to stop taking their prescribed antihypertensive medications, while optimistic coverage of rodent experiments in the field of antiangiogenesis resulted in patients with cancer requesting this unproven treatment from their oncologists. Although the reporters failed in these cases to accurately explain scientific information, not medic reports are as careless. Responsible reporting by journalists can illuminate important issues for the general public that might have otherwise remained obscured in the scientific arena. In some cases, investigative reporters have exposed aspects of medicine and medical science that prompted legislative and policy changes in the health care system. For example, a New York Times probe of fraudulent practices at the Columbia/HCA Healthcare Corp chain of hospitals in March 1997 led to a federal criminal investigation of the company. A Los Angeles Times series on the US Food and Drug Administration’s system of drug approval in 2000 strengthened the claims of those advocating tighter controls at the agency. Extensive coverage by the Washington Post and others of the death of a young patient in a universitybased gene therapy experiment resulted in stronger federal protections for patients enrolled in clinical trials. A Boston Globe series on the hazards of placebo-controlled trials in psychiatry was one of several journalistic investigations that resulted in changes in the way psychiatric patients are enrolled in research protocols. Investigative reporters often rely heavily on anonymous sources who might jeopardize their careers for leaking damning information. These “whistleblowers” also risk being sued once they trust a journalist with sensitive information about their organizations. Journalists can risk exposing their confidential sources when they attempt to substantiate claims by speaking with people who oppose or disagree with the whistleblower. Reporters tread a fine line as they attempt to corroborate information from a whistleblower and try to unearth various aspects of complex issues without exposing their sources. Depending on the situation, reporters can go to great lengths to protect their sources, while others may aggressively pursue stories, even if their sources would prefer not to have their comments exposed. For example, Ralph T. King, a former biotechnology reporter for the Wall Street Journal, interviewed a pharmacist who had been pressured by a drug company not to publish her findings about one of the company’s products. She feared legal action against her if she were quoted in a newspaper. In his lengthy page–one story, King described in detail what the company had done and barely quoted the pharmacist to protect her identity. On the other hand, reporters are not obligated to grant sources the right to not be quoted on public record, especially if these sources say things to a reporter without first clarifying that what they say will be considered “off the record.” An episode of the news magazine 60 Minutes provides a recent example of a reporter who broadcasted comments made by a source, who subsequently claimed that what he said should have been off the record in the show. In this episode, the executive of a Canadian drug company made derogatory comments about a scientist during the interview with CBS reporter Lesley Stahl. To the apparent surprise of the executive, Stahl asked him about it on the air. He replied, “I said to you I’ll say certain things to you off the record. I might well say things in a private conversation off the record . . .” “We’re reporters, we’re not your pals,” Stahl responded. Reporters and those in the health care industry may never be “pals.” However, the mass media play an important role by engaging in public service journalism that uncovers problems in medicine and medical science.