Tuesday, May 19, 2009

Who Pays for Global Health News and Why?

To maintain credibility, news coverage of global health and development issues must be independent because who pays and why dramatically influences the process of what gets told. This is a sleeper issue that does not get enough attention. As a health journalist, I know we have been down this road before—with respect to misleading consumer news coverage of medications and research studies—and it’s not pretty. In the end, it actually hurts people and wastes money.

It hit me last night why I am so passionate about this topic. I went to a presentation about how to improve health care news coverage in the U.S., which was mostly about how many health news reports don’t cover basic issues like costs, availability or provide even a hint of context about whether something is truly broadly beneficial. The event was sponsored by the New York City chapter of the Association of Health Care Journalists, of which I am a member.

One of the presenters, Gary Schwitzer, a former CNN journalist and current journalism professor who founded HealthNewsReview.org, jokingly suggested that I might throw spitballs at him while he was at the podium. (The other presenter was Harry DeMonaco, who helps Boston's Massachusetts General Hospital decide what treatments are both beneficial and cost-effective.) Instead, Schwitzer provided me with an aha! moment.

For more than 20 years, I have worked in an environment where pharmaceutical and medical device companies have a huge vested interested in getting their products covered by the mainstream media in the best possible light.

As Gary Schwitzer and Harry DeMonaco noted, the economic incentives are so great that the influence extends even to what appears in medical journals. Drugs are often compared against placebo instead of current effective treatments, for example, because the results are more dramatic that way. No one can take a chance on a new medication being scientifically shown to be just as good or only marginally better than a less-expensive one.

Add to that human nature—it is very hard to be objective about something to which you have dedicated lots of your time and energy. So naturally, someone who is a principal investigator on a study is going to be enthusiastic about the work and its potential for alleviating human suffering.

I know that—as do many of my colleagues in the health journalism field. And I hope that I have taken account of those sorts of positive psychological and economic biases in my reporting by looking for more outsides sources, bringing a respectful-but-still skeptical attitude to most research studies.

Just as importantly, I benefited from the structural divide that was set up within TIME Magazine that kept the advertising side separate from the editorial side precisely so that I could be as independent as possible in doing my job.

So here I am, trying to get more news coverage—both online and offline—of important issues in global health and development and I find the same built-in biases that make health-reporting trickier than you might at first think.

There is a built-in bias in almost any story about non-government organizations against considering what governments are doing in health. Every story about a specific disease has a built-in bias against discussing primary care systems or the non-medical interventions (like better schools or roads or robust legal and civil rights for women) that could conceivably have an even greater impact.

The consequences are very real. To give just one example, I will never again be able to read another laudatory story about the “generous donation of medical supplies” without thinking about the amount of donated material that I saw in Malawi last year that had either passed its expiration date or was actually useless—and needed to be discarded, all at the expense of the receiver. This is the sort of problem that missionaries 50 years ago dubbed “junk for Jesus.” It makes the folks back home feel virtuous but it is a burden for the supposed beneficiaries.

Given the costs and the way things are going these days in journalism, there is bound to be money coming from interested parties whether in the form of grants, advertising or even accepting a ride in an aid convoy, to cover global health issues. That’s all the more reason to set up rigorous firewalls so that funders and advocacy groups don’t get editorial approval over the final product. News organizations also need to make those policies public so that the larger community can judge for itself how well they are doing.

Budding global health news organizations—or content providers—also need to be more creative about who they tap as funders/advertisers. Maybe recruit the folks who like to fund transparency projects, for example, instead of going after global health or single-issue advocacy money.

There may also be ways of crowd-funding global health news coverage that we haven’t explored.

But I know we need to be paying as much attention to managing these conflicts within the coverage of global health news as we are to “monetizing content,” to use the current buzz-phrase. And it's just as much an issue for citizen journalists/participatory media as for legacy or professional journalists.

Related posts (updated on May 20,2009)
Click #ghnews label for other posts on covering global health
See also "Pro-Publica and Conflicts of Interest"
Read Ivan Oransky's live tweets from Monday night's AHCJ event with Schwitzer and DeMonaco.


David Sampson said...

Great piece.

Somewhat of a sidebar, but this is a powerful insight:

"Every story about a specific disease has a built-in bias against discussing primary care systems or the non-medical interventions (like better schools or roads or robust legal and civil rights for women) that could conceivably have an even greater impact."Reminds me of criticisms that progress in lung cancer mortality is due primarily to drops in smoking rates, thanks to laws, education, etc., as if somehow that doesn't count. I think it does.

Dev Varma said...

I think soon enough, we will have to change the way we think about social change. You're very right, targeting single-issue initiatives can go only so far, even in an issue as specific as global health. The problems of the world necessitate an holistic approach, which means a constant three-way dialectic between governments, NGO's, and journalists. If one group is in the pocket of the other, only some of our problems get fixed (and that is my youthful optimism speaking).

Maxuelo said...

http://www.healthnewsreview.org/ is actually a very good site and I participate in the forum, great info.