Why a Resource Like NutritionFacts.org Is So Necessary

In a study of the dietary advice given by newspapers in the United Kingdom, “no credible scientific basis” was found for most claims. Indeed, “[m]isreporting of dietary advice…is widespread and may contribute to public misconceptions about food and health”—and potentially not only the public.

Scientists like to think they are not influenced by popular media. One study decided to put it to the test. The New York Times reports on scientific research each week, and researchers found that the studies covered by the Times end up being cited in the New England Journal of Medicine more than those that don’t. Seems like the popular press does indeed have an impact on science? Not so fast. That’s just one potential explanation. Perhaps outstanding studies are more likely to be picked up by the media and, independently, more likely to be cited. It’s possible the Times was just earmarking important science and its publicizing of that research didn’t have any effect on how often it was cited in future studies.

How can we disentangle the two? In 1978, there was a three-month strike during which the Times continued to print copies but couldn’t sell them to the public. So, a natural experiment was set up. Researchers compared the number of citations of Journal articles published during the strike with the number published when the paper wasn’t on strike to “discover whether publicity in the popular press truly amplifies the transmission of scientific findings to the medical community.” If the paper were just earmarking important articles, then the strike would have no effect on the studies’ future impact, but that’s not what happened. As you can see from a graph shown in my video Spin Doctors: How the Media Reports on Medicine, the studies covered by the Times during the strike when no one could read them appeared to have no impact on the medical community.

The next question, of course, is whether the press is simply amplifying the medical information to the scientific community or distorting it as well? “[S]ystematic studies suggest that many stories about new medicines tend to overstate benefits, understate risks and costs, and fail to disclose relevant financial ties.” What’s more, “[o]verly rosy coverage of drugs may also result from the direct and indirect relations between journalists and drug companies”—that is, the financial ties between the reporters and Big Pharma with all its perks.

Scientists and physicians often blame the press for the public being “poorly served” by the media’s coverage of medical science. In fact, the famous physician William Osler was quoted as saying, “Believe nothing that you see in the newspapers…if you see anything in them that you know is true, begin to doubt it at once.” Both parties, however, share the blame. Reporters may only have an hour or two to put together a story, so they may rely on press releases. It’s not hard to imagine how drug company press releases might be biased. But, surely, press releases from the scientists themselves and their institutions would “present the facts fairly, unambiguously, and without spin,” right?

Researchers decided to put it to the test. Critics may blame the media, but where do you think the media gets its information? “One might assume” that press releases from prestigious academic medical centers would be “measured and unexaggerated,” but researchers found they suffered from the same problems: downplaying side effects, having conflicts of interest and study limitations, and “promot[ing] research that has uncertain relevance to human health…”

For example, most “animal or laboratory studies…explicitly claimed relevance to human health, yet 90% lacked caveats about extrapolating results to people.” Indeed, “a release about a study of ultrasonography [ultrasound] reducing tumors in mice, titled ‘Researchers study the use of ultrasound for treatment of cancer,’” failed to add “for your pet mouse.”

“For animal research, it is estimated that less than 10% of non-human investigations ever succeed in being translated to human clinical use. Over-selling the results of non-human [lab animal] studies as a promised cure potentially confuses readers and might contribute to disillusionment with science.”

Although it is common to blame the media for exaggerations, most times, they don’t just make it up—it is what the research institutions are sending out themselves. Researchers found that “most of the inflation detected in our study…was already present in the text of the press releases produced by academics and their establishments.” Medical journals, too. Indeed, sometimes medical journal press releases do more harm than good. An analysis of press releases from some of the most prestigious medical journals found the same litany of problems. I don’t think most people realize that journals sell reprints, which are official-looking copies of the articles they print, to drug companies and others. Reprints can bring in big bucks. Drug companies may buy a million copies of a favorable article. Indeed, they “usually buy reprints of studies that they have funded themselves. Unsurprisingly, they buy them only when the results are positive for their drugs, and they use these reprints as a form of marketing.” What’s more, sometimes a company will submit an article and promise to buy a certain number of reprints if it’s accepted, which “is effectively a bribe…” A long-time editor-in-chief at the prestigious British Medical Journal recalled that a woman from a public relations company called him, offered to take him to a restaurant of his choice, “and stopped just short of saying she would go to bed with me if we took the paper.”

“Another conflict of interest for editors relates to advertising—a major source of income for many journals. Most of the advertising comes from pharmaceutical companies.” If they don’t like a study, they can threaten to withdraw their advertising if it’s published. This potentially leaves editors “faced with the stark choice of agreeing not to publish a particular piece or seeing their journal die.”

Even if journalists, as they’re writing an article, have the time to skip the press releases and go directly to the source to read the studies themselves, they may find them “incomprehensible; utter gobbledygook.” Yet even if they do understand the studies, scientific articles are not simply reports of facts. Authors have many opportunities to add spin to their scientific reports, with “spin” defined as distorting the interpretation of results and misleading readers, either unconsciously or with a willful intent to deceive. Researchers looked at randomized controlled trials with statistically nonsignificant results, meaning, for example, a drug was compared to a sugar pill and the difference between the two was essentially nonexistent. Would the researchers just lay out the truth and report that they spent time and money, but, in terms of their primary outcome, got nothing? Or would they try to spin it? In 68 percent of cases, they spun it. There was spin in the abstract, the article summary, which is particularly alarming because the abstract is often “the only part of an article [people] actually read.”

Given all of this, it’s no wonder the media often gets it wrong. Spin in the abstracts can turn into spin in the press releases and result in spin in the news. “Therefore, even if journalists [do their due diligence and] are using the original abstract conclusion in good faith, they still run the risk of deceiving their readers.” Researchers presenting new findings can always be careful to stress how preliminary the findings may be. “But let’s be serious. Powerful and reinforcing self-interests” may prevail.

I think the biggest problem with the way the media reports on medicine, though, is the choice of which stories are covered. In 2003, for instance, SARS and bioterrorism killed less than a dozen people, yet generated over a hundred thousand media reports, which is far more than those covering the actual greatest threats to our lives and health. In fact, ironically, “the more commonplace the cause of death, the less likely it is to be covered by the mass media.” Our leading killer is heart disease, yet it can be prevented, treated, and even reversed with diet and lifestyle changes—now that’s what should be front page news.

If we can’t trust the medical literature on its face, where can we turn? We’re talking life-or-death information here. What we need is someone who will dig deep into the data and translate the gobbledygook into actionable tips on keeping us and our families healthy. If only there was a website we could trust to tell us the unbiased truth…

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If you think just a little spin is bad, there is a much deeper rot in the medical literature. For more on this critical topic, see:

Interested in some specific examples of the spin and conflicts of interest we’ve been discussing? See:

It’s no wonder Physicians May Be Missing Their Most Important Tool.

In health,
Michael Greger, M.D.

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