Tuesday, March 30, 2010

Cats and Dogs - It's Raining Opinion

A Bad Survey Results in Bad Reporting
Today, The New York Times published "Among Weathercasters, Doubt on Warming," a story based on a new survey from George Mason University that concludes there are "tensions between two groups that might be expected to agree on the issue [climate change]: climate scientists and meteorologists, especially those who serve as television weather forecasters."

In brief, only about half of the 571 TV weathercasters surveyed believed global warming has occurred, fewer than a third thought it was "caused mostly by human activity" and more than a quarter agree with the statement that "global warming is a scam." Here are some important under-appreciated facts:

Climate scientists and meteorologists are like cats and dogs, apples and oranges. College degrees versus graduate training and research. Predicting the weather tomorrow versus studying decades of data.

Not all TV meteorologists are created equally. Half don't have degrees in meteorology -- they simply report the weather. Sadly they are often the de facto local science expert because 94 percent of TV stations don't have a full time science reporter. Thus, misinformation and junk science can be easily perpetuated.

Politics forms the backdrop, not the science. I hate this but, as I've said before, the facts sometimes don't matter (Do the Facts Matter? Of Course They Do, Of Course They Don't). There's 130 years worth of information to conclude that CO2, driven up by human activity, is linked to climate change. Unfortunately, those now famous emails from a British group that allegedly tried to suppress some climate data have given climate change deniers a new reason to cast suspicion and doubt on the collective work of the field. It is also notable (and not reported in the NYT story) that 37.9 percent of the survey respondents identified themselves as somewhat or very conservative, 35.1 as moderate, and 27.3 as somewhat or very liberal (1.6 didn't know).

I really don't care where one stands on the political question -- my friends stretch across the spectrum -- as long as there is an open mind and a respect for the facts. But it would interesting to see how the survey might have changed if 1) political leanings were neutralized and 2) sorted by true expertise in the field/years of education. The bottom line is that The New York Times may be making a mountain out of a mole hill by elevating the visibility of a flawed survey.

Between blog posts, you can follow me @pauloestreicher.

Wednesday, March 10, 2010

Gaining Higher Ground by First Finding the Low

Treating the Cause, Not the Symptoms, of Pharmaceutical Industry Reputation
When confronted with a problem or an issue, we look for the root cause, the scene of the crime, Patient Zero. In the case of healthcare industry reputation, however, it seems that executives and consultants have a hard time finding that lowest common denominator. Though the pharmaceutical industry has suffered from behavioral, communication and performance missteps that have lowered reputation, it is low health literacy among consumers and the decline of science journalism that are fundamental to this problem.

Many millions have been spent on advertising campaigns to communicate the value of medicines and the cost of product R&D. Attempts have been made to showcase the role of industry research in modern medical breakthroughs. Disease awareness campaigns have been launched to help people better respond to symptomatic cues and get help. A conciliatory face has been unmasked as concessions on discounts and rebates were recently made during negotiations on healthcare reform.

It does not appear, however, that the “kitchen sink” approach to corporate reputation management is working. According to the yearly Harris poll of public attitudes toward different industry sectors, pharmaceutical companies have roughly the same score as cable companies and automobile manufacturers. The “good job minus bad job” number was nine (with supermarkets leading at 86 and tobacco trailing at -32).1 Last year the number was 15 (with supermarkets at 84 and tobacco companies at -43).2

In the annual Harris Interactive Reputation Quotient survey of the 60 most visible companies, however, the pharmaceutical sector posted its highest reputation scores in five years – up to 31 percent in 2008 from 26 percent in 2007.3 The optimist might say that the upswing in public sentiment is proof that the varied messages and good works of the industry are finally penetrating the gloom. Yet, the cynic might say that it’s all relative; the self-inflicted wounds of other industries make pharmaceuticals look good by comparison. For example, the financial services fell into the reputation cellar with the tobacco industry, both at 11 percent. The auto industry suffered the largest decline (22 percent) in the survey's history. And, remember, 31 percent good for pharma means 69 percent not good.

Wherever the numbers are, they need to be higher. Bolstering industry reputation means generating more trust among the stakeholders. We can go a long way in enhancing the relationship with key stakeholders by delivering on healthcare promises. That is, better outcomes for patients. Generating better outcomes is heavily dependent on appropriate utilization which, in turn, relies on better health judgment.

Better health judgment starts with consumers and the need for them to be more knowledgeable about healthcare. Dropping information – even crucial or compelling data – onto the heads of an unprepared public, or expecting a response to another “call to action,” is unproductive and unrealistic.

In response to these issues and obstacles, the healthcare industry should get behind a massive, sustained effort to enhance health and science literacy.

Of course, having a more knowledgeable public will not guarantee an enhanced corporate reputation. It must be earned. The self-inflicted wounds – the reputation-killing missteps and misdeeds – need to stop.

But, putting that critical issue aside, without an ability to evaluate the facts and evidence, the important health and science issues of the day – stem cells, healthcare reform, research funding, vaccine programs – will continue to be misconstrued and remain political footballs.

When it comes to managing one’s health or the health of one’s family, most people don’t have enough knowledge to evaluate a medical product claim or even formulate the right questions to ask a healthcare provider. This all makes the public an easy target for purveyors of alternative medicines and bogus devices.

This growing problem drew widespread attention when Newsweek put Oprah Winfrey on its cover with the title, “Crazy Talk: Oprah, Wacky Cures & You”.4 To be sure, Oprah has made tremendous contributions to her viewers and to noble causes across the world. But when she give a platform to physicians like Christiane Northrup who has used Tarot cards to diagnose illness, or celebrities like Suzanne Somers who apply, ingest and inject unapproved products in an attempt to stay young, viewers see an endorsement of potentially dangerous treatments and interventions.

Jenny McCarthy, another guest of the show, has used the very unfortunate story of her son to create fear and confusion around vaccines. Indeed, compared to parents of vaccinated children in the U.S., significantly more parents of unvaccinated children believe that vaccine efficacy and safety are low (58% vs. 17%, 60% vs. 15%). Also, significantly more parents of unvaccinated children believe their kids have a low susceptibility to diseases (58% vs. 15%).5

Following the Newsweek article and sharp condemnation by the mainstream medical community, Oprah released a statement saying “I trust viewers, and know that they are smart and discerning enough to seek out medical opinions to determine what may be best…” Trust isn’t the issue, however. It’s whether or not viewers have the ability to differentiate real science from junk science, medical myths from medical facts.

This inability to filter information holds true for the fastest growing sector of media – new or social media. Some commentators have heralded the arrival of “citizen journalists” to fill the void left by the dwindling professional corps. Sorry. Although bloggers help to generate much needed discussion, citizen journalism does not equal journalism. And, with the “viral” nature of the web, every anecdote, half-truth or falsehood has the potential to be perceived as fact, as real news.

Indeed, we need more pros to sift a growing mass of information. Professional health and science journalists must help to communicate the progress and the failures, and to differentiate the facts and evidence from the frauds and junk science. Unfortunately, we’ve seen surveys confirm what we already know about the state of health and science journalism over the past few months. It’s a shrinking, wounded profession. We know the symptoms – they’ve been well documented. Like the global economy, journalism needs a recovery plan.

A recent editorial in the journal Nature recognized that “scientists can do little to stop this bloodletting” though they can at least “help ensure that reporting about science continues to be both informed and accurate.”6 In addition, it was suggested that “the scientific community should work with journalism schools and professional societies to ensure that journalism programmes include some grounding on what science is and how the process of experiment, review and publication actually works.”

In another piece in the same issue, Toby Murcott wrote that science journalists must be more engaged – more a part of the action. They can’t simply massage a press release for their particular readership. He compares science journalism to the clergy, “taking information from a source of authority” and translating it for the congregation.7 He contrasts this with political journalists who, with a knowledge base on par with those who they monitor and interview, engage in an active exchange.

Physicians have a role in this, too. With inaccurate details or story angles developed for shock value, patients can be spooked out of taking their medications or seeking medical attention. Indeed, “communicating” was the first word on the first page in the first article of the first issue (of 2009) of the New England Journal of Medicine.8 Susan Dentzer wrote that “Whether they realize it or not, journalists reporting on health care developments deliver public health messages that can influence the behavior of clinicians and patients.” Unfortunately, many journalists “consider themselves poorly trained to understand medical studies and statistics.”

Yes, the quality of reporting and the training of journalists must be bolstered. A survey released this year by the Association of Health Care Journalists and the Kaiser Family Foundation reported that 43 percent of respondents said training opportunities had declined.9

But addressing this one facet is not enough. Journalism is a business and, thus, a business case needs to be made in order to save (and expand) health and science journalism. The bottom line is that demand is low. Certainly, there’s no dearth of interesting material. It’s just a simple truth that a dreadfully large portion of the audience lacks the background and understanding to feel engaged in the subject areas. In a survey of more than 19,000 U.S. adults, only 11 percent where found to be "proficient" in their health literacy.10 This is where the recovery must begin.

The stakes are high and not just for the employment of journalists. Remember the first trial involving the anti-inflammatory drug Vioxx® in 2005? The jury awarded $253 million to the plaintiff. Why? The science went right over the heads of the jury. In an interview with The Wall Street Journal a juror said, “We didn’t know what the heck they were talking about.”11 Jon D. Miller, director, Center for Biomedical Communications, Northwestern University Medical School told The New York Times that “People’s inability to understand basic scientific concepts undermines their ability to take part in the democratic process.”12

Industry support for a long-term effort targeted at raising health and science literacy could lead to an increased public understanding and appetite for health and science information, news outlets being repopulated with professional journalists to help carry information forward, and a higher and wider industry reputation. Let’s spread intellectual curiosity, and use the marketing and partnering expertise of the industry to achieve these essential goals.
  1. The Harris Poll®, August 18, 2009.
  2. The Harris Poll®, August 7, 2008.
  3. Harris Interactive Reputation QuotientTM (RQ) survey, June 23, 2008.
  4. Kosova, Weston and Wingert, Pat. Newsweek, June 8, 2009, pp. 54-62.
  5. Omer, Saad B. et al. Vaccine Refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable Diseases, New England Journal of Medicine 2009, vol. 360, no.19, pp. 1981-1988.
  6. Nature, vol. 459, no. 7250, p. 1033.
  7. Murcott, Toby. Science Journalism: Toppling the Priesthood, Nature, vol. 459, no. 7250, pp. 1054, 1055.
  8. Dentzer, Susan. Communicating Medical News – Pitfalls of Health Care Journalism, New England Journal of Medicine, 2009, vol. 360 no. 15, pp.1477-1479.
  9. Kaiser Family Foundation, The State of Health Journalism in the U.S., publication #7869, March 2009.
  10. National Center for Education Statistics, The Health Literacy of America’s Adults, publication #2006483, September 2006.
  11. The Wall Street Journal, p. A1, August 22, 2005.
  12. The New York Times, p. F3, August 30, 2005.
Between blog posts, you can follow me @pauloestreicher.