Use Evidence-based Medicine in Reporting

Chiang So-ting - Senior Health Reporter, Ming Pao Daily News (Translated by Altis Wong)

Very often journalists who cover medical stories have to attend news conferences hosted by pharmaceutical companies. The normal run-down is the speakers – most of the time doctors – will pull out a specially made PowerPoint presentation about a study. This is followed by a question-and-answer session for journalists. When the news conference finishes, many journalists will run up to the speaker seeking more information. But most of the reporters can’t help mumbling, “another medicine salesman again”, by the time they leave.

How come the doctor is like a salesman, saying the medicine is this good and that good. When asked about any side effects, he goes: “Not really, only a bit of headache and bone ailments”. Who would believe in that!

It is not uncommon for such doctor-cum-speaker to focus on the advantage of a specific drug or treatment, while playing down the side effects. For instance, at a news conference about a type of cardiac drug, a doctor quoted a relevant clinical study published by “The New England Journal of Medicine”, claiming that the drug he was recommending is effective. But having read the study, I found that the doctor did not mention a main point. “When compared with those who have taken placebos, those who have taken the drug had stopped medication because of the side effects.” I wonder whether this implies there are serious side effects, and that they become so unbearable that the patients had to stop the medication. But the doctor replied without feeling any bit embarrassed that, “there are many reasons for the suspension, not only because of the side effects… we don’t find the side effects that serious… the suspension was also because some patients didn’t want to carry on with the trial…”

Certainly this is not the only example. Similar answers are also given at news conferences by pharmaceutical companies. It leads to the question, is the relationship between doctor and pharmaceutical company too “intimate”? And some medical journalists may have had shared the following experience that I had:

* In interviewing a university professor about a study he had done, I could feel that he was not familiar with the content of the study. He had to go through the document he had in hand to find an answer. When asked about some specific questions, he even told me to ask the pharmaceutical companies directly… who is actually the “boss” of this study – the pharmaceutical company or the professor himself?

* At another interview, before it finished, a group of staff members of a pharmaceutical company had whispered to the doctor who gave the interview. A moment later, the doctor asked me if I could mention about this and that in her report and how will those points relates to the pharmaceutical product. Does this mean the doctors are a soft touch?

Interviewing doctors and other medical professionals is inevitable when covering medical news. But some medical professionals may not be able to provide neutral opinion. In such a case, how can journalists provide balanced reporting?

The conventional way is to ask the opinion of a few more doctors. But the fact is medical journals provide a good answer to it. For many medical-beat reporters, medical journals equal “raw material.” Didn’t journalism teachers tell us…if you need to look for information, get it from “raw material”.

Although there are not many free medical journals available, some fee-based publications will offer free downloads for study that “matters”. The study will also mention an absolute number and a ratio as to how many people had suffered side effects. This will help supplement information provided by pharmaceutical companies which may not be comprehensive.

On downloadable fee-based report, if the print media organization that you work for has the money and willing to pay about US$20 to US$30 (equivalent to HK$155 – HK$233) for a copy, of course, that is ideal. But it is believed most organizations still hope that you can ask doctors who you are familiar with to do the downloading, in a bid to save whenever you can save.

Talk Practical: Commons Between Medicine and Journalism

I have learnt a new term in recent interviews with doctors. It is called Evidence-based Medicine, also known as EBM. Quoting from the website of the Centre for Evidence-based Medicine of the University of Oxford, it is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. From my point of view, its essence is somewhat similar to a famous quote by Chinese scholar Hu Shih, “Say exactly how much the evidence derived. If the evidence supports 70 percent of the issue, you can’t say 80 percent of it.” It is just that reporters are not using this “best evidence” to help patients, when writing stories.

What is best evidence? According to the explanation by some doctors who underwent EMB training, on a clinical study basis, a “golden rule” commonly recognized by the medical field is prospective randomized controlled trials, or RCT. To put it simply, researchers recruit a group of volunteers and patients and give them, randomly, drugs or placebos. That means patients would not know if he is taking drugs or placebos. Some time later, researchers will analyse the data of the two groups to find out if the drug in question is effective.

Looking back at the news conferences by pharmaceutical companies I attended in the past, how many of them quoted studies using RCT? If you ask them whether they have RCT data, many doctors will say something similar to this line. “RCT usually takes several years to do, it is costly and it needs a certain number of patients for testing…not easy to do.” This is true, but their answer gives you the feeling that the doctors are defending pharmaceutical companies.

Evidence-based Medicine has an important role when doctors decide which treatment to adopt. It is believed to be as important as in the case of medical news reporting. Not sure if the Journalists Association will organise any workshops teaching medical news reporters on how to use Evidence-based Medicine in writing their stories.