Statement of Principles of the Association of Health Care Journalists
Members of the Association of Health Care Journalists believe journalists have a special responsibility in covering health and medical news. This responsibility is inherent in journalists' role as watchdogs, holding the powerful accountable and giving voice to the voiceless.
Association members know that readers and viewers may make important health care decisions based on the information provided in our stories.
We embrace the Society of Professional Journalists' code of ethics with its emphasis on seeking truth, providing fair and comprehensive accounts of events and issues, minimizing harm, acting independently and being accountable.
In this statement, we identify some unique challenges that health care reporters face and suggest how to meet those challenges. This effort is one sign of our organization's commitment to help its members improve health journalism, to help them scrutinize their own efforts and to encourage open discussion and debate on how health care news is reported and disseminated.
We further believe that well balanced and thorough news coverage of health encompasses the determinants of health and not merely medical science or the provision of medical services. We suggest that news organizations scrutinize their role as providers of health care news and information, commit to coverage of health care issues and develop a strategy that meets the needs of their audiences.
PROFESSIONALISM, CONTENT, ACCURACY
Because our objectivity and credibility is paramount, health care journalists are bound by professional standards of truth, accuracy, and context in every report. To achieve this, health care journalists should:
- Be vigilant in selecting sources, asking about, weighing and disclosing relevant financial, advocacy, personal or other interests of those we interview as a routine part of story research and interviews.
- Investigate and report possible links between sources of information (studies or experts) and those (such as the manufacturers) who promote a new idea or therapy. Investigate and report the possible links between researchers and private companies, researchers and public institutions, patient advocacy groups and their sponsors, celebrity spokespersons and their sponsors, non-profit health and professional organizations and their sponsors.
- Recognize that most stories involve a degree of nuance and complexity that no single source could provide. Journalists have a responsibility to present diverse viewpoints in context. In addition, anyone with knowledge of the health care industry, of medicine, and of the scientific community knows that many vested interests reside among government health spokespersons, researchers, universities, drug companies, device manufacturers, providers, insurers and so on. To reflect only one perspective of only one source is not wise. Most one-source stories lack depth and meaning. Avoid single-source stories.
- Understand the process of medical research in order to report accurately. Realize, for example, the distinction between Phases I, II, and III drug trials. It is misleading to report bold or conclusive statements about efficacy in Phase I trials since the primary goal of Phase I trials is to evaluate safety, not efficacy. (The National Cancer Institute offers a simple guide.) Be cautious in reporting results of preliminary studies, in vitro or animal studies. Give accurate portrayals of the status of investigational drugs, devices and procedures, including significant caveats and explanations of hurdles, unknowns and potential problems.
- Preserve journalistic independence by avoiding the use of video news releases or the use of quotes from printed news releases. Label and credit the source whenever a portion of a video or printed news release is used.
- Be judicious in the use of television library or file footage. The use of footage from the past may be inappropriate, misrepresentative, or embarrassing to individuals if used today. It may not even fit the topic of the day. Strive to ensure that your television station has policies on the use of health-related file footage by all news personnel.
- Recognize that gathering and reporting information may cause harm or discomfort. Use special sensitivity and understand legal limits when dealing with children, mentally handicapped people and inexperienced sources or subjects. Always consider alternatives that minimize harm while making accurate reporting possible.
- Show respect. Illness, disability and other health challenges facing individuals must not be exploited merely for dramatic effect.
- Remember that some sick people don't like to be called "victims." Be careful with the use of the term "patients." This can contribute to the medicalization of normal states of health. Calling people in an experimental trial "patients" or referring to an experimental intervention as a "therapy" may contribute to the notion of therapeutic misconception, the implication that subjects in a research trial will certainly derive direct therapeutic benefit from what is actually an experiment with uncertain benefits and harms.
- Avoid vague, sensational language (cure, miracle, breakthrough, promising, dramatic, etc.)
- Make sure anecdotes are appropriately chosen to serve the interests of fairness and balance. Avoid the "tyranny of the anecdote." Personal stories used as examples must be consistent with the larger body of evidence. Whenever possible, individuals who had both positive and negative outcomes should be included.
- Quantify the magnitude of the benefit or the risk in the story. Explain absolute risk or benefit, along with relative risk or benefit whenever possible. A 50 percent increase in relative risk may not mean much if the absolute numbers are small. Consider explaining the "number needed to treat" - the number of people you would have to treat with the experimental intervention (compared with the control) to prevent one event. (See information from the Cochrane Collaboration.)
- Report the complete risks and benefits of any treatment, along with the possible outcomes of alternative approaches, including the choices of "watchful waiting."
- Clearly identify and explain the meaning of results that indicate an association, rather than a causal link, between factors in a study. Remember: association is not cause.
- Clearly define and communicate areas of doubt and uncertainty. Explain what doctors don't know as well as what they do know.
- Seek out independent experts to scrutinize claims and evaluate the quality of evidence presented by sources. Apply the same scrutiny and skepticism that would be applied in any other news story. Avoid uncritical acceptance of official or expert pronouncements. Be skeptical about all emphatic claims, particularly about claims that an intervention has few or no adverse side effects.
- Strive to include information about cost and insurance coverage in any reporting of new ideas in medicine.
- Ensure that the total news package (headlines, teases, graphics, promotional material) does not oversimplify or misrepresent. Coach editors, photographers, producers, writers, graphic artists and copy editors to embrace these values in their work.
- Consider public interest the primary criterion when choosing which stories to report. Follow up on those stories that serve a wider public interest. In particular, follow up stories on subsequent failures, negative findings or other reversals of fortune for investigational drugs, devices or procedures should receive coverage comparable to that given initial positive reports.
- Distinguish between advocacy and reporting. There are many sides in a health care story. It is not the job of the journalist to take sides, but to present an accurate, balanced and complete report.
- Be original. Plagiarism is untruthful and unacceptable.
We should strive to be independent from the agendas and timetables of journals, advocates, industry and government agencies. We should nourish and encourage original and analytical reporting that provides audiences/readers with context. Given that thousands of journal articles and conference presentations appear each year, and that relatively few are immediately relevant to our audiences/readers, health journalists have a responsibility to be selective so that significant news is not overwhelmed by a blizzard of trivial reports. We are the eyes and ears of our audiences/readers; we must not be mere mouthpieces for industry, government agencies, researchers or health care providers.
Those who cover health care will encounter many different interest groups including government, academic medicine and research, medical centers, providers, purchasers, advocacy groups, pharmaceutical companies and device manufacturers. Health care journalists should remember that their loyalties reside with the truth and with the needs of the community.
- Preserve a dispassionate relationship with sources, avoiding conflicts of interest, real or perceived.
- Avoid any personal or financial interest in any company in any field related to what is being covered. This includes actual and potential competitors of subjects about whom we report. It is not wise to own stock in health care companies. We must not profit from, nor allow others to profit from, non-public information, including, but not limited to, results in embargoed journal articles and meeting abstracts.
- Remember that journalists face other potential conflicts of interest. Think about questions such as: Were you a patient at a particular hospital? Do you have a relative with a specific disease that could unduly influence your handling of a story? Does this insurance company cover employees in your newsroom? It is the journalist's responsibility to recognize these conflicts and prevent them from influencing stories or story choices. The best way to do this is by constant, open and honest discussion with other reporters, editors or producers.
- Deny favored treatment to advertisers and special interests and resist their pressure to influence news coverage.
- Refuse gifts, favors, and special treatment. Refuse meals from drug companies and device manufacturers and refuse to accept unsolicited product samples sent in the mail.
- Weigh the potential benefits involved in accepting fees, honoraria, free travel, paid expenses from organizers of conferences or events against the desire to preserve our credibility with the audience and the need to avoid even the appearance of a conflict of interest.
- Also weigh the potential benefits of accepting awards from organizations sponsored by an entity with a vested interest in health care against our need for credibility.
- Weigh the potential conflict in accepting support from public, private, or foundation sources.
We must improve our coverage of the structural, institutional, political, financial and ethical issues in health,medicine and health care.
We have a responsibility to encourage editors to pay as much attention to health stories as to medical stories. It is our responsibility to understand the difference between the two types of stories and to help our editors maintain an appropriate balance.
We know stories on health policy and public health are significant and contribute greatly to public debate. We know they are relevant and important for our readers and viewers. We must work harder to make them interesting.
We must work harder within our newsrooms to keep health care coverage comprehensive and proportional.
While brevity and immediacy are touchstones of news reporting, health and medical reporting must include sufficient context, background and perspective to be understandable and useful to audiences/readers. Stories that fail to explain how new results or other announcements fit within the broader body of evidence do not serve the interests of the public. Finally, it is our responsibility to lobby our editors to raise the standards of health reporting. Our beats can be viewed as health, medicine, business, health policy, research, science, finance, politics and other specialized areas of news. We must ensure that our beats don't become so super-specialized that we let important health issues fall through the gaps of our finely defined beats. We must work with editors to ensure that our specialized knowledge, training, expertise and instincts have a voice in the broader editorial decision-making of our publication or broadcast or Web site.