By Trudy Lieberman
I’ve long observed that U.S. health reporters are reluctant to reach out globally to inform their reporting. Whether the issue is drug prices, patient safety, insurance cost-sharing arrangements, vaccines, or long-term care, we stick close to home consulting local sources to frame our work. Likewise, most of us get few inquiries from abroad. That’s too bad because the health stories we’re asked to report are the same ones our counterparts abroad are writing too.
This reportorial parochialism results in poor understanding of foreign health care and makes it easy to report misleading or false claims because we have no knowledge to judge their correctness or to give context so audiences can judge for themselves.
In the 1990s during debate on the Clinton health care plan, The New York Times reported that Canadian women had to wait for Pap smears, a point vigorously refuted by the Canadian ambassador who, in a letter to the editor, told the Times: “You, and Americans generally are free to decide whatever health care system to choose, avoid or adapt, but the choice is not assisted by opinions unrelated to fact.” When Rudolph Giuliani ran for president in 2007, he asserted his chances of surviving prostate cancer were about twice as high in the U.S. than they were in England “under socialized medicine,” as he put it. The claim was later disputed but hardly challenged when he first made it.
A few years ago a German reporter told me that one of the states in his country had limited the size of hamburgers and the quantity of sugary drinks fast food outlets could sell to children. How could the government pass such restrictions in the face of industry pushback, I asked incredulously. The reporter explained their health system is accountable to the public, and disease caused by such foods ends up costing everyone. That belief in the common good makes it easier to limit quantities of questionable foods sold to kids. Everyone has a stake in keeping costs low.
A similar argument, though, could be made here even though our insurance systems are different. Food-related illnesses and the increasingly expensive drugs to treat them feed into what we all pay for medications. Think of how those costly statins and diabetes drugs coming on the market will find their way into our insurance premiums in the next couple of years. I don’t recall this discussion when New York City was considering quantity limits for the sale of soft drinks. And it was amazing that early coverage of the expensive hepatitis C drug Sovaldi included no context about what Britain’s National Institute for Health and Care Excellence was doing to evaluate the drug and prioritize its use. Calling England is something we don’t do.
When I travel abroad and talk about the U.S. health system, it’s apparent that people in England or Canada or Germany have as little information about our system as Americans have of theirs. As part of my Fulbright experience in Canada two years ago, it became clear journalists needed a way to share knowledge of their own health care systems with their counterparts abroad. Canadians believed Obamacare was a truly universal health system like their own. Americans believed Canadians were dying on the streets because they couldn’t get MRIs. Neither was true.
With the support of EvidenceNetwork.ca, based at the University of Manitoba, which hosted my trip, I gathered nine journalists from seven countries including Ivan Oransky, M.D., AHCJ’s vice president, and myself. The others represent Australia, Canada, the United Kingdom, The Netherlands, Italy, and Portugal. Most have participated in three international health journalism conferences over the past few years.
The panelists represent different areas of expertise ranging from hospital safety practices and insurance systems to antibiotics, overtreatment, and conflicts of interest in medicine. Ray Moynihan, based at Bond University in Australia, was the inspiration for many of us and his seminal study published in The New England Journal of Medicine in 2000 taught us how to question pharmaceutical marketing, drug company claims and the role of physicians with conflicts of interest in overprescribing medications. Moynihan got us to think about the evidence, something most journalists here were not doing at the end of the 1990s. He was a natural for this panel of experts.
How can U.S. journalists use the expertise of the panel? I asked our Italian panelist Amelia Beltramini, an AHCJ member, what help she could use from journalists in other countries. She told me she wanted other journalists to help her work on a European Sunshine Act to make it easier to find documents. I shared what’s happening here with secrecy at the federal health agencies. She’s also disturbed by the influence of the pharmaceutical industry in educating health reporters and the ethical conflicts it poses. We have a similar issue here with National Press Foundation seminars sponsored by drug companies that educate reporters.
How can U.S. health journalists tap into the expertise of our foreign counterparts?
The next time The Commonwealth Fund publishes its international comparisons, email a panelist in England or the Netherlands and ask why it’s easier to get after-hours care in those countries than it is in the United States. That’s more interesting than simply repeating the stats in a press release. When the next “blockbuster” statin shows up, contact NICE to learn about the UK’s treatment guidelines. When you write a piece about those sky-high deductibles and out-of-pocket maximums for Obamacare policies, find out how other countries like Portugal deal with user fees. Portugal does have a national health system with some user fees. People with low incomes don’t have to pay them, and those who do pay no more than about $54 U.S. for most services.
Contrary to what editors might say, Americans are interested in how other countries deal with health care. Last summer in Denmark I spent an afternoon with officials who manage the long-term care services for the city of Copenhagen. When I returned, I reported what I had learned for a column distributed through the Rural Health News Service. Many community newspapers picked it up. One reader from Colorado Springs emailed to tell me he enjoyed the piece and passed along another story about a village build for Alzheimer’s patients in Amsterdam. “If only we could do this in the Springs,” he said. “Is it really that out of the question?” Those stories got him to think outside the United States box. That’s exactly what international journalistic collaboration can do.
Trudy Lieberman (@Trudy_Lieberman) is a contributing editor to the Columbia Journalism Review and a fellow at the Center for Advancing Health. She also blogs for Health News Review. She pulled together a panel of international expert journalists to help reporters add another dimension to their reporting and first wrote about it in this CJR column.
