How I Did It: Marilynn Marchione concludes an impressive career in medical writing

Marilynn Marchione

Marilynn Marchione was the Associated Press’s chief medical writer for the last 10 years of her long career in journalism.

Deciding to retire this year was not easy because she loved her job and rarely woke up thinking, “How long till I don’t have to do this anymore?” The pandemic delayed her plans for more than a year because she didn’t want to miss the chance to report an important story and because it didn’t feel right to leave the job at a time of such enormous need.

Marchione took time out of her busy schedule recently — between relaxing on the beach and reading a good book — to share what she learned over her long career of covering medical research. From emphasizing the substantial responsibility of health journalists to get their reporting right, to discussing what she’s learned from her mistakes, to highlighting what chops are needed to report on medical research well, her wisdom is like a 10-minute master class on what it takes to be an accurate, thoughtful, responsible, and incisive medical reporter.

Tell us a bit about how you got into health journalism and covering medical research initially.

A mystery illness that hospitalized my first child made me realize there was nothing more important to write about than health. I initially intended to major in science in college before switching to journalism, so I already had an appreciation for the scientific method and evidence. I worked for three large daily newspapers in various reporting and editing jobs before joining the AP. I focused on building general news writing and reporting skills while watching for an opportunity to specialize.

At what was then the Milwaukee Journal, medical writer Neil Rosenberg became a mentor and threw stories my way that he couldn’t get to; I succeeded him when he left the beat in the early 1990s. I sought opportunities to cover medical conferences and had roughly a dozen science reporting fellowships that gave me sources and a national and international perspective. Through these, I met AP’s medical editor, Daniel Q. Haney, who also became a mentor and encouraged me to apply to succeed him when he retired in 2004. And that sick baby of mine? She fully recovered and is now a doctor.

How long did it take before you felt confident about reading and interpreting the findings of studies and knowing the right questions to ask researchers?

First, I’ll say that I felt confident before I should have. It’s an illusion you can get if you write cleanly and aren’t challenged on things that matter versus style or approach. Editors without a science background can be lulled or seduced by clean or clever writing and blind to more substantive issues in copy. I learned most by studying the work of top medical writers, how they covered something I had written on, and from their advice and frank critiques of my work. Experience matters, but gaining confidence is not so much about time on the job as it is about having the right skills and perspective. I’ve seen people who’ve spent decades reporting on medical research make the same mistakes over and over again. I’ve also seen young writers who acquired the necessary skills right away.

Personally, I felt more competent at vetting research after a summer-long Knight reporting fellowship that sadly no longer exists at the CDC, where I attended the epidemic intelligence service (EIS officer) training program that included instruction in statistics and hands-on field research. Science writers need to know the basics of statistics, especially study designs and limitations, to do a good job. Understanding a few key principles, such as confidence intervals, sample size for statistical significance, and the evidence for subgroup or secondary versus primary endpoints, makes a huge difference.

Can you share any stories about mistakes you made in your career related to covering medical research and what you learned from them?

I’ve truly learned more from my mistakes than from my successes, and I am mindful that a mistake in medical writing is more costly than in any other field – what we write has great sway over readers’ decisions about their health. One of my worst mistakes involved a heart study — I wrote that it had found that dual anti-platelet therapy was ineffective and possibly harmful, but I did not make clear high enough in the story that the study I was writing about had tested it for primary prevention, not in people who recently had stents placed for whom that therapy was well established.

The story was not technically wrong, but it was misleading, and some readers stopped taking heart medicines because of it. A few hours after the story went out, at the urging of the study leader, I moved up the reference to the particular patient population and clarified the situation, and wrote a follow story the next day, but I knew some damage had been done. I’ve told this story at various talks to remind myself and others of the great responsibility we carry, and that even being technically right can still be wrong.

What are the most important things you’ve learned in your career about covering medical research?

Above all is that humility is one of a science writer’s greatest assets and hubris is the opposite of that. Be aware of the limitations of what you know, the expertise you don’t have, the knowledge that others have. Seeking outside comment on a study or topic is not just a requirement box to check off when you’re doing a story. Many times, I’ve thought I understood the implications of a study’s findings only to hear them put in an entirely new light by a doctor or scientist who did previous work on the topic, or the discussant of the study at a medical meeting who deeply dissects the results. Much credit for any success I’ve had goes to the many sources through the years who have helped me gain context and understanding, often on short notice, even if it meant talking me out of doing a story and that they wouldn’t wind up being quoted. It’s just as important to know what not to write and when to walk away from a story as it is to recognize one in the first place.

It’s also important to have a firm principles – especially during a pandemic when there’s so much pressure to bend the rules of evidence — and a respect for statistics and the scientific method. You can go far, unfortunately, by relying heavily on anecdote and hunches to sell a story, but it’s not the right thing to do.

How has covering medical research changed over the years of your career? Do you think it’s easier, more difficult, or otherwise different covering medical research today?

I think it’s harder to do a good job today for a variety of reasons, most of them to do with speed, which is the enemy of thoughtful work. I’m a big fan of the embargo system, where top journals and groups hosting major medical conferences provide data a couple days in advance of publication to science writers who have signed agreements to use the information to prepare well-researched and thoughtful print/broadcast/online content. Increasingly, journals are publishing on short notice as soon as important research has gone through peer review.

The rise of preprints – and the marketing of findings in them by academic institutions and corporate sponsors – has flooded the Internet with very accessible, tantalizing, but unvetted research. Preprints have an important role and there is value in them for the scientific community, but they pose a great temptation for writers, especially those without science backgrounds and can lead to premature stories. The rise of video as a way many people get news also poses great challenges, as there is simply little room for nuance and depth. The contraction of the industry and loss of journalism jobs also is a threat to good work because there’s just less of it and fewer people doing it.

What mistakes do you see newer journalists making when they first start covering medical studies or problems that you see in everyday medical study coverage today that you’d most like to see fixed?

One rookie mistake I see is too little context in stories — writing as if that study or piece of research is definitive rather than a contribution to what’s known about something, a part of a larger whole that is still being defined. There’s too much reliance on anecdote, the experience of a single patient or study participant who may or may not be representative of the big picture but is available and willing to go on camera or be quoted.

The biggest mistake, though, is lack of critical thinking. There isn’t enough questioning, common sense, “how do you know what you claim is true” reflected in many stories. There’s not enough skepticism of company claims, especially when they go dumpster diving for positive signs after missing a primary endpoint — just a general naivete and willingness to question and deeply think through a claim or story proposal.

What has it been like retiring from years of covering medical research in the midst of the biggest global pandemic in a century?

Retiring was a hard step for me because I’ve loved my job and the AP, and never (well, rarely) woke up thinking, “How long till I don’t have to do this anymore?” It’s the right thing for me at this phase of life. As cliché as it sounds, I want to spend more time with my family and friends, and doing other things. The pandemic delayed my plans for more than a year because I would not want to miss the chance to report such an important story and because it didn’t feel right to leave a job like mine at such a time of need. The pandemic closely followed my exclusive reporting on the gene-edited babies in China, an exhausting story for a few months as we tried to verify that extraordinary claim. So the last few years have been intense, and I’m happy to look back and see that legacy.

If you were just starting out as a health journalist covering medical research, how would you start, what would you do differently, or what advice would you most want to hear?

Learn some basics of statistics (numbers are your friends, not enemies to be feared), challenge rather than congratulate yourself, find good mentors, study and learn from others. Analyze their stories, who they called for comment. Pay attention to the questions that others ask at press conferences, and learn to recognize holes in the information you’re being given. Question claims and learn to think critically. Become familiar with at least the main principles of genetics, which is only going to be more important going forward. Follow the money, don’t be naïve about corporate influence, and disclose major financial relationships of your sources to your readers.

Have a good attitude and realize that every job, every person you meet, is a chance to learn and gain skills. At all three newspapers where I worked before joining the AP, I started as a copy editor because that was the available position, then worked my way toward what I wanted to do. The best way to get a job you want is to do a really good job at the one you have.

Tell us about one of your favorite or proudest stories or series you covered and why it was important to you.

It’s the story of CRISPR babies in China, a historic milestone with enormous scientific, societal and ethical implications. That story came to me partly because of my track record reporting on the rise of gene medicine over the previous decade. After the initial tip, it was several months before I learned the identity of the scientist involved, and then several months more to get to interview him, investigate and try to verify his claims. I had the help, trust and tremendous resources of the AP, including talented staff in Beijing, and the most supportive and skilled editor imaginable.

We were always mindful of the possibility of a Raelian-like hoax, and I was not going to be the reporter to rush out a “scientist claims he’s doing the unthinkable”-type story just to score clicks. We took our time to go down all possible avenues to vet the claim, seek evidence and probe the ethical issues. I’m incredibly proud that the initial story as well as our follow-up work proved so accurate and have stood the test of time.

Anything else you want to add or any other anecdotes of favorite assignments to share? 

I wanted to be among the best in my field and to write stories that were understandable by any reader while also passing muster with experts. I truly believe that a journalist’s role is to present facts so readers can make up their own minds. I hope I’ve helped some understand the wonders of medical science, and to use the knowledge to have better lives.

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