Behavior modification for 'White Coat Myopia' Date: 01/06/11
In the new year, resolve to find powerful, relevant stories that don't begin and end with doctors.
By Andrew Holtz, M.P.H.
Every year end brings a flood of stories about the "Top Medical Breakthroughs." And over the rest of the year there is no shortage of front page headlines announcing new drugs, devices and clinical trial results. But I think the intensive cultivation of medical news reports leaves fertile acreage of health stories untilled.
When we or someone we know has a heart attack or is diagnosed with cancer, we want to know about the latest findings about statins and stents or chemotherapy versus surgery. But on most days most of us are mostly healthy. We want to stay that way.
So rather than a burning curiosity about the latest model of drug-eluting stent and how it may tip the balance between PCI (Percutaneous coronary interventions) vs. CABG (Coronary artery bypass graft surgery) for that heart attack we hope won't strike today, what people really want to know is what's new and important that might affect their heart health.
Sure, we are in the news business ... so it's not enough to repeat the basic advice to eat better and be more active. But if you expand your perspective from a narrow focus on medical interventions, you will find studies, policies and events that relate to health in ways that connect directly to the daily lives of many more people.
One good place to start New Year's themed stories is with the Healthy People 2010 goals and then the new Healthy People 2020 goals. The new goals have added a number of objectives in several areas including older adults and for well-being, two areas that might be worth a closer look. To continue the heart health theme, look at the Heart Disease & Stroke page.
How are we doing on smoking? Tracking surveys from the CDC's National Center for Health Statistics indicate that tobacco control progress seems to be stalling (PDF). There is more talk about whether the people who still smoke are somehow different from those who have quit (or not started) in recent years, so new approaches may be needed.
The FDA announced in early January that, based on new authority contained in the Family Smoking Prevention and Tobacco Control Act of 2009 (PDF), it will begin reviewing tobacco products to see if they are "substantially equivalent" to products that were sold in 2007.
How about obesity and diabetes? Which areas in the country are doing better or worse and what explanations are there? Do your readers/audiences know that city dwellers tend to be trimmer than rural residents? Do they know why? One recent article investigated associations between commute times, grocery store locations and obesity. AHCJ's slim guide, Covering Obesity, addresses some of the societal changes that have fostered obesity in the United States.
How has the recession affected heart health? It seems that surgical procedures are down and probably more people are dropping their medicines. Both are related to losses of jobs and insurance. Is the cutback in medical interventions reflected in heart disease outcomes? And if not, what would that say about what the biggest influences on heart health really are?
The 2009 AHCJ conference in Seattle included a session in which Stephen Bezruchka, M.D., gave attendees a preview of a paper suggesting that health might actually improve during the recession. (Journal article: "The effect of economic recession on population health")
Other recent AHCJ conference sessions on related topics include:
- Chicago 2010: "Incorporating social determinants into your local health coverage" | Article about the panel
- Washington, D.C. 2008: "Community ... the health story"
This session featured documentary journalists who created the PBS series "Unnatural Causes" about how money, geography, politics and policy influence health.
Recently the Centers for Disease Control and Prevention demoted stroke from being the third leading cause of death in the United States to the fourth, based on 2008 numbers. That change offers a news hook to look at broad trends. (Report | News release)
Searching journals such as the American Journal of Public Health (AHCJ members get free access) can produce items that you might not find in JAMA, NEJM, JACC, etc. For instance, a report in June documented an inverse association between local health department budgets and cardiovascular health. So a news hook might be: How might state and local cuts to local health department budgets affect rates of heart disease in your community?
One further thought: The American Heart Association and American College of Cardiology and similar organizations are great sources of information about certain medical interventions. However, while they have a basic understanding that smoking, obesity, sedentary lifestyles, etc., produce a lot of patients for their members, they tend to be rather uninformed about the evidence on changing human behavior or how social, economic, political, built environment and other forces influence health - and specifically who gets sick and who doesn't.
So try expanding your outreach to the CDC, American Public Health Association and groups like Active Living By Design that have expertise in human behavior and social determinants of health to find tips that go beyond the same-old drug and device stuff. For help getting to know the CDC website, download AHCJ's slim guide "Navigating the CDC: A Journalist's Guide to the Centers for Disease Control and Prevention's Web Site."
Don't get me wrong, I'm all for spicy stories about gee whiz medical advances and sweet tales of research ingenuity, but like salt and sugar, they shouldn't dominate the news diet. And they don't need to. There are piles of powerful and relevant health stories out there that don't begin and end with doctors in white coats.
Andrew Holtz, M.P.H., is a member of AHCJ's board of directors and an independent journalist based in Portland, Ore. He is a former medical correspondent for CNN, writes the ScriptDoctor column on medicine in the media in Oncology Times and is the author of three books that use popular TV shows to explore issues in health care.