Reporting risk—that's entertainment

When I was doctoring, cursing the media was part of the job—like moaning about the General Medical Council or the BMA negotiators. So when I announced that I was going to become a medical journalist, I was prepared for my fellow doctors to accuse me of betrayal and curse me by association. Instead, they cheered me on. I was their special agent going undercover into the enemy camp. Eight years later, here is my dispatch from behind the lines. Reporting risk in the media has been a tougher mission than I thought.

My most basic intelligence is that journalism—of any sort—is mostly about entertainment. Even news, science articles, or serious medical programmes have to be entertaining if they are to inform and educate, and in the struggle to engage people the journalist's favourite weapon is the story. That doesn't have to mean dumbing down; but human nature dictates that the best stories (think of juicy office gossip) are surprising, unusual, dramatic, or emotive and usually personal—all key ingredients of stories about, for example, killer bugs, the pill scare, and the measles, mumps, and rubella (MMR) vaccine.

Even when you are committed to covering a scare story (often because other media are), it is still possible to set out the real risks. But there is a feeling in news journalism that numbers are a big turn-off for the audience (unless you are talking money markets, for some reason). So although you might want to say early on in your report that the risk of venous thrombosis from such and such a pill is 30 per 100 000, compared with 15 per 100 000 from another type of pill, the snappy headline usually ends up as “Pill doubles risk of blood clots.” You can sneak in the comforting statistics later on, but the seed of worry has already been sown.

Numbers are a big turn-off for the audience

I used to be a big fan of comparing health risks to the every day gambles that people are more used to grappling with. I even drew up a list: the risks of crossing the road, flying in a plane, or winning the lottery. But I would not have been comparing like with like; the stakes are different. As my wife's general practitioner commented on our baby's 1 in 150 risk of having Down's syndrome, “You wouldn't back a horse at those odds, but if the chances of a plane crashing were that high, you wouldn't venture further than the airport car park.”

Figure 1.

In the struggle to engage people the journalist's favourite weapon is the story

Credit: KOBAL: STILL FROM FILM THE WORLD BUSINESS

I have always felt more comfortable reporting the less “sexy,” bread and butter of real medicine—breast lumps rather than bacterial meningitis. But there is still a duty to entertain and engage the audience, so we often include the patient's voice. The human interest story can work beautifully but it is virtually impossible to find one patient, or even a handful of patients, who can represent the real spread of experiences of a disease. And once you have heard the moving story of a woman who noticed a breast lump in the shower and went on to have a mastectomy, how reassuring is the expert guest who reminds you that 9 out of 10 breast lumps are actually benign?

One of my other duties as a journalist is to try to be balanced; to represent fairly both or all sides of a debate. So in a discussion about the risks of living near electricity pylons, for instance, there might be a debate between a public health expert reflecting the overwhelming scientific evidence that it is safe and a mother who is convinced that the pylon was to blame for her child's leukaemia. No contest. The expert comes over all clusters and p values, the mother is a real person with a moving story about a child. Well meaning experts can also send out confusing messages about risk just by virtue of their scientific pedigree. It is a rare scientist who will stick his or her neck out and say that pylons are “safe” if there is any risk at all, however small. I don't blame them.

So how can journalists ensure a realistic balance? Some would say that we should deny the anti-pylon lobby groups of this world a voice at all since they are non-expert minorities. Or perhaps give them only a few seconds out of the 10 minute discussion to reflect the balance of opinion? Or only invite pro-pylon experts who are really engaging speakers—a bit like hiring the top barrister? No matter what my personal opinion on the issue, I cannot spin debates in that way.

I don't want to sound like an apologist for bad journalism. I have just found it interesting that even with the best of intentions, reporting health risks in the media is a bit of a minefield. My best guide as I tiptoe through it is the memory of those patients that I used to see in the surgery, worrying themselves sick over a “good story.”