University Times

Where do you get your medical information? TV? Newspapers? The Internet? Periodicals? Word of mouth? Advertising?

In an era of proliferating mass media outlets, which sources should you trust for accurate health and medical information? How do you distinguish reliable news from false or incomplete information propagated by those with hidden agendas?

Representatives of local print and television broadcast media, along with a Pitt/UPMC medical news public relations specialist, teamed with an expert on the impact of mass communication to confront those questions during “Making Medical Headlines,” which kicked off the seventh annual Mini-Medical School 2006 lecture and discussion series sponsored by Pitt’s School of Medicine.

Speakers were: Lisa Rossi, associate director of the UPMC/Health Sciences News Bureau; Anita Srikameswaran, medical and science writer for the Pittsburgh Post-Gazette who holds a medical degree from the University of Manitoba, Canada; Mary Robb Jackson, veteran general assignment reporter for KDKA-TV, and Brian A. Primack, assistant professor of medicine at the Pitt medical school who has researched the effects of mass media messages on health.

According to Primack, there is a real societal danger to health from misinformation, because human beings, particularly youth and adolescents, are so susceptible to persuasive visual cues, both consciously and unconsciously.

To prove the point, he displayed the 26 letters of the alphabet in different typefaces associated with common products and asked audience members to identify the products. Most people were able to do so.

“What we saw here is how incredibly easy it is to convey information in little tiny persuasive sound bites,” Primack said. He said he was not surprised by the depth of the indoctrination, given that the average adult spends 15 years of life watching TV.

“You were able, by just looking at a letter and perhaps with a little splash of color, to have words roll off your tongue that don’t even belong in the English language: ‘Pepsi,’ ‘Oreo,’ ‘Jell-O,’ ‘Eggo,’ ‘M&Ms.’ When was last time you had an Eggo? Maybe never. But when you see that particular ‘E,’ it just pops into your head.

“Do you remember the slogan for Eggo waffles?” he continued. “That’s right: ‘Leggo my Eggo.’ Of those of you who knew that, how many of you are ashamed that that information is taking up brain space right now?” he joked.

While that exercise was relatively harmless, the exposure to visual cues that continuously bombard undiscerning citizens has a decidedly dark side, Primack said.

“For example, we’ve known about the dangers of smoking for about 50 years, and yet it is still the leading cause of preventable death in this country,” he said. “And we now know that the most important risk factor for adolescents starting to smoke is not parental smoking, not peer smoking, not rebelliousness, not sensation-seeking but exposure to smoking in movies.”

Visual symbols enter the eye and go directly to the optic lobe, the part of the brain that processes visual information and that is connected with the emotional response system, bypassing the frontal lobe, that is, the thinking part of the brain, Primack said.

“What you end up having are emotional appeals that suggest that smoking is associated with power, relaxation, sexuality — exactly the myths that teens believe when they have that first cigarette. Our adolescents are receiving their ‘health information’ from movies, not from the information we attempt to give them in their classes, and the results are over 440,000 deaths a year, about 40,000 of which are from second-hand smoke.”

Similarly, alcohol advertisement is geared to adolescents because marketers know that those who start drinking at age 15 are four times more likely to become alcoholics than those who take their first drink at age 21.

“It’s no wonder that our 8-12-year-olds can name more brands of beer than they can name U.S. presidents,” he said.

Primack then displayed for the audience a print ad for Lipitor, a drug commonly prescribed for high cholesterol.

“This is pharmaceutical advertising that masquerades as health information,” Primack maintained. The actual information on ingredients, dosages, side effects and other considerations is buried in fine print and contrasts with a serene picture that dominates the image, he said.

“The message is that there are dark clouds looming in front of you, clouds of high cholesterol, of heart attack, of death. But guess what? If you take Lipitor, you can put your feet up and just enjoy the cool, blue water,” he said.

“Is Lipitor a good drug for some people? Absolutely. I have a lot of patients on Lipitor. It is it the right drug for everyone? Absolutely not. The excuse for this form of advertising is, ‘What’s wrong with telling the public about potential benefits? They’ll then go to their doctor and together they’ll figure it out.’”

What’s wrong is that the consumer will take as fact what is really the advancing of an agenda for higher pharmaceutical sales, he said.

“And when we’re talking about multi-faceted, complex information like medical stories, you realize just how incredibly complex it can be to accurately report medical information even when you are trying your absolute best to do so and you’re unbiased. This kind of information has to be processed in the frontal lobe, in the pre-frontal cortices, in the more complex thinking parts of the brain,” Primack said.

The other discussants generally agreed with Primack.

KDKA-TV’s Jackson said, “People are more influenced by the visual, but the point is to really weigh what it is you’re seeing, and most of us don’t do that. Also you can’t just rely on one source. That’s really true on any subject, not just health and medicine. There’s the Internet, there are newspapers, magazines. And for something that affects you personally, you should talk with your doctor.”

As a general assignment reporter, Jackson arrives at work each day with the pressure of not knowing what her next project will be. “I love my job because every day is such a mystery,” she said.

“Thirty years ago I was taught that the perfect news story had one of the following: tips, tots, vets or pets,” Jackson said. “Now I guess we can add docs or meds.”

According to Science magazine, health stories rank third in network coverage, and health news tops the list of the number of stories read by those over 50, Jackson said.

“In my typical day, I get an assignment and I have to find experts who can talk about the research. I always try to personalize the story, to get a patient to talk about a condition, for example. I’ve researched it, done interviews, edited copy, videotaped and the story is shown on the evening news that day.”

She also has limited air time, usually 90 seconds to pack everything into a report.

“But the amount of information is enormous and many times conflicting,” she said. “I had a researcher tell me years ago that hormone replacement therapy for women was nirvana, the best thing since sliced bread. But over the years, that’s been shown to be not the case.”

In another instance, a study in the late 1990s on two drugs published in the Journal of the American Medical Association (JAMA) reported that the drugs could be a cure for all cancers.

“If it’s in JAMA we should be impressed, right? Not so. For one thing, time changes the subject as new research is done. So you always need to have your [skepticism] detector working. I urge you to learn if boosterism is involved in the research. Learn which studies are tied to which drug companies or other vested interests,” Jackson said.

Srikameswaran of the Post-Gazette said, “In [daily] print media it’s hard for us to capture the broad view and work it into something that people will want to read, to still bring in a personal interest. But if we reported on a research study before, and something comes out that conflicts with that, we try to follow up and say this is updated information. One study said this, but this new study said that. And if there’s a conflict of interest to acknowledge that.

“One of the things we always do is to look at where the information is coming from. So one of the reasons you see a lot of stories that report on studies in journals is because that means the information has been peer-reviewed, that experts have okayed it.”

Other questions to ask include: Where were the findings published? How many people participated in the study? What are other people’s thoughts on the study?

“I’ll also often turn to the NIH (National Institutes of Health), to government sources, medical literature searches,” to look for confirming or conflicting information, she said.

Rossi, who described her job as facilitator between researchers at Pitt and UPMC, and the various local, national and international media organizations that cover stories on medicine and science, told the audience, “You need to be aware of potential conflicts of interest. That needs to be weighed by the reader. And we need to be transparent about that,” citing, for example, sources of funding for research studies, she said.

“My job is to increase awareness about our programs and services, which enhances the institution’s national reputation,” Rossi said. “But we represent the interests of the organization’s faculty and patients; we don’t work for the media.”

She and news bureau colleagues spend most days determining what is newsworthy, asking whether people are going to care about the news and wondering whether or not it will get coverage. “We identify and communicate stories, loosely defined as useful, interesting and important information. We usually focus on newly published research findings, new research programs or clinical services, major funding or awards and stories of human interest.”

Her group also focuses on hot topics such as avian flu, and on new or emerging trends either in research or in the delivery of health care, she said.

Rossi writes press releases that are cleared for accuracy by the researchers themselves, fills media interview requests and pitches story ideas to the appropriate media outlet. “I do a lot of ‘selling,’ but I also believe in what I’m selling,” she said.

But her power is limited, she noted. “It’s a common misconception that we can control a news story, guarantee a placement or make sure it’s run as a puff piece. That is not the case at all,” Rossi said. “But we can influence the news. A well-written news release can affect if and how a reporter covers a story.”

She defined a good news release as being clear and succinct, not overstating or fabricating information, providing context, addressing key questions and simplifying complicated subjects — all in an interesting, compelling way.

“We also compete with other organizations that are trying to get their news releases reported,” Rossi said. “Reporters can’t cover every story, so timing is everything. But we have no control over their end: An editor can nix the idea or can the story.”

Or, rarely, editors make an error that finds its way into the public domain.

Years ago a well-known AIDS activist had come to UPMC for a liver transplant and the Associated Press, in a headline, reported that he had died. “In the paragraph right under the headline it said he was recovering in the ICU,” which was true, Rossi said.

In another example, a national magazine placed the University of Pittsburgh in Philadelphia, she said.

“I offer these examples not to be critical, but to show that we all share in the responsibility to be accurate in presenting our information,” she added.

The April 18 discussion was moderated by Margaret McDonald, Pitt associate vice chancellor for academic affairs in Health Sciences.

Mini-Medical School 2006 events are scheduled for every other Tuesday evening from April 18 to June 27.

The events are free and open to the public, but pre-registration is required (www.minimed.pitt.edu or 412/647-UPMC, select option No. 1).

—Peter Hart