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Lighting the way

Risk communication in the media must be well-balanced and well-presented if patients and doctors are to make informed decisions

A lighthouseThe communication of risk is a topic that has preoccupied people from all walks of life, whether economists, insurers, or financial analysts. In healthcare, risk/benefit analysis has been central to shaping and managing clinical trials, and the communication of risk/benefit ratios has been predominantly in the domain of scientists and medical strategists.

However, recent events have called for greater scrutiny of clinical trial information and, in the future, complex data and analysis will be readily available to all physicians and, critically, to the healthcare consumer. Following, is an exploration into the communication of healthcare risk and the implications of this new wave of transparency for healthcare communicators.

Towards greater transparency
The Vioxx debacle has prompted new US legislation that aims to expand the existing registry of clinical trials, while making a new national data bank of clinical trial information publically accessible. The Fair Access to Clinical Trials (FACT) Act of 2005 require all clinical trials to be registered in the database in order to obtain approval from the US Institutional Review Board.

Following in the footsteps of the FDA, the European Medicines Agency (EMEA) recognises the need to improve its own ability to follow up and monitor safety issues and is introducing a new law to come into effect as this article goes to print (November 2005). The legislation has powers that go beyond those of the FDA and aims to put in place a coherent approach to the detection, assessment, minimisation and communication of risk in Europe. Under this new legislation EMEA can demand additional safety and efficacy studies from pharmacos after a drug is on the market. So, a drug can be withdrawn, not only on the grounds of safety, but also if new clinical evidence indicates less drug-efficacy than previously thought.

This drive toward greater transparency is creating new channels of communication for clinical trial data. For example, PLoS Clinical Trials, an international, peer-reviewed, open-access journal will be launching in March 2006, and will publish clinical trials regardless of the direction of the results or perceived importance of the trial. The publishers, the Public Library Science (PLos), claim that the results of 50 per cent of trials remain unknown because only positive results are usually published.

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So what does all of this mean for the PR function? There is a flawed assumption that greater access to clinical trial data will lead to a better-informed patient community. This assumption underplays the enormous influence of the media in the translation and interpretation of risk/benefit information. This is the missing piece of the jigsaw and the area where PR is poised to have the greatest impact. But first, we need to examine how the media approach the reporting of risk.

How the media approach risk
It is worth reminding ourselves that the media have no obligation to present risks as a relative concept. Take for example, the reporting of transport issues: Travellers in a car are nearly six times more likely to die on the roads than travellers on the railways, while total deaths per year from road accidents are, on average, 500 times higher than deaths from rail crashes. Nevertheless, road accidents and road death - because they are seen as routine - fail to attract anything like the degree of media attention comapred to (relatively rare) railway accidents. (Health in the News, Risk, reporting and media influence, King's Fund 2003).

Healthcare is now a mainstream topic in the media, which has led to a huge appetite for stories that tend to polarise drugs into either 'hero' or 'villain', depending on whether the benefits of a drug or procedure are perceived to outweigh the risks, or vice versa.

In 2003, the King's Fund commissioned a paper, Health in the News - Risk, reporting and media influence, which posed the question: Is public interest well served by the media?

The Kings Fund report categorised conditions by a measure called deaths per news story. This analysis showed a huge variation in the actual risk and the news values of different stories. Ironically, reports on relatively small or unproven risks, such as BSE and MMR, vastly outweighed reports on such major killers as obesity and mental health problems. (Health in the News, Risk, reporting and media influence, King's Fund 2003).

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Among the suggestions for improving the reporting of risk were:

  • More robust handling of data analysis by news media - particularly by non-specialist journalists - in accessible terms, to help lay audiences put risks into perspective 
  • A better understanding (by experts, policy makers and media) of how the public perceive and interpret health risks 
  • A greater readiness to track patterns of risk reporting over time 
  • More skilful presentation of health issues by experts and policy makers for news outlets, with more focus on accessible language.

The extent of media influence
News reporting conventions encourage the juxtaposition of opposing views; typically from two experts who are both invited to put their side of the argument. However, this format may give an impression of balance that does not reflect the weight of the evidence.

For example, a survey by the Economic and Social Research Council showed that, although almost all scientific experts rejected the claim of a link between the MMR and autism, 53 per cent of those surveyed when the media coverage was at its height assumed that because both sides of the debate received equal media coverage, there must be equal evidence for each. Furthermore, stories about health risks are invariably communicated as human-interest stories and the balancing commentary containing the carefully worded scientific data about relative risk is often drowned by powerful visuals and anecdotes of 'real people'.

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The implications for PR

All things are not equal
To date, healthcare communicators have been able to direct journalists towards trial results that are significant and warrant media attention. In the future, the media's ability to self-select information will mean that we need to be on hand to assist them with the interpretation of trial information and, in some cases, persuade them of the merits, or otherwise, of a rogue publication or report. We need to ensure that the information over load does not dilute the impact of the more robust and more significant data..

Lost in translation
Our job has always been to translate technical data into meaningful information for our audiences. In the future, the sheer volume and availability of data will present new challenges. We need to ensure that we understand the intricacies of the data, to enable us to distil the information in a way that is not only clear for the media but also relevant for consumers.

We also need to find ways to educate the media on the concepts such as risk reduction and relative risk.

Ensuring media appeal
We need to work harder to ensure that 'Cinderella' conditions and public-health stories get the attention they deserve from the media. Research shows that psychiatric illness receives much less newspaper coverage than physical illness, and the coverage it does receive is four times more likely to be negative (Lawrie 2000). This means we need to find new ways of putting our stories across and that, for example, in the field of mental health, we need to overcome media prejudices by tackling them head on or connecting with journalists on a personal level. According to the King's Fund, news values are shaped by the priorities of the news organisation, its proprietor, or the personal interests of individual journalists.

Informed debate
Over and above this, as a profession we should be embracing the field of 'the communication of risk', and facilitating partnerships between our clients and the media, to lead the discussion on what constitutes best practice; to draw up guidelines or principles so as to avoid the 'hero' or 'villain' portrayals of the past (see table, above). As we move forward into an era of greater transparency, more than ever, there is need for a more informed debate about risk and ways of communicating it.

the author
Jennie Talman, managing director, Chandler Chicco Agency

2nd September 2008

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