Archive for September 2011
By: Rebecca Cerio
Science policy demands, at its very core, communication of scientific information. Making sure that science is distributed to and understood by the people who need it, whether they be politicians or the public at large, is the interface where science policy meets science journalism.
Communicating science to the public can often be a challenge. Science is a highly specialized, highly technical field, and science journalists often summarize the science involved in new findings for brevity, clarity, and that elusive “interestingness”. However, there are always examples of editing gone too far: experimental designs mangled, quotes cherry picked out of context, conclusions and significance misrepresented. It’s easy for scientists to roll their eyes, shake their heads, and blame it on journalists who don’t understand science.
However, a recent discussion started by David Kroll on PLoS Blogs has pointed out that sometimes it’s the scientists who don’t understand journalism.
In one camp are the scientists. Scientists’ main experiences have often been with scientific publishing, where everything is peer reviewed, properly qualified, and fact-checked to death. Inaccurate media articles about science often strike them as embarrassing and/or frustrating. After all, obviously the journalist didn’t understand the science and didn’t care enough about their article to fact-check it with the scientist they were interviewing. This is often seen as a failing of the journalist and of the editor that let the article be published.
On the other side are the journalists, who argue from a completely different place. In the comments on the Kroll post, George Johnson laid bare the crux of their argument:
The ethics that have been instilled in me over many years is that it is forbidden to show unpublished copy to a source and that getting approval for the speaker’s quotations is a violation of the professional standards of journalism. [emphasis added]
The source has already given blanket approval to use anything she might say when she agreed to go on the record. Nothing more is needed. Also, journalists are there to take facts and turn them into a story for their audience. They are under no obligation to write something that the source likes. In fact, taking a finding and reporting it in a way that the scientist might disapprove of (for instance, quoting a vaccinologist in an anti-vaccine piece) is their right. It’s what freedom of the press is all about. Why should scientists get the right to fact-check (and possibly influence) stories when, say, politicians do not? If journalists allowed their sources to influence their writing, that would inject the source’s bias into the piece.
Science journalist and popular blogger Ed Yong argued both sides of the issue in his reply to Kroll about fact-checking in science journalism,
The downside of doing this is that some people start asking for wholesale changes, tonal changes, or start going back on what they actually said (and meant).
The upside, and I think this is significant, is that while journalists can fact-check specific things, we don’t always know the ways in which we can screw up. Unknown unknowns, and all that. An innocuous choice of word can make a sentence completely wrong and it can take an expert’s eye to spot that.
In a very real way, this entire debate is a value judgment between scientific freedom and journalistic freedom. Scientists want the freedom to have their work reported accurately, while journalists want the freedom to interpret the facts and present a story without interference. Everyone can agree that there is a balance to be struck. Finding this balance will minimize the possibility for inaccurate and biased reporting and raise the bar for science writing.
Practical suggestions from all sides for finding this balance include going to an independent scientific source for fact-checking, allowing a source to fact-check only relevant portions of the copy, or simply being alert for and resistant to attempts to alter the article’s tone or conclusions in the source’s suggestions. According to John Rennie‘s comment on Kroll’s post, the decision ultimately lies with the journalist. His opinion?
Sources can ask for any changes they like. I’ll only make ones that I think are right for the story. If writers aren’t prepared to stare down their sources over that principle, they shouldn’t be sending sources anything.
By Brenda Kostelecky
Chronic illness is the most common reason people seek healthcare in the United States (1). Unfortunately, while the American healthcare system is often well equipped to treat acute injury and disease, it can be poorly suited to those with chronic conditions. Since the number of people with such conditions will increase as the American population ages, improving healthcare quality for patients with persistent conditions has become a key objective for many policymakers.
One of the major reasons people with chronic illnesses get short shrift is that financial incentives are heavily skewed toward acute care treatment (1). Healthcare plans tend to provide better coverage for treatments where the patient shows consistent, measurable improvement. Such improvement is not necessarily possible for chronic conditions and may not even be the goal of treatment. Instead, slowing disease progression or maintaining a patient’s status (e.g. maintaining mobility with physical therapy) may be the only option available given the current state of medical science. Without adequate coverage for (and therefore access to) such treatments, chronically ill patients’ conditions often worsen and ultimately become more expensive. Another issue that disproportionately affects the chronically ill is that few healthcare plans offer reimbursement for time spent coordinating between care providers. This lack of financial incentive to coordinate care is particularly troublesome given that an average Medicare beneficiary with at least one chronic condition sees eight doctors per year (1). Lack of coordination frequently results in chronically ill patients receiving duplicate tests, differing diagnoses, contradictory advice and incompatible medications from different healthcare providers.
Several healthcare models aimed at treating chronic illnesses have demonstrated improvements in healthcare quality as well as reduced costs. One such model, the Medical Home Model, has been tested over the past 40 years in 100 diverse individual demonstrations (2). A medical home is defined by the Congressional Budget Office as a “clinical setting that serves as a central resource for a patient’s ongoing medical care” (3). Fields, Leshen & Patel identified factors common to seven successful medical homes and pinpointed four core elements these homes use to enhance efficiency and prevent complications (2). First, in all successful medical homes studied, a well trained, non-physician professional was specifically designated to coordinate care for an appropriate load of patients. Second, patients had round-the-clock access to providers to answer health questions and prevent avoidable emergency room visits. Third, the successful medical homes enhanced their use of information technology to track and monitor patients, evaluate practitioner performance, and predict which patients were at high risk for complications. Finally, a system of effective payments to incentivize coordinated care was implemented. These payments weren’t necessarily large and many successful programs didn’t offer significant performance pay.
Successful medical homes provide promising evidence that improved chronic care quality and cost reduction can be simultaneously achieved. However, there are many important challenges that lie ahead for policymakers. Scaling up and standardizing new healthcare systems from individual demonstrations will be complex; successful systems will need to suit urban and rural areas, regions with many non-native English speakers, and areas with large aging populations, etc. Policymakers need to identify which elements of model healthcare systems truly add value and focus efforts on implementing those pieces of the puzzle. It will also be challenging to provide financial incentives such that the proven value-adding elements are effectively utilized. The Patient Protection and Affordable Care Act (PPACA) of 2010 gives federal support to alternative healthcare models including medical homes. PPACA includes provisions to test new delivery and payment models and stipulates that resources for medical homes be provided for Medicare and Medicaid. If federal support continues, there is good reason to be optimistic that substantial improvements in chronic disease care quality can be achieved hand-in-hand with slowing the relentless rise of healthcare costs.
- Anderson & Knickman. Changing The Chronic Care System To Meet People’s Needs. Health Affairs vol. 20 no. 6 (2001):146-160.
- Fields, Leshen & Patel. Driving Quality Gains And Cost Savings Through Adoption Of Medical Homes. Health Affairs vol. 29 no.5 (2010):819-826.
- Congressional Budget Office. Budget options, volume 1: health care [Internet]. Washington (DC): CBO; 2008 Dec [cited 2010 Apr 10]. Available from: http://www.cbo.gov/doc.cfm?index=9925.