Global health funding goes awry, but the media doesn't care

I wanted to point this out because this combines my two pet peeves about American media: lack of proper coverage of science, health and medical stories, and little, if any attention to significant international issues.

This story is big as far as global health issues go. It is about two studies – one by the WHO, which examined the impact of UN health programs in underdeveloped nations, and another by University of Washington and Harvard researchers, which looked at ways in which money from such programs is being spent.

The studies point to evidence that suggests that accelerated UN initiatives can actually be harmful to certain countries (like some African nations), which slash their own medical services on account of availability of international aid.

They also show that the amount of donations a country receives is not proportional to the gravity of the health crisis there; in other words, certain countries (like Ethiopia and Uganda) that receive significant amount of aid actually have fewer health issues than many (like Nigeria or Pakistan) that don't get sufficient financial help.

The most disheartening find was that the money wasn’t really helping in many poor nations because the UN was merely trying to resurrect ineffective health systems that were already in place, but were not really working.

Sanhita Reddy points out in the Columbia Journalism Review that these studies were hardly reported in mainstream newspapers and Web sites in the U.S.

A Wall Street Journal blog reported just half the story, giving a rosy-eyed picture of the quadrupling of global health funding, without detailing the observation that the money isn’t helping as much as it should.

Surprisingly, an article in the Seattle Times was perhaps one of the the most comprehensive reports of the findings in a newspaper. After going over the numbers and results, the piece actually elucidates on what the waning significance of organizations like the WHO and UNICEF might mean for global health since more money now comes from NGOs and private donors.

Not so surprisingly, a business magazine (Forbes) and a science magazine (Scientific American) had the most expansive coverage of the studies.

Thank goodness for niche journalism!

Talking of which, the CJR piece is obviously more expansive than mine.

The media pandemic

In the last couple of days my daily news diet has consisted of letting the morning broadcast blare in the half hour it takes me to get ready and out the door. It’s safe to say that about 20 minutes of the half hour has been about the swine flu.

The media are always looking for that next big issue to rally around; they need to cover airtime, we get it, and they’re not always blessed with a Specter defection or a Biden gaffe or the 100-day itch. Unfortunately or fortunately, it’s easier to see through this thick fog of media hype when it’s a political incident blown out of proportion, but a lot harder when the story deals with a less familiar topic – the two subjects that always come to my mind as big media nemeses are the economy (granted, the media wasn’t alone in this), and the haze that surrounds scientific or medical news stories.

In their urge to get the story out there, fast and loud, journalists don’t ensure if the hype is indeed proportional to the facts. Going by the swine flu coverage it would be hard to believe that the death rate from this flu is the same as that is to be expected from most flus, and that people who have been treated are responding to medication.

Social networking sites, for all their advantages, help feed the frenzy. Swine flu has been among the top three trending tweet topics this week. Of course, blaming Twitter for what people choose to tweet about is sort of like blaming Google for the content it spits out from all across the Web. But even so, a tweet a second about the flu doesn’t help calm down the already disproportionate furor. Including glaringly false Twitter posts like this one: “Swine Flu Confirmed Cases in Mexico is about nearly 3,000.”

Simon Jenkins makes a good point in the Guardian that the death tolls from ongoing wars or a real epidemic like AIDS – which take way more lives than the swine flu ever will – are hardly given the emphasis that a “sudden” outbreak like this one is. This goes back to the age-old media problem: information only attains the status of news when there is an “event” – usually something that is abrupt and unexpected - and when that does happen, the press focuses on the event without covering the context or big picture. Instead of going on and on about the numbers and possible escalation and inevitable doomsday, journalists could have taken this opportunity to talk about larger issues – as Erik’s post did on problems with the meat industry, livestock farming and disease.

What makes this press frenzy nearly pointless is that despite the widespread coverage of swine flu, as Jenkins notes, there are very few steps one can take to consciously reduce the chances of getting it (unless you follow Biden’s advice and lock yourself up in your house, avoiding subways and planes, and well, air).

On the other hand, there is a lot one can do to keep from getting more serious illnesses like AIDS with more difficult modes of transmission where large scale paranoia could actually drill sense into people and save lives.

I don’t intend to belittle this outbreak – of course, the swine flu is significant – it has taken over a hundred lives in Mexico, is spreading rapidly in several countries around the world, and the WHO has raised its pandemic alert level to 5. People should be made aware.

However, the simple truth is that there can’t be much of a preparedness plan against bugs that spread through aerosols and constantly change their surface structure to avoid immune responses.

Richard Besser of the CDC put it best: “microbes don’t read the plan, and you need to move away from the plan pretty soon after day one.”

Putting this in the context of incalculable risk, Ben Goldacre explains – amazingly – why it is almost impossible to assess how much of a risk this could – or could not – be. Hence, according to him people should neither be casting the swine flu as an unstoppable epidemic nor dismissing it as too much hype.

But that’s what the media does – it predicts, and innovates and foretells, be it the result of a presidential election, the length of an ongoing war, or the number of people who are going to die from swine flu.

Where predictions should have been happening is in the scientific community. As this New Scientist article explains, North American pigs have been incubators for these flu viruses for years, and scientists should have seen it coming. Since the late ’90s, the viruses have been evolving by mixing with different strains of human and bird flu viruses, which have made them more virulent. Since its genetic makeup is so novel, it is harder for the human system to target an immune response to.

There is a very real fear that this flu could become a pandemic considering its ease of transmission. But there is also a possibility that this virus - like many viruses before it - may peter out because it may not be able to survive and spread in humans.

No one knows. The media should not be pretending that it does.

That wide schism between science and journalism

Having been in scientific research for almost a decade, it always appalls me to hear science reporters make sweeping generalizations and oversimplifications on television. While this is by no means confined to broadcast news, the most erroneous bits of science information do come from soundbites of so-called experts called upon to enlighten lay audiences about complex scientific topics, usually on the pretext of an equally poorly-reported study in a newspaper. Unfortunately most scientists aren’t listening to that news report and most laymen aren’t schooled to realize that it ranges from anywhere between mildly misleading to dangerously inaccurate. This article in today’s Washington Post, which distinguishes between evidence and opinion in scientific reporting, is illuminating.

The biggest problem in science reporting, as I see it, is that scientific studies rarely have enough evidence to make categorical conclusions. Journalism, on the other hand, is all about conclusions; journalists are trained to jump to conclusions long before all the relevant facts are available – think of all the speculation and analysis and hearsay and exit polls that gets widely reported in mainstream media as if it were indistinguishable from fact. "You are making news here," Chris Matthews often cries after doggedly challenging a political strategist to make a prediction about an election result that is months away.

While a political pundit’s word is as good as news in politics, no research will be published in the journal Nature because a Nobel prize-winning scientist “thinks” something might be true (notwithstanding the in-high-places-prejudice that exists in academic research).

As David Brown is attributed as saying in the Post piece, science reporters have to take excessive care not to make foregone conclusions. They should be able to give the reader sufficient facts and background on all the evidence that is available on a given subject, and follow up, as research progresses. A reporter should spend less time telling a reader what to conclude from a study and more time detailing the evidence available so that the latter may be allowed to make his own conclusions.

A good example of the really shoddy reporting that happens in science is a recent reportage of a study that found links between areas with higher rainfall and the prevalence of autism. All the study really concludes is that potential environmental factors linked to precipitation levels might, when combined with genetic and behavioral influences, cause an increased incidence of autism. As Ewen Callaway notes in the New Scientist, headlines in newspapers ranged from Heavy rainfall could be linked to autism to -- appallingly -- Autism: Blame it on the rain.

This is not to say that this problem with opinions overriding evidence is not existent in other areas. For better or for worse, it is more clearly visible in science reporting, I think, because science so steadfastly relies on hard data and factual evidence. Every result you ever report has to be tested, refuted, challenged, reproduced and proved beyond doubt to be true. “That could just be an artifact,” my professor would say in graduate school, after my fifth consistent reproduction of an experiment. Inspite of this ruthless insistence on accuracy (one that among many other things prompted me to quit science), nothing you read in a peer-reviewed science journal can be taken as the gospel truth (boy, do gospels have it easier).

For every successful experiment in science, there are usually a dozen failed attempts, about two-dozen repititions, and a hundred contradictory results published elsewhere. Then there are a whole slew of exceptions, conditions, factors, and biases that might have influenced the results.

So, while it might be sensational and eye-catching to report that rain causes autism, it is far from the truth. “Environmental factors related to precipitation might contribute to autism,” is less exciting but closer to the truth, and might prevent a potential mass exodus from Seattle.