My 15 minutes of fame.

The reporting of “medical news” has become an important part of the barrage of information available in print, in electronic media, and, of course, in the 4 billion or so sites on a Google search for health-related topics. My own brush with this phenomenon came about through co-writing an editorial1 on one of the most pedestrian issues that one can imagine: How much water should one consume each day above and beyond that dictated by thirst? We concluded that drinking excess amounts of water above that induced by thirst was not backed by scientific evidence, although the question had not been well studied. What I learned about the media and the reporting of health-related issues from this experience may be instructive to others who happen to have their work become the object of a press release and thereby stumble into the world of health reporting. First, I learned that there are at least three kinds of “journalists.” True reporters want to encapsulate scientific findings and pass on the information to an audience. They may ask a “probing” question but mostly will simply want to know the outcome of the study or the review and the significance of the findings. Second, there are the talk show hosts. They are quite innocuous, will mostly give you 5 min, will not really prepare to discuss the issues with you, and will be quite happy to fill some air time. If it is Australia, then the air time will be when you are typically asleep, however. There are some extended radio and television talk shows. Often these are on public radio or local cable stations, and here, too, the experience is quite benign and comfortable. Their producers may book another “expert” just to be sure you are not tongue tied or, worse yet, boring. Then there are the “health or medical reporters,” and they can be a problem. Health reporting has become a staple of television and print news, and it can be quite pernicious. Reporters often misunderstand the nature of research and the interpretation of scientific results. The nature of observational studies often leads to great confusion for the public, because journalists tend to treat every observational research study as though it actually creates a new “fact.” The result is often a complete muddling of the issue with an assumption that causality had been established. The investigators who performed the studies typically appreciate the limitations of their studies; health reporters often do not. Perhaps an even more unfortunate aspect of health reporting, particularly on the common “lifestyle” issues regarding what you should eat or drink or avoid, is the desire to abide by journalistic impulses to give credence to “both sides of the story,” even though, in many of these issues, one side is often the position of an advocate who has a large economic stake in his or her position. For example, one of the reporters of our study felt compelled to cite the opinions of Fereydoon Batmanghelidj. He apparently is, as described by the Wall Street Journal,2 “a controversial researcher who extols the benefits of water in two books, and calls relying on thirst to regulate hydration ‘the greatest tragedy in medical history.’ He and other water aficionados believe that by the time people feel thirsty, they are already dehydrated.” Other beverages, particularly caffeinated ones, according to this view, simply do not count. This is nonsense,3 but it gains credibility by the journalist’s mentioning it as part of the attempt at “balance.” Some of the counterarguments can, of course, have real validity. Michaud et al.4 found in a careful and important observational study that compared with individuals who drank less water than is typical, particularly those who smoke, individuals who drank large amounts of water (by self-reporting) showed a trend to lower rates of bladder cancer. What was found was that self-reported fluid intakes that approximate typical fluid intake in the United States reduce the risk for bladder cancer compared with low fluid intake. The reporter, however, described the results as follows: “For instance, a 10-yr study of nearly 48,000 men published in the New England Journal of Medicine in 1999 found the risk of bladder cancer fell 7% for every cup of water subjects drank per day.” Not exactly. One had to compare the risk for bladder cancer with those who drank unusually small amounts of fluid each day to show that incremental amounts of fluid were protective. The reporter’s efforts to show some expertise in the matter led to inappropriate conclusions. Of course, the investigators whom the reporter approaches may also inject their own biases in a forum that does not have the scientific rigor found in a peer-reviewed publication. An example of this phenomenon was one journalist’s citation of a study about hydration and blood viscosity. The study’s author told the reporter that “some fluids like juice have been shown to increase blood viscosity, whereas water decreases it, at least temporarily.” The health implication is that high blood viscosity may lead to vascular consequences such as stroke and that water but not juices may be beneficial to prevent stroke. The actual article found nothing of the kind given that it was an observational study and not a therapeutic trial. The authors of that study were careful to point out the limiPublished online ahead of print. Publication date available at www.jasn.org.