Skewed coverage of psychotropics

There are well known cases in which a scientific journalist has been criticized for conveying speculation as fact, eg, global warming¹ and immunizations.⁴ I am concerned we are experiencing this problem in the case of antidepressants and other psychiatric medications.

Depression poses an extraordinary public health problem and there’s a tremendous need for innovation in treatment and improved patient outcomes. Most scientific experts agree that we do not understand the pathophysiology underlying depression nor the mechanisms of action of antidepressants. But, as with many other medical disorders that are not yet clearly understood, clear professional guidelines for depression treatment are in place.⁵ These guidelines testify to the complexity of treating depression and unambiguously support the value of antidepressants as a major component of treatment. Guidelines such as these are derived from careful interpretation—a vetting process—of data. Participation in this process should not be limited to scientific experts, but the interactions required in the vetting process should be subject to rules of scientific inquiry.

A scientific journalist usually chooses his or her experts and sources at his or her discretion, free of the vetting practice described above. There are recent instances in which journalists have formulated innuendos drawing upon published research and “connected dots” that may not coincide with prevailing expert opinion.⁶ This kind of journalism poses profound implications for the public, especially when it runs counter to prevailing professional opinion.

One example can be seen in a blog from The Chronicle of Higher Education.⁷ John Horgan, a professional journalist, describes a friend who has a depressed teenage son and refers to the work of other journalists and selected experts to discredit antidepressants’ benefits. A quick review of readers’ comments demonstrates how articles like this one can mislead consumers to reject what may be the best treatment option for depression. When journalists draw their own scientific conclusions, rather than simply report on the conclusions reached by scientists, there’s a potential for misinformation and confusion.

Guidelines may help

What can be done about the potential impact of unvetted journalism on individual patients? I am not against an open dialogue about the risks and benefits of antidepressants, but given the complexity of the issue, I argue that anyone who wishes to voice an opinion via scientific journalism is obligated to follow the rules of the scientist—not the rules of the journalist—and participate in a thoughtful, balanced, and logical process that keeps the patient’s interests closely in mind. In Horgan’s case, he might have acknowledged that his friend’s son’s antidepressant discontinuation carried a risk of a negative outcome. That is, he could have mentioned the benefit side of the risk-benefit calculation.

Journalists should follow guidelines to prevent scaring readers into jumping to unilateral conclusions, stopping their needed medications and relapsing, or worse. There’s precedent for such guidelines. In 2001, several organizations collaborated to release “Reporting on Suicide: Recommendations for the Media.”⁸ A recent study found that these guidelines impacted journalists’ behavior.⁹ Similar guidelines should be developed for journalists who report on scientific studies related to psychiatric treatments. I welcome hearing case examples in which patients decided inappropriately to discontinue medications in response to reading news articles.

Bottom Line

By interpreting medical data to make it more interesting and understandable to readers instead of reporting on it, scientific journalists are affecting the public’s understanding of mental health issues, most notably the effect of antidepressants.   Scientific journalists who wish to voice their opinion should be obligated to follow the rules of the scientist, not the journalist. Guidelines for journalists who report on psychiatric scientific studies should be developed.

Related Resources

• U.S. Department of Health & Human Services. The Affordable Care Act, section by section.
  www.healthcare.gov/law/full/index.html.
• The New York Times Company policy on ethics in journalism. www.nytco.com/press/ethics.html.
• Pew Research Center’s Project for Excellence in Journalism. Ethics codes. www.journalism.org/resources/ethics_codes.

Disclosure
Dr. Glazer is a speaker for Merck and Otsuka America Pharmaceutical, Inc.

References

1. Carvalho A. Ideological cultures and media discourses on scientific knowledge: re-reading news on climate change. Public Underst Sci. 2007;16(2):223-243.

2. Centers for Medicare & Medicaid Services (CMS), HHS. Medicare, Medicaid, Children’s Health Insurance Programs; transparency reports and reporting of physician ownership or investment interests. Final rule. Fed Regist. 2013;78(27):9457-9528.

3. Pew Research Center’s Project for Excellence in Journalism. Ethics codes. https://www.journalism.org/resources/ethics_codes. Accessed November 21, 2012.

4. Smith MJ, Ellenberg SS, Bell LM, et al. Media coverage of the measles-mumps-rubella vaccine and autism controversy and its relationship to MMR immunization rates in the United States. Pediatrics. 2008;121(4):e836-e843.

5. American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder, third edition. https://psychiatryonline.org/content.aspx?bookid=28&sectionid=1667485. Published October 2010. Accessed November 21, 2012.