Image from PAHO’s collection Research on the Move,by Jane Dempster
What’s the issue?
People around the world are becoming increasingly interested in news of clinical research that will help inform their health choices and improve their lives, as patients get more and more involved in decisions regarding their health care [1-3]. The media is supposed to fill the gap that exists between the world of research and that of the general public; its job is to translate the findings into a language everyone can understand. However, health-conscious consumers of news stories oftentimes find themselves having to choose between contradictory advices or basing their decisions on news that contain factual errors or report partial findings. Usually the problem is not in how the original research is set up or conducted, but in how journalists are interpreting it and communicating it to their audiences [1, 4-6].
Research to Practice
Scientific news compete daily with a wide range of other types of news, so journalists feel the need to present them in a way that will capture the editor’s attention and create headlines that will sell. At the same time, hospitals, physicians, and commercial research institutions strive to get public attention [2, 7]. As a result, science is often sensationalized and portrayed in ways incompatible with its nature .
When reporting on health research, reporters should focus on evidence instead of opinion, without forgetting that “not all evidence is created equal” . In other words, just because a study has been published does not mean it was carried out with the required rigor, or that it took into account other intervening variables that may have led to the final outcome and may be affecting the reliability of the research results. Besides, different types of studies provide evidence with different levels of strength. In addition, journalists must be aware of possible financial and non-financial conflicts of interest that could be influencing a study’s conclusions.
Furthermore, in order to communicate scientific findings science first needs to be put in context and it is necessary to keep in mind that reporting on a single and new study can often be misleading. Research must be situated within the larger body of literature and compared to other studies that use different methods and populations, taking into account that scientific truth exists in context relative to past discoveries that are continuously subject to revisions [2, 3]. One way journalists can do this is by seeking out systematic reviews. A systematic review attempts to synthesize the best available research on a specific question after an exhaustive review of studies written on the same theme. The evidence selected in a systematic review meets pre-specified quality criteria that minimize bias, in order to produce more reliable findings that can be used to inform decision-making. A trustworthy source of health-related systematic reviews is the Cochrane Library, an online collection of databases that brings together rigorous and updated research [8, 9]. Journalists should keep in mind that systematic reviews of randomized controlled clinical trials offer the strongest level of evidence when reporting research findings.
In order to improve the way journalists interpret science to the public, they need to take into account the following. First, that correlation between two events is not the same as causality; so a cause-and-effect relation should not be implied from their association. Second, that science often finds itself in the world of probabilities, instead of in the world of certainties. Finally, given that most medical news stem from scientific studies, reporters need to have background knowledge in type of research studies, research methods, interpreting research results and analyzing systematic reviews, and they need to understand the difference between absolute and relative risks [1-4, 7]. These are a few elements that may help improve scientific coverage, but certainly not the only ones.
Lastly, it is important to acknowledge that the problem with scientific news stories is not just a journalistic problem. Not only do health researchers eager to feature their stories often use appealing headlines that may not completely reflect the results of the study, but their investigations are generally too complex for the common reader. Researchers can contribute by working hand in hand with journalists to write a good press release that simplifies the information and interprets it in the adequate context and by providing a space for reporters to ask questions .
Both journalists and the general public would benefit from the publication of information that is adequately framed and that shows awareness of the studies’ limitations. Reporters need to work hard to find and interpret the material on which they are basing their stories, while consumers could improve their understanding of a topic by comparing and contrasting sources and being critical of what the news present as facts.
To promote the publication of news stories consistent with scientific results and framed within the appropriate context, a number of watchdog blogs have been created. Their aim is to check the facts and critique science coverage . These blogs are created by journalists and for journalists, and provide a quality control that encourages fellow colleagues to strive to get it right the first time. “Blogs allow scientists to respond quickly to science news they may disagree with and to support their argument through stronger primary resources” . Furthermore, blogging promotes the creation of a knowledge-based and actively participant community, allowing for collaboration that ensures continual and immediate criticism of science research. Canadian journalist Julia Belluz’s blog “Science-ish” serves to illustrate these characteristics.
Institutions such as Harvard and Mayo Clinic also provide newsletters and news digests that are reliable and evidence-based. Another increasing trend is medical practitioners that wish to inform a broader audience through mainstream communication channels. The radio programs that Dr. Elmer Huerta has been producing since 1989 are an example of such trend. Dr. Huerta is the president of the American Cancer Society and the founder of the Cancer Preventorium at the Washington Hospital Center. These institutions and professionals often have an understanding of research implications and scientific issues that journalists may lack, and may be a key source for patients looking to inform their decisions on healthcare and lifestyles if scientific journalism fails to meet their expectations.
Acknowledgements: Daniella Restrepo wrote this case study. Eleana C Villanueva, Research Advisor, provided guidance and reviewed the case study.
Works Cited(1) Angell M, Kassirer JP. Clinical research -- what should the public believe? N Engl J Med 1994;331:189-190
(2) de Semir, V. (2010). Scientific journalism: Problems and perspectives. International Microbiology, 3(2), 125-128.
(3) Kere, J. (2013). Unfounded fear or hype? Communicating risk and progress [Video webcast]. Retrieved from http://www.youtube.com/watch?v=vMwfCrw1ib8&feature=youtu.be
(4) Luiz, O. (2007). Jornalismo científico e risco epidemiológico. Ciência & Saúde Coletiva, 12(3), 717-726.
(5) Belluz, J. (2013). CCC Evidence and public media [Video webcast]. Retrieved from http://www.youtube.com/watch?v=bmuy4mxVIhk&list=PL444961DCCCC60369
(6) WCSJ (2013). Misuse them and abuse them: fighting for facts in science journalism. Retrieved from: http://wcsj2013.org/misuse-abuse-them-fighting-facts-science-journalism/
(7) Johnson T. Medicine and the media. N Engl J Med 1998;339:87-92
(8) Campbell Collaboration (2013). What is a systematic review? Retrieved from: http://www.campbellcollaboration.org/what_is_a_systematic_review/
(9) The Cochrane Library (2013). About Cochrane systematic reviews and protocols. Retrieved from: http://www.thecochranelibrary.com/view/0/AboutCochraneSystematicReviews.html
(10) Putnam, L. (2011). The changing role of blogs in science information dissemination. Issues in Science and Technology Librarianship, (65), 4.
Last Updated on Thursday, 22 August 2013 09:19
Washington, D. C. Aug 7, 2013. We are pleased to inform that we have selected the winners of PAHO’s short-term subsidy program "Strengthening research capacity in the area of health policy and systems”. The program aims to strengthen research capacity in health policy and systems in Latin American and the Caribbean, particularly in the areas of financing, governance and human resources. More than 80 applications were received from 18 countries. Four projects were chosen by a panel of eight Health Systems and Policy Advisors based on the scientific quality, feasibility and pertinence of the project.
The winning projects are:
- What would be the financial reforms that ensure the best provision of equitable services in the context of universal health coverage. Researcher: Heitor Werneck;
- Governance and decision-making within the Chilean Health System: identifying strategies for its strengthening from health decision-makers. Researcher: Claudio Mendez;
- Estimación de la oferta y demanda de médicos de familia para el sistema de salud chileno. Researcher: María Paulina Rojas Villar; and
- Development of a Policy Framework for Universal Health Coverage in Trinidad and Tobago: Identifying Strategies to Overcome Implementation Challenges. Researcher: Edwin Vicente Bolastig.
Human Resources for Health, Bioethics and Research Unit
Department of Health Systems and Services
Pan-American Health Organization
Photos: In Bogota, pedestrian casualties to road traffic accidents were marked with a star in the pavement. Road traffic accidents are a leading cause of mortality and injury throughout Latin America. Images from PAHO’s collection Research on the Move, by Jane Dempster, (www.paho.org/artforresearch)
The Issue: Uncontrolled bleeding from Trauma Wounds
Injuries are extremely common in the developing world and lead to more than five million deaths there a year, which is approximately the number of people who lose their lives to HIV/AIDs, malaria, and tuberculosis combined (3). Many of these deaths are due to hemorrhaging or uncontrolled bleeding. Over 90 percent of trauma deaths in the world occur in low and middle income countries; and about one third of all in-hospital deaths from trauma specifically are due to hemorrhaging, which is made worse by the stimulation of clot breakdown during trauma (2).
Research to Practice: Tranexamic Acid to Allow Clotting; the Role of Collaboration
Tranexamic acid has been previously used to control the bleeding of those undergoing elective surgery. A group of researchers decided to investigate its effectiveness to treat uncontrolled bleeding in trauma patients, since nothing was known regarding the benefits or harms of its use in these injuries. This new clinical trial spanned 274 hospitals in 40 different countries. The trial compared tranexamic acid versus placebo in 20,211 trauma patients with significant bleeding. Treatment was administered within eight hours of the injury. Patients were only included in the trial if the doctor was uncertain as to whether or not to administer tranexamic acid. The results of this trial showed that tranexamic acid significantly reduced overall mortality, mostly by reducing death due to bleeding. Treatment was most effective if given soon after the injury. If tranexamic acid is given within 3 hours of injury it reduces the risk of bleeding to death by about one third.
In addition to the important results of this large trial, it also demonstrated the importance of collaboration. The clinical trial was conducted by the CRASH-2 collaborators, a network of research managers and researchers from different countries who were working together to determine whether tranexamic acid could also aid trauma patients; many of them had contributed to the earlier CRASH trial. These researchers were all trained in the proper clinical trial methodology. Now, these researchers are able to continue researching within this field or others. Through the training and collaboration of this trial, important information was obtained, and equally important was the empowerment of the researchers in the participating countries, and the creation of local capacities and networks.
What’s Next: Implementation and Use of Tranexamic Acid and Continued Capacity Building in Low and Middle Income Countries
Tranexamic acid has been found to be an effective treatment that reduces the risk of bleeding to death. In addition, tranexamic acid was shown to be highly cost effective in high, middle, and even low income countries (4). This makes it an important drug for countries with small health budgets that are afflicted with high rates of trauma (4). The authors of this trial hope that the drug will be made available to doctors treating trauma patients everywhere (2) and the international network is working together to ensure global dissemination and implementation of the results. However, more research should take place regarding the specifics, such as the role of tranexamic acid in traumatic intracranial bleeding. (1).
The international training and collaboration with researchers from around the globe should continue as a method of producing more comprehensive and relevant research to the betterment of all the countries in the world. This empowerment and capacity building will provide these researchers the respect that they need to continue pursuing their own research objectives and the research priorities of their countries. The training of research professionals in countries with varying resources aids in starting research programs all over the world. Different areas have different problems and need different solutions. By conducting widespread research, it is possible to determine these problems and work for specific solutions that benefit the countries where the research is taking place. Many of these studies would not be possible without the participation of countries from which the problem being studied is prevalent. Those countries that have the ability to supply the participants should benefit most from the findings of the study. Empowerment and capacity building are the initial steps toward creating long-lasting and vital scientific discoveries.
Acknowledgements: Stefanie Soelling wrote this case study. Luis Gabriel Cuervo provided guidance and reviewed the case study. Ian Roberts proof read the case study for accuracy.
1. CRASH-2 Trial Collaborators. Effect of tranexamic acid in traumatic brain injury: a nested randomised, placebo controlled trial (CRASH-2 Intracranial Bleeding Study). BMJ. 2011;343:d3795. [Link]
2. CRASH-2 Trial Collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2) a randomized, placebo-controlled trial. Lancet. 2010;376(9734):23–32.
3. Gosselin RA, Spiegel DA, Coughlin R, Zirkle LG. Injuries: the neglected burden in developing countries. Bull World Health Org. 2009;87 [Link http://ref.scielo.org/wstt6v]
4. Guerriero, C., Cairns, J., Perel, P., Shakur, H., Roberts, I on behalf of the CRASH-2 trial collaborators. Cost-effectiveness analysis of administering tranexamic acid to bleeding trauma patients using evidence from the CRASH-2 trial. PLOS One. 2011;6(5):e18987
5. CRASH-2 collaborators. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet. 2011;377:1096–1101.
Last Updated on Wednesday, 07 August 2013 15:11
Last Updated on Wednesday, 07 March 2012 05:37