Policy lets many see study but restricts reporting
On his new blog, Embargo Watch, Ivan Oransky, M.D., writes about an embargo policy that restricts journalists from writing about papers even when they are widely available to doctors, medical schools and hospitals.
Oransky, who is treasurer of AHCJ’s board and executive editor of Reuters Health, has written about embargoes before for Covering Health and TheScientist.com, questioning whether embargoes are serving the public, the scientific journals or journalists.
In this case, The American Journal of Respiratory and Critical Care Medicine placed an embargo on a study it made available “through HighWire, a Stanford University service that many publishers use to make electronic versions of their journals available.”
This was a new one for me. Embargoed papers not being available to anyone but the press, sure. But available to many doctors — and anyone doctors showed them to — for two weeks before we could write about them?
Oransky discussed the policy with the director of communications and marketing at the American Thoracic Society, which publishes AJRCCM, and reports on the response from him as well as from other public relations professionals and reporters.
One particularly interesting comment points out that investors are likely seeing studies release on HighWire, perhaps giving some an unfair advantage financially.
Oransky: Find sources with outside perspective
AHCJ Treasurer Ivan Oransky, M.D., who’s also the executive editor of Reuters Health and a teacher at NYU, stopped by Ed Yong’s “Not Exactly Rocket Science” blog to offer his tips for finding sources when reporting on studies.
Oransky writes that the key is to focus on a source that provides outside perspective, not just on a source that provides an opposing viewpoint. Sometimes, Oransky says, that outside perspective will simply reinforce what the study’s authors have said. And there’s nothing wrong with that.
He also gives practical directions for finding knowledgeable sources, with specific suggestions both for reporters on deadline and for those who have the luxury of reporting things out a little.
Oransky: Medical study embargoes serve whom?
Embargoes, a fairly frequent topic of discussion on Covering Health, seem to bring out strong feelings in some people.
In one recent example allegedly involving embargoes, TheStreet.com’s Adam Feuerstein attempted to combat a rumor that the New England Journal of Medicine would be publishing an article about the experimental lung cancer drug seliciclib - a rumor that was seemingly driving up the stock price of Cyclacel Pharmaceuticals.
Feuerstein looked at his advance copy of NEJM and reported that no such article was coming out. He was immediately accused by a commenter on the story of having broken the NEJM’s embargo.
Photo by Billingham via Flickr
As Reuters Health Executive Editor - and AHCJ board member - Ivan Oransky asked, “Is saying what’s NOT in an embargoed journal breaking the embargo?” Oransky concluded that it was not a case of breaking an embargo. The ensuing discussion on Twitter and in the comments on Feuerstein’s article is interesting. For the record, the NEJM apparently sided with Feuerstein, according to a commenter on the story.
Today, Oransky weighs in on the wider topic of who is served by embargoes on medical studies:
Two weekends ago, at ScienceOnline2010, I heard an interesting thing about embargoes. Connie St. Louis, who directs the science journalism masters’ program at City University, London, told an audience that one of the reasons for embargoes on scientific journal studies is that with more eyeballs on the study before publication, it’s more likely researchers will catch flaws in papers, which can then be pulled.
In other words, just as the FDA requires drug companies to monitor drug side effects in large populations once a drug is approved, in what’s called post-marketing surveillance or phase 4 testing, because such side effects may not show up in relatively small trials, this is a sort of post-acceptance peer review. So if a reviewer doesn’t catch an error during the normal course of peer review, journals can use the embargo period as a backstop.
I hadn’t heard that before, and I consider myself fairly well-acquainted with the arguments for and against embargoes. But it reminded me again that for all the talk of embargoes serving the public by allowing reporters to write more-informed stories, there are serious questions about whether journals are the group that gains most from embargoes.
As it turned out, I was in the midst of another episode that reminded me of that. Last week, the Cochrane Library published their quarterly set of reviews. Among them was a review of whether opioid drugs, when used as prescribed, carried a high rate of addiction. Cochrane researchers found that they don’t. That’s not the biggest research finding ever, but when you run a health news wire service filled with dozens of stories a day, like I do, it’s something worth covering. Plus, opioid dependence remains a big issue, for celebrities and lawmakers alike.
That study was embargoed for 7 p.m. Eastern on the 19th. Around the same time I was reviewing it, the Annals of Internal Medicine press packet hit my desk. That packet — embargoed until 5 p.m. Eastern Monday the 18th — included a paper that said high doses of opioids, even if prescribed, increased the risk of overdose. Again, not the most shocking study ever, but researchers and advocates continue to debate whether these drugs, when used in prescribed doses, are dangerous.
I figured the best way to serve our readers would be a story that included both of these studies, both as context for the other. Trouble was, if I ran one based on the Annals study, I couldn’t mention the Cochrane review. And if I waited for the Cochrane review’s embargo to lift, a competitor might run the other story. (Yes, we think about these things.)
So I emailed Jennifer Beal, who runs media relations for the Cochrane Library’s publisher, Wiley, explaining the situation, and asking her if she would consider moving the embargo. She returned my message right away, saying politely that she couldn’t, and explaining why, in a message that I found thoughtful.
“We thought about it very carefully but felt that our guiding principle with embargoes is that we are giving media an opportunity to investigate a story fully without the pressure to publish immediately, so that the story is still ‘new’ on the day the research gets published, and is therefore available for public consumption,” she wrote. “If we were to agree to a moved embargo, it would mean that you…would be writing about a story where the research was not available for the public to read if they wish and make up their own minds.”
The opioid study, she noted, was “one of approximately 160 articles publishing on Wednesday; this is a big operation where the publication schedule is planned out a long way in advance, so it is not possible to move forward the publication date.” (In a long-planned move, Cochrane is now going monthly, which will distribute the reviews more evenly.)
Based on resource constraints, I decided we could only run one story on opioid addiction or overdose last week. We ended up running a story on the Annals study, which seemed a bit more newsworthy than the Cochrane review. As it turns out, a number of news organizations covered the Annals study — Seattle’s LocalHealthGuide ran an item, which the Seattle Times picked up; The Seattle Post-Intelligencer, and our competitors HealthDay and Bloomberg, among others. As far as I can tell, only a site called MedIndia ran a story by the Health Behavior News Service pegged to the Cochrane review.*
(I should say here that I’m a big fan of the Cochrane Library, access to which is an AHCJ benefit. Some have criticized them for rejecting everything other than randomized double-blinded controlled clinical trials, but I’d rather see more rigor than less, given how often hype and poor evidence tend to rule the day. So this isn’t really about a problem at Cochrane. It’s about how embargo policies, whether well-intentioned or not, often make me wonder whether they serve the public.)
So whom did this Cochrane embargo serve? I’d argue it didn’t serve the public, because we and others couldn’t include news of it in the story we did decide to run. You might even say it didn’t serve Cochrane either, since I’m guessing many of my colleagues decided not to run something on it for similar reasons. And their rationale for not moving the embargo at least had the public in mind.
The episode reminded me of the CDC-autism embargo fiasco last fall, in which the CDC and the journal Pediatrics refused to lift an embargo on autism rate data that many in the autism advocacy community had already reported on. To me, the Cochrane decision was more justifiable, even if I didn’t like it.
Many have questioned embargoes, notably Vincent Kiernan, in his 2006 book “Embargoed Science.” Kiernan makes a convincing argument that embargoes serve journals most, by giving reporters something to cover every month or every week. Nowadays, that’s even more true, I think, as I see an increase in papers embargoed just 1-2 days, rather than the typical 5-6.
Still, when you run a high-volume news service, as much as you’d like to, it’s not reasonable to reject all embargoes in favor of 100% enterprising reporting. Our clients would be very unhappy, and justifiably so. Instead, we can try to cover studies with as much skepticism and context as possible. But when I hear yet another reason why embargoes might help journals, as I did at ScienceOnline2010, I’m only encouraged more to challenge the idea that embargoes are there for the public, and at least force journals to defend how they handle them.
Ivan Oransky, M.D., is executive editor of Reuters Health and AHCJ treasurer. Follow him on Twitter, where he periodically gets into debates about embargoes, among other things.
*Update:
After this post was published, we heard from Lisa Esposito, editor of the Health Behavior News Service, who tells us that Medscape and Elsevier Global Medical News did cover the Cochrane opioid review.
Oransky on H1N1, pandemic, vaccination and 1976
Filed under: Health journalism, Hot Health Headline, Public health
AHCJ board member Ivan Oransky appeared on Brian Lehrer Live to discuss H1N1. The relevant segment starts at about 38:50 into the show.
Among the issues discussed:
- Why H1N1 is a “pandemic,” what that really means, and how the designation has affected the public perception of the outbreak.
- The effectiveness of the widespread adoption of hand sanitizers, especially in the context of flu and other viral outbreaks.
- Vaccination and the lessons/relevance of the 1976 swine flu “outbreak,” in which the vaccine turned out to be more dangerous than the actual flu.
- The level of immunity created by the first wave of H1N1 earlier this year.
- Media behavior during this outbreak, and the media’s responsibility to communicate as much information as possible without being “sensationalist.”
AHCJ board names new officers
The AHCJ board of directors elected a new set of officers to take their seats at the upcoming fall board meeting.
Charles Ornstein of ProPublica was selected as president, Karl Stark of The Philadelphia Inquirer was named vice president, Ivan Oransky of Reuters Health was named treasurer and Julie Appleby of Kasier Health News was named secretary. Trudy Lieberman, board president for the past five years, assumes the new role of immediate past president.
A new board was seated after July elections by the entire AHCJ membership. The board members then voted on officers.
Other members of the board of directors are Felice J. Freyer of The Providence Journal; Phil Galewitz of Kaiser Health News; Andrew Holtz, a Portland, Ore., independent journalist; Carla K. Johnson of The Associated Press; Maryn McKenna, an independent journalist and author; Mike Stobbe of The Associated Press; and Irene Wielawski, an independent journalist from Pound Ridge, N.Y.
The Association of Health Care Journalists is an independent, nonprofit organization dedicated to advancing public understanding of health care issues. Its mission is to improve the quality, accuracy and visibility of health care reporting, writing and editing. AHCJ is housed at the Missouri School of Journalism.
Science journalists peer into the future
Six journalists explored “The Future of Science Journalism” during a panel at the Cambridge Science Festival at the MIT Museum.
Panelists included Jill Abramson, managing editor of The New York Times; Philip Hilts, director of the Knight Science Journalism Fellowships; Cristine Russell, a freelance journalist and senior fellow at the Harvard Belfer Center for Science and International Affairs; Andrew Revkin, reporter and blogger for The New York Times; Ivan Oransky, managing editor for online at Scientific American and AHCJ board member; and Evan Hadingham, senior science editor for NOVA.
Abramson predicts future journalism may not be on paper but that “journalism will continue to thrive” based on her belief that “there is a human want and need for trustworthy information about the world we live in, information that is tested, investigated, checked again, analyzed and presented in a cogent form.”
Oransky cites Twitter as a way of getting a new generation back into science and discusses the value of engaging with your audience.
Watch the video online.
Oransky to take helm at Reuters Health
Filed under: Health journalism, Health policy, Member news
AHCJ board member Ivan Oransky, M.D., has been named executive editor of Reuters Health. He assumes RH’s top editorial job from Bob Saunders, who is retiring. Oransky leaves the position of managing editor for online at Scientific American.
Ivan Oransky, M.D.
Oransky, first elected to the AHCJ board in 2002, will remain in New York for the new job, which he starts on June 15.
“Joining Reuters Health is a great opportunity to lead a talented team that has built a highly authoritative, comprehensive and successful news service over the years,” Oransky says. “I look forward to even more success by bringing newly available technology to bear.”
“I’ve known Bob and the team, and the work they do, for almost a decade, so it will be a real pleasure to work with them at 3 Times Square.”
Oransky has helped lead AHCJ’s efforts to build a new Web site with resources for its members that debuted in July 2007 and he has continued to advise the organization on how to increase its online presence.
Traffic to Scientific American’s Web site has increased 50 percent since Oransky’s arrival, something he attributes to his staff’s efforts, including posting more items, becoming more news cycle-driven , adding more regular features and using social media, such as Twitter, to connect with readers. MinOnline.com recently cited the site as one of three science-related titles to have fared well in the past year.
Oransky also teaches medical journalism in New York University’s Science, Health, and Environmental Reporting program and at the City University of New York’s Graduate School of Journalism and is a clinical assistant professor of medicine at the New York University School of Medicine, where he received his medical degree.
Blog breaks down Wyden’s talk, plan (#ahcj09)
AHCJ board member Ivan Oransky blogged about Sen. Ron Wyden’s talk at Health Journalism 2009 on April 17.
Wyden’s Healthy Americans Act would require nearly everyone to buy health insurance. He believes the way to pay for everyone to be covered is by limiting the tax-exempt status of health insurance premiums.
Oransky lays out some details about Wyden’s plan and brings up some questions that the senator didn’t answer during his presentation.
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Health Journalism 2010, AHCJ's annual conference, features a world-class program with story ideas, sources, stronger reporting skills, chances to meet newsmakers and network with other journalists.
- Health and education: Covering these intersecting beats
- Reporting on the business of health care
- Health reporting resources for journalists on state and local government beats
- Shortened Lives: How location, lifestyle affect health
- Covering a complex story for the long haul
- Aging in the 21st Century: Presentations and tip sheets
- AHCJ calls for better information from Joint Commission Web site
