Sick and Tired
At first I thought it would be easy to criticize the journalists on the public health beat. But after a year of following several reporters, I discovered there's no easy cure for what ails them
Everyone’s crowded around the boardroom table on a chilly October afternoon for the Ryerson Review of Journalism’s first story meeting. My foot’s tapping impatiently as the student beside me pitches her story; then, it’s my turn.
“Public health reporting,” I suggest. “It’s surrounded us through what some are calling the year of panic: Mad Cow disease, West Nile virus, SARS. Masked people flashed across our televisions at night and lay folded on our doorsteps when we woke. We learned that our hamburgers may be lethal and mosquito bites can be worse than itchy. But what,” I wind up, “did journalists learn about public health reporting? How are these stories covered, what are the reporting and editing pitfalls? And what makes them news in the first place?”
My colleagues stare blankly. A woman at the other end of the table muffles a yawn with her sleeve. “Are you waiting for something else to happen?” someone asks. In the weeks ahead, I’ll get used to this kind of response. A faculty advisor will wrinkle his forehead, peer through his eyebrows, and ask, “What are you going to do to make this current? SARS? Mad Cow? Who’s gonna want to talk about them a year later?” Even my handling editor, who professes enthusiasm, won’t be able to hide his worry: “It’s unfortunate you won’t have any fresh scenes in this,” he’ll allow at our first meeting. But at the boardroom table, my colleagues really try to be positive. “Ah, SARS will come back,” says one with a reassuring flap of the hand. “Maybe we can manufacture something and release it,” suggests our editor from the head of the table, and we all snicker.
Glancing around at a salad of pitying faces, I’m embarrassed. I have the most boring story in the history of the Review.
André Picard knows this feeling. The acclaimed public health reporter for The Globe and Mail has won six awards in that role, including the Canadian Policy Research Award. He says his “pet issues” are not epidemic infections but the rate of heart disease, diabetes and childhood obesity. Of the 706 stories crowned by his byline in the past three years, no fewer than 172 addressed these three issues. Many ran on page A1. “More than 16.5 million Canadians – half the population – are considered at risk of developing diabetes,” he wrote last October, linking the increased risk to an “explosive obesity epidemic.” Mundane trends like these, Picaard says, are the really important public health stories.
Yes, but are they news? That’s a battle to be fought, one day at a time. “Sometimes, editors will say, ‘Haven’t we written about heart disease before?'” Picard says. “And I will say, ‘Yes, but haven’t we written about Paul Martin before?'”
The picture changes, of course, when a mysterious illness has people dropping like flies. That’s news, no doubt about it – until people stop dying. But in the aftermath of last year’s global SARS scare, both journalists and public health experts began questioning the volume and accuracy of the reporting. A rash of symposia broke out around Toronto, in which reporters and public health officials discussed the coverage with academic experts. A study by Margaret MacNeill and Larry Hershfield from the University of Toronto’s Centre for Health Promotion suggested there was poor communication between the press and public health officials. Seth Feldman and Daniel Drache, the director and associate director for the Robarts Centre for Canadian Studies at York University, said the volume of stories had peaked after the World Health Organization slapped a travel advisory on Toronto – with the infection rate well into its final slump. Karen Palmer, a public health reporter at the Toronto Star, was one of only a handful of reporters who showed up repeatedly at the conferences. “What did we do wrong and how can we do better next time?” she asked at each one. Few experts offered clear answers.
At the Canadian Asso ciation of Journalists’ annual conference last spring, a panel addressed the debate. In a small basement room in Toronto’s Hilton hotel, Picard hunched over his laptop as he read his speech. One problem with the SARS coverage, he said, was that the press fed panic by presenting key numbers “in a cumulative fashion” – with each incidence of sickness piled upon all the previous ones. If, instead, the stories had been presented with an epidemic curve – a graph that shows the rise and decline of new cases – readers would have seen “quite clearly, that the outbreak peaked on March 26 – at least one month before news coverage peaked.”
Reporters also failed to question the messages sources gave them, Picard said. “Was it really necessary to quarantine 10,000 people? Did we really need to shut down hospitals? Did we really need to screen visitors going into hospitals in Kenora, 1,750 kilometres north of Toronto? Are 24 deaths really a lot when 6,000 people die of old-fashioned influenza and pneumonia each winter?”
All good questions, for sure, but as for the volume of coverage, just what were reporters supposed to do? Maureen Taylor, a medical and health reporter for CBC’s The National, says a dramatic new story is always going to win the race for air time. “How many nights a week would you watch The National if all I told you was ‘Quit smoking, get up off the couch and eat better’?” she asks. “Those are huge public health issues, but there’s not a lot of news value in those things. When there is, I cover it, but when there isn’t, I’m not going to beat you over the head with it. My job is not to make you healthier. My job is to cover health news. And SARS was news.”
I’m heading home for Christmas when I hear on the radio that a case of Mad Cow has been isolated in Washington State. I must admit even I am tempted to turn the dial: I’m a bit Mad Cowed out. But at least it could help my story stay current. Meanwhile, we’ve begun talking about art for the Review. My colleagues and I agree my story will likely need an illustration, not a photo. We talked for a minute about how to “illustrate complexity.” Maybe a cow in a mask with a mosquito biting it?
Well, no, I think we’ve seen enough masks, thank you. Though few on Toronto streets last spring actually saw anyone sporting this accessory, The Winnipeg Free Press was one of many to brand SARS-related stories with the logo of a man wearing a mask. The picture was from China, but since it sometimes ran on the same page as stories about SARS in Toronto, Helen Fallding, the paper’s science reporter, jokes that on the planes headed for Pearson, “only the Manitobans would be wearing masks.”
But what other pictures were there? Visuals are elusive when the real story is locked away under quarantine. And that’s the beginning of the problem with packaging complicated stories in hard-news spaces. It’s even harder to slap catchy and precise headlines on murky public health stories. Picard remembers one story he wrote, about a study indicating that Aspirin might not help, and could sometimes harm, people with heart conditions if they also had high blood pressure. The Globe’s headline read: “Aspirin may be doing heart patients little good: Study sees limited benefits in many cases.” Picard’s real message was more complicated: the study was a warning against self-medication without medical supervision.
Messages can just as easily be lost or confused in the body of a story when wording is oversimplified or condensed. Helen Branswell, a health reporter for Canadian Press, says she can’t remember when CP began using the term “highly infectious” to describe SARS. But in an interview, microbiology and infectious disease expert Dr. Donald Low told her that once precautions were taken, the new virus’ transmission rate was lower than that of influenza. Branswell then persuaded her editors to quit using the term. “It’s like sailing,” she says. “You think you’re heading somewhere and you think you’re right and then you’re not, so you have to adjust your course.”
Early January: SARS is back! China’s confirmed two new cases – could this mean those elusive “fresh scenes” for my story? But no one’s dead yet and officials believe the outbreak is much milder this time; one patient has already been discharged. But then – Yes! – there’s news from Vietnam: 14 confirmed human cases of something called the avian flu. The virus, apparently spread to humans through infected poultry, has possibly taken 13 lives. Public health is on the front page again.
I’m not the only one waiting around for the angel of viral death. The National’s Taylor, for one, is unapologetic. “I’ve become obsessed with infectious diseases actually,” she says, her eyes wide as she knits words into a meandering exclamation point. “I find them the most interesting stories to cover because they’re so unpredictable – I love smallpox, I liked doing influenza this year – other viruses, you know, I can’t wait – or even the flesh-eating disease, there are still people getting flesh-eating disease in this city – when was the last time you heard about that – and that’s an interesting bacteria….”
Finally, she pauses. “I tell people I miss SARS,” she confesses, “and they go, ‘Well, that’s awful. People died.’ And that’s true,” Taylor concedes. “I don’t mean to make light of that, but what I mean is, it’s fascinating to be a health reporter in Toronto when this is happening right under your nose. This is never going to happen to me again, probably.” She gazes off for a moment, then snaps back to attention. “Avian flu – it would be so cool to be in Vietnam right now, where… what is going on with this bird flu? It’s fascinating.”
Front pages everywhere greet avian flu with fanfare. “This could be way worse than SARS,” reads a Globe headline over a piece by medical reporter Paul Taylor, who muses: “Could this be the start of a global flu pandemic, just like the one that swept the planet after the First World War, killing between 20 million and 40 million people?” Maybe. But maybe this too will pass and reporters will again be criticized for sensational coverage. The biggest problem for public health reporters is a lack of solid information. As they brace themselves for “the next pandemic” that everyone seems sure will strike, sooner or later, with devastating results, the best reporters can do is watch for clues to something that might not even exist. “If this goes the way of 1918 we’ll all know people who die,” says CP’s Branswell about the bird flu. For now she’s watching for a case in Canada, or an indication it can spread from human to human. “Every day I have to make choices,” she says, “and I will continue to make choices as we find out more.”
It’s a paradox: a new illness’ mysteriousness makes it news, but also makes it almost impossible to cover well. Branswell says it’s easy to find fault with SARS coverage after the fact. “The damn thing didn’t even have a name,” she says. “My sense was that everyone was trying to do the best job we could with the little we knew.”
If it’s hard for seasoned health reporters to navigate unknown lands like this, it’s harder for those with no background. Dr. Michel Brazeau, chief executive officer for the Royal College of Physicians and Surgeons of Canada, says reporters not on a health beat tend not to probe stories deeply: “All they want is a 50-second quote.” When the Mad Cow story broke after a case was confirmed in Fairview, Alta., last May, the weekly Fairview Post was suddenly in the middle of a huge national story. But with a staff of one sports reporter and editor Arthur Williams, the Post lacked both the resources and the expertise to analyze the public health impact. “I can’t be at every news conference in Edmonton,” says Williams. Instead, he gathered what detai ls he could from the Internet and concentrated, as always, on issues directly affecting Fairview – the economic impact on area cattle ranchers, a local group trying to develop alternate specialty beef products and markets.
But even science reporters like Winnipeg’s Fallding can be confounded by the elusiveness of hard facts – for which she often blames government officials’ obstructiveness. “In Manitoba we have the best Mad Cow research facilities but scientists were told they couldn’t return our calls,” she recalls, “since information had to go through an official spokesperson.” Denied access to the labs to report first-hand on the Mad Cow investigation, she was left reporting official statements. Before asking a question, she could usually have written down officials’ answers: We’re monitoring the situation.
“There’s an old-fashioned school of thought with some that we don’t need to know,” Fallding says. As part of last year’s anti-West Nile efforts, several rural communities in southwest Manitoba were fogged with malathion. The chemical was controversial for reportedly killing beneficial insects, and some people worried about long-term effects on the water supply. To help evaluate these fears, Fallding requested statistics on the number of Culex mosquitos (the type carrying the virus) in the region. Dr. Joel Kettner, the chief medical officer of health for Manitoba, told her the numbers weren’t yet compiled in a way the press would understand. “They finally gave us the information but it was long after the summer was over and the mosquitos were dead,” says Fallding. (The data did indicate an especially large Culex population.)
Dr. James Young, Ontario’s public safety commissioner, concedes that reporters didn’t always get information promptly during the SARS outbreak. “But we didn’t have enough information either,” he says. “We kept nothing secret.” Reporters’ frustration reflects a feeling that people always have in an emergency: “they want to know everything,” Dr. Young says. “They want to know the result, they want to know when it’s going to be over – as quick as possible. And that’s human nature and that’s correct. Unfortunately at the beginning of an emergency, that’s the answer you don’t have.”
When officials withhold incomplete or preliminary information, it’s because they want to make sure the public gets a consistent and accurate message, says Dr. Young. This conflicts with reporters’ need for fresh answers and new angles. Yet, the relationship between reporters and public health officials is symbiotic. Reporters rely on health officials as the only authoritative sources of facts, and health officials need reporters to get their message out. If the two can’t trust each other, both jobs get a lot harder.
Last summer, Toronto’s public health department launched an education campaign aimed at tamping down public fears of West Nile virus. On bus shelters and garbage bins, a huge mosquito cowered under a bold caption: “Don’t Let Them Spread Fear.” I was not the only reporter to wonder: are they talking about the mosquitoes or the press? So I asked Dianne Chester, the communications coordinator for Toronto Public Health’s West Nile division. “Oh,” she assured me, “it was the mosquitoes.” But moments later she added, “[The press] don’t necessarily get the message correct.”
Toward the end of January, we talk about art for the stories again. It seems mine is one of only three that still doesn’t have any art planned. Big surprise. “Is your story about SARS?” asks our editor. “‘Cause we were talking about having a picture about SARS. But it’s about other things too, right?” I shrink from explaining the theme all over again. “I just don’t want to see a picture of a mask,” I sigh.
By now, even the season of SARS postmortems has finished. Most reporters stopped showing up by the end of October, when York’s Feldman and Drache release d their report on the pattern of SARS coverage. Looking out at a room of empty seats, the two professors, with matching Colonel Sanders beards, greying hair and bobbing moustaches, announced that coverage in three Toronto-based newspapers (the Star, the Globe and the Post) jumped during the World Health Organization’s travel advisory to between 200 and 300 per cent of average levels, with each paper printing up to 25 SARS-related articles a day. A reporter in the front row picked a fight with the researchers, saying he didn’t see the news value of the research. “Give me a lead for tomorrow’s paper for your report,” he said. “That’s what I’m asking. Give me a lead, 25 words.” The two researchers said he could take whatever meaning he wanted from the numbers, but he kept digging: “What’s my lead?” he demanded. “Write my lead for me.”
Finally, someone in the back drawled, “I think that’s your job.” She was missing the point. This was yesterday’s story, the last thing a reporter or editor wants to spend time thinking about. And now, yes, it’s last year’s story. But if it’s true that public health catastrophes loom all around us – and that the next global pandemic is overdue – reporters’ and editors’ fatigue at thinking through the issues heightens the risk of repeating the same mistakes. “We wrote too much about SARS when we knew little,” says Picard, “and we’re not writing enough about SARS now that there are lessons to be learned.” But if public health reporting poses special challenges to both reporters and expert sources, at least it’s on the map now. As Picard says, “After years writing about stuff like infectious disease and prevention, my bosses suddenly think my job is important, not just quirky.”
Krissy Gordon was the Chief Copy Editor for the Summer 2004 issue of the Ryerson Review of Journalism.