Infinitesimal risk as public health crisis: news media coverage of a doctor-patient HIV contact tracing investigation

Beyond belief: a cross-genre study on perception and validation of health information online

Natural language undergoes significant transformation from the domain of specialized research to general news intended for wider consumption. This transition makes the information vulnerable to misinterpretation, misrepresentation, and incorrect attribution, all of which may be difficult to identify without adequate domain knowledge and may exist even in the presence of explicit citations. Moreover, newswire articles seldom provide a precise correspondence between a specific claim and its origin, making it harder to identify which claims, if any, reflect the original findings. For instance, an article stating "Flagellin shows therapeutic potential with H3N2, known as Aussie Flu." contains two claims ("Flagellin ... H3N2," and "H3N2, known as Aussie Flu") that may be true or false independent of each other, and it is prima facie unclear which claims, if any, are supported by the cited research. We build a dataset of sentences from medical news along with the sources from peer-reviewed medical research journals they cite. We use these data to study what a general reader perceives to be true, and how to verify the scientific source of claims. Unlike existing datasets, this captures the metamorphosis of information across two genres with disparate readership and vastly different vocabularies and presents the first empirical study of health-related fact-checking across them.

The discursive construction of HIV stigma in Irish print media

As interlocutors in national level discourse with the power to influence public opinion and inform policy, the news media are an important data source in understanding the constitutive roles played by culture and discourse in shaping health experiences and outcomes. This paper reports on a critical discourse analysis of news media coverage of HIV in the Republic of Ireland between 2006 and 2016. This period is significant because of the considerable increase in new HIV diagnoses that occurred in Ireland after the 2008 recession. Analysis of articles (n = 103) demonstrated a pattern of dividing practices whereby people living with or affected by HIV were frequently positioned as somatically and morally deficient via discourses of risk and responsibility. Little focus was given over to examination of the structural drivers of HIV, occluding the social context of the epidemic. The findings suggest that media discourses on HIV have the potential to other people living with HIV and generate stigma by invoking a dynamic of blame and shame frequently implicated in the stigma process.

Medicalization and the Depiction of Lay People in Television Health Documentary

This article examines the depiction of lay people within television health documentaries. We build on previous research to analyse the medicalization of health coverage and the function of lay depictions in two health documentaries. Depictions of lay people serve to personalize and normalize medical care and to legitimize medical surveillance and intervention. We argue that, in spite of some recent research demonstrating challenges to medicine, a medicalized perspective remains dominant in television coverage. Lay depictions are predominantly drawn on to support medicine but can also serve to invoke challenge. However, when challenges are presented, we contend that these documentaries work to neutralize them through the manner in which content is framed within the exposition.

Developing a Critical Media Research Agenda for Health Psychology

This article outlines reasons why psychologists should concern themselves with media processes, noting how media are central to contemporary life and heavily implicated in the construction of shared understandings of health. We contend that the present research focus is substantially medicalized, privileging the investigation and framing of certain topics, such as the portrayal of health professionals, medical practices, specific diseases and lifestyle-orientated interventions, and restricting attention to social determinants of health as appropriate topics for investigation. We propose an extended agenda for media health research to include structural health concerns, such as crime, poverty, homelessness and housing and social capital.

Waging war: discourses of HIV/AIDS in South African media

This paper explores a discourse of war against HIV/AIDS evident in the Daily Dispatch, a South African daily newspaper, from 1985 to 2000, and discusses the implications of this in terms of the way in which HIV/AIDS is constructed. The discursive framework of the war depends, fundamentally, on the personification of HIV/AIDS, in which agency is accorded to the virus, and which allows for its construction as the enemy. The war discourse positions different groups of subjects (the diseased body, the commanders, the experts, the ordinary citizens) in relations of power. The diseased body, which is the point of transmission, the polluter or infector, is cast as the 'Other', as a dark and threatening force. This takes on racialised overtones. The government takes on the role of commander, directing the war through policy and intervention strategies. Opposition to government is couched in a struggle discourse that dove-tails with the overall framework of war. Medical and scientific understandings pre-dominate in the investigative practices and expert commentary on the war, with alternative voices (such as those of people living with HIV/AIDS) being silenced. The ordinary citizen is incited to take on prevention and caring roles with a strong gendered overlay.

The experience of risk as 'measured vulnerability': health screening and lay uses of numerical risk

As clinical and epidemiological research turns increasingly to statistical probabilities in the identification and management of disease, numerous risk factors have emerged that are applied to individual health surveillance. However, the application of statistical risk is interpreted differently by lay persons from the way it is by public health or medical professionals. This paper examines the experience of being designated as at risk of a serious health condition. Specifically, an examination of the experiences of people with elevated blood cholesterol levels and men with elevated prostate-specific antigen (PSA) levels is presented in order to characterise the risk experience. This paper deals primarily with how being at risk symbolically alters health identities, with an introduction to the concept of measured vulnerability. Measured vulnerability refers to the capacity for scientifically-derived statistical measures that are intended to tame randomness and provide certainty in managing risk to, instead, produce uncertainty and anxiety in those to whom the statistic is applied.

Newspaper media reporting of motor vehicle crashes in Singapore: an opportunity lost for injury prevention education?

Newspaper media advocacy can help steer public attention away from motor vehicle crash (MVC) injuries as a personal problem to that of a social and public health issue. If used properly, newspaper media is potentially a powerful mass educator on MVC prevention. However, there is often a conflict of interest in which newspapers, in an attempt to boost readership and revenue, may over-emphasize and sensationalize the human-interest aspect of an MVC story. The aim of this study is to examine newspaper articles of MVCs in Singapore to assess how our newspaper media coverage portray MVCs and identify factors that mitigate injury and educate the public on injury prevention measures. Details of the MVC were extracted from 12 months of newspaper coverage in Singapore. Two independent coders were used to establish inter-rater reliability. From 1 January to 31 December 2007, 201 articles about MVCs were published. About 74.1% of articles assigned blame to a particular road user, negligence on either road user was implied in 56.7% of articles, and road safety messages were mentioned in 8% of the articles. The mainstream communication tone used was positive for law enforcement (71.1%) and neutral towards injury prevention or road safety messages (89.1%). Newspaper media reporting of MVCs in Singapore generally does not include injury prevention messages or highlight injury-mitigating measures. This is a lost opportunity for public education. Collaboration between public health practitioners and newspaper media is required to address this issue.

Cancer and the media: how does the news report on treatment and outcomes?

BACKGROUND

Cancer receives a great deal of news media attention. Although approximately half of all US patients with cancer die of their illness or of related complications, it is unknown whether reports in the news media reflect this reality.

METHODS

To determine how cancer news coverage reports about cancer care and outcomes, we conducted a content analysis of US cancer news reporting in 8 large-readership newspapers and 5 national magazines. Trained coders determined the proportion of articles reporting about cancer survival, cancer death and dying, aggressive cancer treatment, cancer treatment failure, adverse events of cancer treatment, and end-of-life palliative or hospice care.

RESULTS

Of 436 articles about cancer, 140 (32.1%; 95% confidence interval [CI], 28%-37%) focused on survival and only 33 (7.6 %; 5%-10%) focused on death and dying (P < .001, chi(2) test). Only 57 articles (13.1%; 10%-17%) reported that aggressive cancer treatments can fail, and 131 (30.0%; 26%-35%) reported that aggressive treatments can result in adverse events. Although most articles (249 of 436 [57.1%]; 95% CI, 52%-62%) discussed aggressive treatments exclusively, almost none (2 of 436; [0.5%]; 0%-2%) discussed end-of-life palliative or hospice care exclusively (P < .001, chi(2) test), and only a few (11 of 436 [2.5%]; 1%-6%) discussed aggressive treatment and end-of-life care.

CONCLUSIONS

News reports about cancer frequently discuss aggressive treatment and survival but rarely discuss treatment failure, adverse events, end-of-life care, or death. These portrayals of cancer care in the news media may give patients an inappropriately optimistic view of cancer treatment, outcomes, and prognosis.

'Taking charge of your health': discourses of responsibility in English-Canadian women's magazines

This article presents an examination of the ways in which responsibility for health is constructed in popular English-Canadian women's magazines. Women's magazines are a unique media form, acting as guidebooks for women on matters relating to feminine gender roles and are important to examine as part of the corpus of societal discourses which frame our understandings of what it means to be healthy and how good health is achieved. Using discourse analysis several techniques were found which reinforce women's individual responsibility to create and maintain good health for themselves and their families. The magazines instruct women/readers directly about their health-related responsibilities and outline the negative consequences of inaction or incorrect action. The magazines also use the traditional discursive technique of women's personal accounts as both cautionary tales and inspirational stories to encourage readers to actively pursue healthy behaviours. Reflecting and reinforcing the discourse of healthism, women's magazines consistently present health as an important individual responsibility and a moral imperative which creates an entrepreneurial subject position for women. The article concludes by discussing the implications for women's magazine audiences within the ongoing feminist debate about this cultural industry.

Memory bias in health anxiety is related to the emotional valence of health-related words

OBJECTIVES

A model based on the associative strength of object evaluations is tested to explain why those who score higher on health anxiety have a better memory for health-related words.

METHOD

Sixty participants observed health and nonhealth words. A recognition memory task followed a free recall task and finally subjects provided evaluations (emotionality, imageability, and frequency) for all the words. Hit rates for health words, d', c, and psychological response times (PRTs) for evaluations were examined using multi-level modelling (MLM) and regression.

RESULTS

Health words had a higher hit rate, which was greater for those with higher levels of health anxiety. The higher hit rate for health words is partly mediated by the extent to which health words are evaluated as emotionally unpleasant, and this was stronger for (moderated by) those with higher levels of health anxiety. Consistent with the associative strength model, those with higher levels of health anxiety demonstrated faster PRTs when making emotional evaluations of health words compared to nonhealth words, while those lower in health anxiety were slower to evaluate health words.

CONCLUSIONS

Emotional evaluations speed the recognition of health words for high health anxious individuals. These findings are discussed with respect to the wider literature on cognitive processes in health anxiety, automatic processing, implicit attitudes, and emotions in decision making.

The portrayal of HIV/AIDS in two popular African American magazines

Mainstream magazines and other media have been found to both reflect and influence existing values and beliefs regarding health and medicine. Little is known about how media directed toward specific cultural or other market groups may differ. The present study examined how HIV and AIDS are portrayed within a specific ethnocultural medium, the two highest circulating magazines directed toward African American and African Canadian readers. The portrayal of HIV/AIDS from January 1997 to October 2001 in Ebony and Essence magazines was examined through manifest and latent content analysis. African American people were described paradoxically both as powerless victims in the face of the disease and as members of a strong and identifiable community of "sisters" and "brothers" available to respond to prevent and cope with the disease. Polarization between Blacks and Whites was accomplished by frequent emphasis on the higher rates of HIV/AIDS amongst Black Americans. Both the church and spirituality were highlighted as means of prevention education and coping.

Canadian Aboriginal people's experiences with HIV/AIDS as portrayed in selected English language Aboriginal media (1996–2000)

This paper describes the portrayal of HIV/AIDS in 14 mass print newspapers directed towards the Canadian Aboriginal population and published between 1996 and 2000. Based on qualitative content analysis the research examines both manifest and latent meanings. Manifest results of this study indicate that women and youth are under represented as persons with HIV/AIDS. The latent results note the frequent references to Aboriginal culture, and the political and economic position of Aboriginal Canadians when discussing the disease, the person with the disease, the fear of the disease and the reaction of the community to the person with the disease. Unlike mainstream media where the medical frame is dominant, HIV/AIDS are here contextualized by culture, identity, spirituality and political-economic issues.

Newspaper framing of fatal motor vehicle crashes in four Midwestern cities in the United States, 1999-2000

OBJECTIVE

To examine the public health messages conveyed by newspaper coverage of fatal motor vehicle crashes and determine the extent to which press coverage accurately reflects real risks and crash trends.

METHODS

Crash details were extracted from two years of newspaper coverage of fatal crashes in four Midwestern cities in the United States. Details and causal factors identified by reporters were compared to data from the National Highway Traffic Safety Administration's Fatality Analysis Reporting System (FARS) using odds ratios and two tailed z tests.

RESULTS

Papers covered 278 fatal crashes over the two year period, in contrast to 846 fatal crashes documented in FARS. Papers assigned blame in 90% of crashes covered, under-reported restraint use and driver's risk of death, failed to reflect the protective value of restraints, and misrepresented the roles played by alcohol and teen drivers.

CONCLUSION

Newspaper coverage did not accurately reflect real risk. Papers presented fatal crashes as dramas with a victim/villain storyline; in keeping with this narrative strategy, papers were most likely to cover stories where a driver survived to take the blame. By highlighting crashes that diverge from the norm, focusing on the assignment of blame to a single party, and failing to convey the message that preventive practices like seatbelt use increase odds for survival, newspapers removed crashes from a public health context and positioned them as individual issues. Public health practitioners can work with media outlets in their areas to draw attention to misrepresentations and change the way these stories are framed.

Advocacy for public health: a primer

Public health advocacy is the strategic use of news media to advance a public policy initiative, often in the face of opposition.

Evaluation and management of medically unexplained physical symptoms

BACKGROUND

Medically unexplained physical symptoms (MUPS) and related syndromes are common in medical care and the general population, are associated with extensive morbidity, and have a large impact on functioning. Much of medical practice emphasizes specific pharmacological and surgical intervention for discrete disease states. Medical science, with its emphasis on identifying etiologically meaningful diseases comprised of homogeneous groups of patients, has split MUPS into a number of diagnostic entities or syndromes, each with its own hypothesized pathogenesis. However, research suggests these syndromes may be more similar than different, sharing extensive phenomenological overlap and similar risk factors, treatments, associated morbidities, and prognoses. Examples of syndromes consisting of MUPS include chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivities, somatoform disorders, and 'Gulf War Syndrome.'

REVIEW SUMMARY

This paper is a narrative review of the increasing body of evidence suggesting that MUPS and related syndromes are common, disabling, and costly. It emphasizes that MUPS occur along a continuum of symptom count, severity, and duration and may be divided into acute, subacute (or recurrent), and chronic types. Predisposing, precipitating, and perpetuating factors influence the natural history of MUPS.

CONCLUSIONS

Effective symptom management involves collaborative doctor-patient approaches for identification of problems based on a combination of medical importance and patient readiness to initiate behavioral change, negotiated treatment goals and outcomes, gradual physical activation and exercise prescription. Additionally, efforts should be made to teach and support active rather than passive coping with the symptoms.

Television documentary in New Zealand and the construction of doctors by lower socio-economic groups

The medical profession remains central to the provision of health care and the treatment of illness within contemporary society. However, the image of doctors and the relationship of the profession with the public is contested. The public persona of doctors has been subjected to re-negotiation in recent years as a result of factors such as health care reforms, the increased autonomy of other health professionals, the rise of the health consumer, and well-publicised cases of medical misadventure. We argue that television viewing is one influential way through which images of medical doctors are socially negotiated. This paper explores the construction of doctors through an analysis of television health documentary coverage and the accounts of lower SES participants in New Zealand. It demonstrates how televised depictions of doctors are integrated into the lifeworlds of viewers. We show that multiple and often contradictory representations of doctors, within both television health coverage and the accounts of our participants, conflate the traditional characterization of the caring professional with more recently established characterizations such as the medical entrepreneur and the bungling quack. The result is a complex and contextually variable image of doctors that embodies tensions surrounding public anxiety over health care reform. Recourse to this more pluralistic image of doctors provides a way for participants to work through the dilemmas posed by reduced access to medical care and the uncertainties of medical treatment, while still maintaining support for universal access to medical care.

Benefit and risk perceptions in transfusion medicine: blood and blood substitutes

Blood transfusion is a remarkably safe, routine procedure in clinical medicine. However, little attention has focused on the perceptions of risk associated with the receipt of blood, blood products or 'blood substitutes'. It is pertinent to ask (i) what key stakeholder groups know about transfusion, (ii) how safe they perceive blood/blood products to be, (iii) how the latter information might influence their own and others' perceptions of risk linked to transfusion, and (iv) the extent to which approved blood substitutes might be preferred over autologous or donor blood. An appreciation of what stakeholders perceive to be the benefits and risks of the receipt of blood and blood substitutes will inform future transfusion strategies. To obtain such information, a programme of research has been initiated at Nottingham. Surveys have targeted key stakeholder groups, namely, UK adult blood donors and nondonors, anaesthetists, general practitioners and health care journalists. Experimental studies examining message framing and cueing have also been conducted with undergraduate students. Such research will improve misunderstandings about current issues associated with blood donation and transfusion against the backdrop of changing public trust of health care professionals and attitudes and expectations on blood safety and benefits of blood substitutes.

'The cold hard facts' immunisation and vaccine preventable diseases in Australia's newsprint media 1993-1998

The news media have the potential to influence public perceptions about childhood vaccination. Research has quantified the extent of positive news reportage on immunisation but no studies have explored the rhetorical nature and the core appeals that characterise positive reportage. To complement our previous research on the rhetorical nature of anti-immunisation reportage, this paper reviews positive coverage of immunisation in over four and a half years of Australian newsprint media. Three core topics dominated the reportage; the problem of vaccine preventable diseases and low immunisation rates, notions of who is responsible and the implied solutions. The threat of vaccine preventable diseases was conveyed using panic language, disease personification, quantification rhetoric, stories of personal tragedies and portentous tales from yesteryear. Attribution for low immunisation rates ranged from blaming parents to blaming lack of government coordination. However, most blame framed individuals as responsible. The most popular spokespersons were representatives of professional medical bodies who tended to be cast as voices of authority, castigating the ignorance and apathy of parents. Urging of compulsory vaccination, pleas for parents to immunise their children and the provision of information about vaccine preventable diseases were the most frequently occurring implied solutions. Immunisation was promoted as a modern medical miracle, health professionals were portrayed as soldiers in the fight against killer diseases and urges to immunise were usually conveyed through the use of stern directives. Understanding how immunisation messages are framed in the media and the core values to which those messages appeal highlights opportunities for media advocates to enhance desired messages and reframe those which are considered antipathetic to the goals of public health advocacy.

Coverage by the news media of the benefits and risks of medications

BACKGROUND

The news media are an important source of information about new medical treatments, but there is concern that some coverage may be inaccurate and overly enthusiastic.

METHODS

We studied coverage by U.S. news media of the benefits and risks of three medications that are used to prevent major diseases. The medications were pravastatin, a cholesterol-lowering drug for the prevention of cardiovascular disease; alendronate, a bisphosphonate for the treatment and prevention of osteoporosis; and aspirin, which is used for the prevention of cardiovascular disease. We analyzed a systematic probability sample of 180 newspaper articles (60 for each drug) and 27 television reports that appeared between 1994 and 1998.

RESULTS

Of the 207 stories, 83 (40 percent) did not report benefits quantitatively. Of the 124 that did, 103 (83 percent) reported relative benefits only, 3 (2 percent) absolute benefits only, and 18 (15 percent) both absolute and relative benefits. Of the 207 stories, 98 (47 percent) mentioned potential harm to patients, and only 63 (30 percent) mentioned costs. Of the 170 stories citing an expert or a scientific study, 85 (50 percent) cited at least one expert or study with a financial tie to a manufacturer of the drug that had been disclosed in the scientific literature. These ties were disclosed in only 33 (39 percent) of the 85 stories.

CONCLUSIONS

News-media stories about medications may include inadequate or incomplete information about the benefits, risks, and costs of the drugs as well as the financial ties between study groups or experts and pharmaceutical manufacturers.

Tet offensive: winning hearts and minds for prevention. Discourse and ideology in Vietnam's "Health" Newspaper

A quantitative content (CA) and qualitative discourse analysis (DA) was made of all 67 articles in the February 1995 ("Tet") issue of Suc Khoe ("Health"), a bi-weekly newspaper issued by Ministry of Health, Hanoi, Vietnam. The aim was to uncover discursive strategies used in the construction of health-related meaning during a period of rapid economic transition and latent ideological struggle in Vietnam. The DA was based on the work of i.a. Foucault, Fairclough, Thompson, and Fowler. The CA showed a strong domination of Western sources. There were four themes: prevention, cure, the Tet festival, and crime and punishment. In the two first, health-related groups, prevention (n = 31) dominated over cure (n = 22), modern (n = 19) over traditional (n = 13) medicine, and overall, the theme of continuity (prevention and crime/punishment) over change (cure and Tet), reflecting Vietnam's programmatic pluralism in the health field and its ideological struggle against outside influences. The DA revealed three mixed but unintegrated discourses in the material; "popular" (simplistic, authoritarian, and sentimentalizing), "expert" (technical, egalitarian, and uncritical), and "nationalist" (administrative, impersonal and propagandistic). Prevention was mainly expressed via the popular discourse, whereas cure was represented, prospectively, by the expert discourse, and retrospectively, by the nationalist discourse. This combined order of discourse functions, we suggest, as a disciplinary "Discourses of Order". A proposed integrative CA/DA model relates content themes and discursive foci to the classical rhetorical dichotomy hope/fear. We see "Health" as struggling to uphold traditional besieged values under the new economic policies by using preventive propaganda in both medical and political terms. These findings are compared with expressed editorial policy statements.