“In an era where trustful and effective science communication is essential, we need to rethink and change the current ecosystem. Researchers and institutions should move from the ‘publish or perish’ model to a model in which researchers make every effort to avoid distortion and hype,” write Isabelle Boutron, MD, PhD, Paris Descartes University, France, and colleagues.
Boutron and colleagues performed three Internet-based randomized controlled trials (RCTs) to compare the effect of spin on patients’ and caregivers’ interpretations of news stories about pharmacologic treatments.
“We defined ‘spin’ as a misrepresentation of study results, regardless of motive (intentionally or unintentionally), that overemphasizes the efficacy or overstates safety of the treatment as compared with that shown by the results,” the authors explain.
Each of the RCTs evaluated 10 news stories that reported either a preclinical study, a phase 1/2 non-RCT, or a phase 3/4 RCT. For each of the three study types, the investigators selected news stories reported with spin in the press. They then used two versions of the stories — one reported with spin and a version rewritten without spin.
The researchers also anonymized the stories, removing identifying information (such as journalist names and references to the original articles), and replaced treatment names with hypothetical ones.
A total of 900 individuals participated in the trial, all of whom were drawn from Inspire, a large online network of patients and caregivers. Within each RCT, 300 participants were randomized 1:1 to assess a news story with or without spin.
The primary outcome was participants’ interpretation of the benefits of a treatment reported in a story. This was evaluated by their responses to the question, “What do you think is the probability that ‘treatment X’ would be beneficial to patients?” Patients and caregivers responded using a 10-point scale, with 0 indicating “very unlikely” and 10 indicating “very likely.”
Regardless of study type, patients and caregivers were more likely to believe a treatment would be beneficial if the news story contained spin than if it did not (mean scores for preclinical studies, 7.5 vs 5.8, P < .001; phase 1/2 non-RTCs, 7.6 vs 5.8, P < .001; and phase 3/4 RCTs, 7.2 vs 4.9, P < .001).
Communication of medical studies occurs within a complex system in which spin may originate from various sources, including researchers, peer-reviewers, editors, funders, institutions, and the public, the authors note.
In some cases, influencing forces may also affect stakeholders and exacerbate the spin cycle. These forces include pressure to publish, obtain citations, gain media coverage, and grab the public’s attention.
Because of these interrelated factors, Boutron and colleagues stress the need for change at multiple levels. In addition, many researchers would benefit from training to improve their skills in communicating research to a lay audience.
And readers themselves can also use tools to develop their skills in critically analyzing health news stories, add Boutron and colleagues.
In an interview with Medscape Medical News, Stephan Fihn, MD, MPH, University of Washington, Seattle, highlighted a form of tacit collusion at different levels of reporting that contributes to sustaining the spin cycle of misleading health news.
Although he stressed a lack of malicious intent at each level, Fihn underscored the common pressures between journals that want to publish positive papers so that they obtain prominence, authors who have similar interests but also believe that positive results will help with funding applications, and the lay press, which naturally wants articles that will make a splash.
“Personally, I think it’s a big problem,” he said.
“The losers are the members of the public, who can be confused or misled, and ultimately become cynical,” as a result of this spin, he concluded. “And, also the scientists who try their best to cleave to the truth and are unable to see their work published in top journals.”
A coauthor Ivan Oransky is a vice president at Medscape and volunteer cofounder of Retraction Watch, which has received writing fees for journalism from various publications and grants from the Laura and John Arnold Foundation, Helmsley Trust, and John D. and Catherine T. MacArthur Foundation. In addition, an author has reported serving as an academic editor at BMC Medicine. The remaining authors have reported no relevant financial relationships. Fihn has reported serving as the deputy editor for JAMA Network Open.
BMC Med. Published online June 4, 2019. Full text