Lisa Schnirring of the University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP) asked me to comment on a new research paper showing that students take infectious diseases that have been much-covered in the media more seriously than diseases that have had less media attention. The paper’s authors interpreted this as evidence that media coverage distorts people’s perceptions of infectious diseases. I thought it was likelier that some characteristics of some infectious diseases – such as the potential to launch a pandemic! – rightly make them a bigger concern for both the media and the public than diseases without those characteristics.
I sent Lisa this fairly blistering critique of the paper. She toned it down in what she published on the CIDRAP News website on November 5, 2008.
This paper reaches a very familiar conclusion, one that extends well beyond infectious diseases. Whenever you look at the level of public concern about a set of risks, the extent of media coverage of those risks, and the technical seriousness of the risks, you find that public concern and media coverage are strongly correlated with each other, and that neither is strongly correlated with technical seriousness.
In the 1980s I introduced my “Risk = Hazard + Outrage” formula to help account for findings like these. When a risk is high in outrage (dreaded, unfamiliar, unfair, memorable, etc.), both the public and the media will tend to take it more seriously than its technical seriousness (its “hazard”) justifies. But when a risk lacks these outrage factors, the public and the media will tend to shrug it off regardless of its technical seriousness.
That’s a long way from proving that media coverage causes a distortion in public concern. The paper makes the elementary mistake of imputing a particular causal meaning to correlational findings. Because their student respondents took highly covered diseases more seriously than less covered ones, the authors concluded that coverage influences the level of concern. But journalists naturally try to cover issues their readers and viewers consider important – so it is certainly credible that the causality is in the opposite direction: concern → coverage. Or both concern and coverage could be effects of the same causes, such as outrage. Odds are all three effects are real: public concern influences the amount of coverage; the amount of coverage influences public concern; and both are influenced by other characteristics of the risk/disease in question.
The authors assert that the media cover “rare and dramatic events.” But of course it is also true that people are especially interested in rare and dramatic events. The human tendency to put a priority on novelty is hardly a result of media sensationalism; it is a cause of media sensationalism.
Moreover, the human tendency to put a priority on novelty is often useful. To be sure, rare and dramatic events are sometimes statistical outliers of no great policy importance; medical slang uses the term “fascinoma” to describe a case that is weird and fascinating but too atypical to be genuinely significant. But often rare and dramatic events are also sentinel events. The five “high” coverage diseases studied in this paper’s three experiments were anthrax, SARS, avian flu, Lyme disease, and West Nile virus. Think about these five. The anthrax attacks of 2001 alerted the U.S. to the potential seriousness of bioterrorism, and led to a huge reallocation of resources. SARS looked at first like every virologist’s worst fears come true; it took a while to learn that super-spreaders were rare and the disease was susceptible to traditional epidemiologic measures. Avian flu is already a panzootic and represents the likeliest current source of a potentially disastrous influenza pandemic. Lyme disease was underdiagnosed and undertreated for many years until the media (and suffering patients) pushed the medical establishment to take it more seriously. Of the five, only West Nile virus is arguably less important than the amount of media coverage (and public concern) has implied.
Do the authors really think that North American students need to know more about yellow fever than about these five? Do the authors really think that North American policymakers face more pressing decisions about yellow fever than about these five? (Even West Nile virus poses difficult policy decisions vis-à-vis the comparative risk of the disease and the pesticides used to control it – though both risks are lower than the public supposes.)
The authors asked students “how serious” they thought various diseases were, how confident they were that they were actually diseases at all, and how likely they thought their peers were to get the disease in question. Amount of media coverage had a small but statistically significant relationship with the first two measures, and no relationship with predicted prevalence. But what does it mean to ask people “how serious” a disease is? Is anthrax more serious because it’s a possible weapon of mass destruction? Is avian flu more serious because it can mutate into a pandemic virus? The media and the public consider these factors relevant to the diseases’ importance … and their newsworthiness. The authors appear to dissent from those judgments, apparently believing that a disease’s seriousness is the same thing as its deadliness.
Note also that newsworthy diseases often break policy ground that affects society’s preparedness for less newsworthy diseases as well. Anthrax, for example, has had a big impact on bioterrorism preparedness policy – which certainly includes preparedness for a tularemia attack.
Bottom line: The media pay more attention to diseases that are new, that have unsettled policy implications, and that might give rise to disasters (natural or anthropogenic) than to diseases that lack these qualities. Undergraduates and medical students share this media interest. The paper’s authors apparently don’t.
I’m being a little unfair here. I don’t actually disagree that the media can become fascinated with an unimportant but interesting risk, and that their fascination can mislead the public to consider the risk more serious than it is (and thus lead to pressure on policymakers to take it more seriously than they should). I can think of some very good examples in the environmental realm.
But the case is a lot harder to make in the realm of infectious diseases.
The aspect of all this of greatest interest to CIDRAP, I think, is that avian flu is following SARS in becoming a symbol of the media’s and the public’s supposedly foolish fascination with infectious diseases that haven’t killed a lot of people yet. With a little effort, I’m sure we could unearth similar complaints from the early years of HIV – a pandemic that the public health profession considered merely a fascinoma for far too long. I’m sure we could find similar complaints about how foolish it was to worry about whether New Orleans’s levees would hold in a hurricane, or about whether securitized mortgage instruments might destabilize the economy.
Sometimes the media miss these potentially serious risks until they become serious in the here-and-now. But sometimes they do their job right. In those cases, the media’s early coverage helps the society take appropriate precautions – and inevitably scoffers emerge to argue that such coverage is excessive until after lots of people start dying.
There are two huge problems with media coverage of avian flu: It has died down too quickly, and it hasn’t been hooked clearly enough to the pandemic threat. The authors of this paper imagine quite a different problem: that the coverage convinced many people the risk might be serious before there were piles of bodies to prove it.
Copyright © 2008 By Peter M. Sandman