Where health journalism ends: independence, public relations and education
The boundary of health journalism turns on independence: whether the writer's work is editorially independent, who pays for it, and whether it sets out to inform the public or to publicise or educate.
Independence as a condition of membership
In 2010 the Association of Health Care Journalists had about 1,000 members, mostly journalists. Editorial independence was the cornerstone of eligibility: more than half of a member's work had to be editorially independent journalism, and a lot of advocacy work, or work for an advocacy organisation, did not count as independent, even where the organisation advocated more research in an area and was not part of industry. The association also aimed not to have members who pitch press releases or stories to other journalists.
The National Association of Science Writers had about 2,500 members in 2010, and besides journalists they included public information officers and people involved in publicity. Having been published in the lay press was a requirement of membership.
The UK's Medical Journalists' Association takes pride in its autonomy and in its motto, independent and bloody minded. Its members include medical, health and pharmaceutical journalists as well as doctors, nurses, therapists and academics, and they contribute to national and regional newspapers, professional journals, business and consumer magazines, radio, television and the web.
Journalism and public relations
Wikipedia defines medical journalism as the dissemination of health-related information through mainstream media outlets, but the definition is not wholly satisfactory, because it ignores what many would see as an essential distinction between journalism and public relations. A better definition may be the title of Ragnar Levi's 2001 book, Medical Journalism: Exposing Fact, Fiction, Fraud, which covers pitfalls, stakeholders and their vested interests, telling facts from fiction, asking better questions and seeking better sources.
A key difference between journalism and public relations, or indeed medical writing, is that journalists are not paid by the companies whose products they write about, so they are free to ask awkward questions and to approach a subject from any angle they wish, within their own organisation's agenda if it has one. A public relations specialist, as the UK's Institute of Public Relations describes the role, communicates with the target audience directly or indirectly through media, with an aim to create and maintain a positive image for their employer and a strong relationship with the audience. Such specialists may write press releases that end up reproduced by the media, but they are not journalists. Nor can medical writers engaged by clients to write news reports or press releases call themselves journalists, because journalists must be truly objective and without any conflict of interest in their reporting. Medical charities, non-governmental organisations and universities, however, all employ science communicators to publicise their research, and such work is paid writing about science in a less commercial environment than corporate public relations.
True journalism differs from public relations and from uncritically reproducing press releases. It involves doing background research into the context surrounding the finding being reported, seeking comments from independent experts, and highlighting the negative as well as the positive aspects. Even so, newspapers and magazines commonly reproduce uncritically the press releases that flood into their offices, a practice nicknamed churnalism that is often the result of budget cuts.
Working as both journalist and public relations consultant
One freelance who works as both journalist and public relations consultant holds that the combination is ethically delicate, because a writer who starts working for a company is inevitably biased while a journalist has to be impartial, so it is crucial to keep public relations jobs strictly separate from journalism. As a journalist, that freelance never writes about products or services handled in a public relations job.
Holding to that separation has sometimes meant declining projects from clients who did not understand how important it is, which was not always easy, because it could mean missing a profitable contract. The same freelance has never regretted those decisions, and many clients appreciate the standard because they know they can trust the writer.
Sponsorship and conflicts of interest
In health care journalism, writers may have direct responsibility for the final content and its approval, so they must exercise extreme caution when interacting with pharmaceutical and biotechnology companies.
The veteran journalist Gary Schwitzer noted a disturbing increase in questionable alliances between news organisations and industry sponsors. As of 2019, the National Press Foundation had until recently offered all-expenses-paid trips to health care journalism workshops sponsored by drug and device companies, where, as with continuing medical education, the sponsors often had influence over the agenda and the presenters. Gifts from the top two sponsors of the 2017 World Conference of Science Journalists came to just under half a million dollars. Industry pressure, real or perceived, may at times guide editorial decisions about content or advertisement layout. At the University of Colorado, Coca-Cola, a significant non-drug sponsor of a conference, may have had delayed influence: shortly after the conference a CNN reporter contributed to a story on the obesity epidemic that identified lack of exercise as a cause and did not mention sugary soft drinks.
If health journalism is to remain more than a vehicle for advertising, conflicted money has to be removed. Foundation support, or advertisements for products that make no health claims, such as a fitness tracker, a body weight scale or a meditation app, could serve as ethical alternatives.
Health journalists are reminded that journalism school teaches students to keep a dispassionate relationship with their sources, and they must be wary of support that undermines the power of their words and be aware of the commercial drivers of content and layout, minimising their influence whenever possible. As one eminent journalist and professor told his students, their obligation is to the public, and not, at heart, to those who pay them, their editor, their sources, their friends or the advancement of their career.
Informing rather than educating
In 2010 a member of the board of the Association of Health Care Journalists held that, for all its really important by-products, journalism is not health education but a matter of informing people. He added that journalism should focus on accountability: fact-checking and keeping researchers honest, whether the matter is conflicts of interest or study designs. The president of the National Association of Science Writers, like many journalists, distinguished the goals of science from the goals of journalism: her job is not to train researchers to speak to the public but to serve the public need, and her publication exists not for an educational mission but to satisfy a need to know.
The board member saw interesting potential in the blogs that physicians and researchers were then starting, but cautioned that not all of this writing is strictly journalistic: if someone with an interest has funded the writing, it is not journalism, although people who are not journalists are doing things that all would agree are journalism. The president also saw a place for scientists writing for the general public but would not call their work journalism: no scientist she knew had a reporter's training, and journalists would always be needed for that. Scientists, in her view, are good at giving the insider's look and journalists at reporting and analysing, and both perspectives have value.