health journalism – Close Read

Clarity and soundness

I feel a lot of non-science editors just switch off when they read science stuff.

A friend told me this earlier today, during yet another conversation about how many of the editorial issues that assail science and health journalism have become more pronounced during the pandemic (by dint of the pandemic being a science and health ‘event’). Even earlier, editors would switch off whenever they’d read science news, but then the news would usually be about a new study discussing something coffee could or couldn’t do to the heart.

While that’s worrying, the news was seldom immediately harmful, and lethal even more rarely. In a pandemic, on the other hand, bullshit that makes it to print hurts in two distinct ways: by making things harder for good health journalists to get through to readers with the right information and emphases, and of course by encouraging readers to do things that might harm them.

But does this mean editors need to know the ins and outs of the subject on which they’re publishing articles? This might seem like a silly question to ask but it’s often the reality in small newsrooms in India, where one editor is typically in charge of three or four beats at a time. And setting aside the argument that this arrangement is a product of complacency and not taking science news seriously more than resource constraints, it’s not necessarily a bad thing either.

For example, a political editor may not be able to publish incisive articles on, say, developments in the art world, but they could still help by identifying reliable news sources and tap their network to commission the right reporters. And if the organisation spends a lot more time covering political news, and with more depth, this arrangement is arguably preferable from a business standpoint.

Of course, such a setup is bound to be error-prone, but my contention is that it doesn’t deserve to be written off either, especially this year – when more than a few news publishers suddenly found themselves in the middle of a pandemic even as they couldn’t hire a health editor because their revenues were on the decline.

For their part, then, publishers can help minimise errors by being clear about what editors are expected to do. For example, a newsroom can’t possibly do a great job of covering science developments in the country without a science editor; axiomatically, non-science editors can only be expected to do a superficial job of standing in for a science editor.

This said, the question still stands: What are editors to do specifically, especially those suddenly faced with the need to cover a topic they’re only superficially familiar with? The answer to this question is important not just to help editors but also to maintain accountability. For example, though I’ve seldom covered health stories in the past, I also don’t get to throw my hands up as The Wire‘s science, health and environment editor when I publish a faulty story about, say, COVID-19. It is a bit of a ‘damned if you do, damned if you don’t’ situation, but it’s not entirely unfair either: it’s the pandemic, and The Wire can’t not cover it!

In these circumstances, I’ve found one particular way to mitigate the risk of damnation, so to speak, quite effective. I recently edited an article in which the language of a paragraph seemed off to me because it wasn’t clear what the author was trying to say, and I kept pushing him to clarify. Finally, after 14 emails, we realised he had made a mistake in the calculations, and we dropped that part of the article. More broadly, I’ve found that nine times out of ten, even pushbacks on editorial grounds can help identify and resolve technical issues. If I think the underlying argument has not been explained clearly enough, I send a submission back even if it is scientifically accurate or whatever.

Now, I’m not sure how robust this relationship is in the larger scheme of things. For example, this ‘mechanism’ will obviously fail when clarity of articulation and soundness of argument are not related, such as in the case of authors for whom English is a second language. For another, the omnipresent – and omnipotent – confounding factor known as unknown unknowns could keep me from understanding an argument even when it is well-made, thus putting me at risk of turning down good articles simply because I’m too dense or ignorant.

But to be honest, these risks are quite affordable when the choice is between damnation for an article I can explain and damnation for an article I can’t. I can (and do) improve the filter’s specificity/sensitivity 😄 by reading widely myself, to become less ignorant, and by asking authors to include a brief of 100-150 words in their emails clarifying, among other things, their article’s intended effect on the reader. And fortuitously, when authors are pushed to be clearer about the point they’re making, it seems they also tend to reflect on the parts of their reasoning that lie beyond the language itself.

Journalistic entropy

Say you need to store a square image 1,000 pixels wide to a side with the smallest filesize (setting aside compression techniques). The image begins with the colour #009900 on the left side and, as you move towards the right, gradually blends into #1e1e1e on the rightmost edge. Two simple storage methods come to mind: you could either encode the colour-information of every pixel in a file and store that file, or you could determine a mathematical function that, given the inputs #009900 and #1e1e1e, generates the image in question.

The latter method seems more appealing, especially for larger canvases of patterns that are composed by a single underlying function. In such cases, it should obviously be more advantageous to store the image as an output of a function to achieve the smallest filesize.

Now, in information theory (as in thermodynamics), there is an entity called entropy: it describes the amount of information you don’t have about a system. In our example, imagine that the colour #009900 blends to #1e1e1e from left to right save for a strip along the right edge, say, 50 pixels wide. Each pixel in this strip can assume a random colour. To store this image, you’d have to save it as an addition of two functions: ƒ(x, y), where x = #009900 and y = #1e1e1e, plus one function to colour the pixels lying in the 50-px strip on the right side. Obviously this will increase the filesize of the stored function.

Even more, imagine if you were told that 200,000 pixels out of the 1,000,000 pixels in the image would assume random colours. The underlying function becomes even more clumsy: an addition of ƒ(x, y) and a function R that randomly selects 200,000 pixels and then randomly colours them. The outputs of this function R stands for the information about the image that you can’t have beforehand; the more such information you lack, the more entropy the image is said to have.

The example of the image was simple but sufficiently illustrative. In thermodynamics, entropy is similar to randomness vis-à-vis information: it’s the amount of thermal energy a system contains that can’t be used to perform work. From the point of view of work, it’s useless thermal energy (including heat) – something that can’t contribute to moving a turbine blade, powering a motor or motivating a system of pulleys to lift weights. Instead, it is thermal energy motivated by and directed at other impetuses.

As it happens, this picture could help clarify, or at least make more sense of, a contemporary situation in science journalism. Earlier this week, health journalist Priyanka Pulla discovered that the Indian Council of Medical Research (ICMR) had published a press release last month, about the serological testing kit the government had developed, with the wrong specificity and sensitivity data. Two individuals she spoke to, one from ICMR and another from the National Institute of Virology, Pune, which actually developed the kit, admitted the mistake when she contacted them. Until then, neither organisation had issued a clarification even though it was clear both individuals are likely to have known of the mistake at the time the release was published.

Assuming for a moment that this mistake was an accident (my current epistemic state is ‘don’t know’), it would indicate ICMR has been inefficient in the performance of its duties, forcing journalists to respond to it in some way instead of focusing on other, more important matters.

The reason I’m tending to think of such work as entropy and not work per se is such instances, whereby journalists are forced to respond to an event or action characterised by the existence of trivial resolutions, seem to be becoming more common.

It’s of course easier to argue that what I consider trivial may be nontrivial to someone else, and that these events and actions matter to a greater extent than I’m willing to acknowledge. However, I’m personally unable to see beyond the fact that an organisation with the resources and, currently, the importance of ICMR shouldn’t have had a hard time proof-reading a press release that was going to land in the inboxes of hundreds of journalists. The consequences of the mistake are nontrivial but the solution is quite trivial.

(There is another feature in some cases: of the absence of official backing or endorsement of any kind.)

So as such, it required work on the part of journalists that could easily have been spared, allowing journalists to direct their efforts at more meaningful, more productive endeavours. Here are four more examples of such events/actions, wherein the non-triviality is significantly and characteristically lower than that attached to formal announcements, policies, reports, etc.:

Withholding data in papers – In the most recent example, ICMR researchers published the results of a seroprevalence survey of 26,000 people in 65 districts around India, and concluded that the prevalence of the novel coronavirus was 0.73% in this population. However, in their paper, the researchers include neither a district-wise breakdown of the data nor the confidence intervals for each available data-point even though they had this information (it’s impossible to compute the results the researchers did without these details). As a result, it’s hard for journalists to determine how reliable the results are, and whether they really support the official policies regarding epidemic-control interventions that will soon follow.
Publishing faff – On June 2, two senior members of the Directorate General of Health services, within India’s Union health ministry, published a paper (in a journal they edited) that, by all counts, made nonsensical claims about India’s COVID-19 epidemic becoming “extinguished” sometime in September 2020. Either the pair of authors wasn’t aware of their collective irresponsibility or they intended to refocus (putting it benevolently) the attention of various people towards their work, turning them away from the duo deemed embarrassing or whatever. And either way, the claims in the paper wound their way into two news syndication services, PTI and IANS, and eventually onto the pages of a dozen widely-read news publications in the country. In effect, there were two levels of irresponsibility at play: one as embodied by the paper and the other, by the syndication services’ and final publishers’ lack of due diligence.
Making BS announcements – This one is fairly common: a minister or senior party official will say something silly, such as that ancient Indians invented the internet, and ride the waves of polarising debate, rapidly devolving into acrimonious flamewars on Twitter, that follow. I recently read (in The Washington Post I think, but I can’t find the link now) that it might be worthwhile for journalists to try and spend less time on fact-checking a claim than it took someone to come up with that claim. Obviously there’s no easy way to measure the time some claims took to mature into their present forms, but even so, I’m sure most journalists would agree that fact-checking often takes much longer than bullshitting (and then broadcasting). But what makes this enterprise even more grating is that it is orders of magnitude easier to not spew bullshit in the first place.
Conspiracy theories – This is the most frustrating example of the lot because, today, many of the originators of conspiracy theories are television journalists, especially those backed by government support or vice versa. While fully acknowledging the deep-seated issues underlying both media independence and the politics-business-media nexus, numerous pronouncements by so many news anchors have only been akin to shooting ourselves in the foot. Exhibit A: shortly after Prime Minister Narendra Modi announced the start of demonetisation, a beaming news anchor told her viewers that the new 2,000-rupee notes would be embedded with chips to transmit the notes’ location real-time, via satellite, to operators in Delhi.

Perhaps this entropy – i.e. the amount of journalistic work not available to deal with more important stories – is not only the result of a mischievous actor attempting to keep journalists, and the people who read those journalists, distracted but is also assisted by the manifestation of a whole industry’s inability to cope with the mechanisms of a new political order.

Science journalism itself has already experienced a symptom of this change when pseudoscientific ideas became more mainstream, even entering the discourse of conservative political groups, including that of the BJP. In a previous era, if a minister said something, a reporter was to drum up a short piece whose entire purpose was to record “this happened”. And such reports were the norm and in fact one of the purported roots of many journalistic establishments’ claims to objectivity, an attribute they found not just desirable but entirely virtuous: those who couldn’t be objective were derided as sub-par.

However, if a reporter were to simply report today that a minister said something, she places herself at risk of amplifying bullshit to a large audience if what the minister said was “bullshit bullshit bullshit”. So just as politicians’ willingness to indulge in populism and majoritarianism to the detriment of society and its people has changed, so also must science journalism change – as it already has with many publications, especially in the west – to ensure each news report fact-checks a claim it contains, especially if it is pseudoscientific.

In the same vein, it’s not hard to imagine that journalists are often forced to scatter by the compulsions of an older way of doing journalism, and that they should regroup on the foundations of a new agreement that lets them ignore some events so that they can better dedicate themselves to the coverage of others.

Featured image credit: Татьяна Чернышова/Pexels.

The virus and the government

In December 2014, public health researchers and activists gathered at a public forum in Cambridge, Massachusetts, to discuss how our perception of diseases and their causative pathogens influences our ideas of what we can and can’t do to fight them. According to a report published in The Harvard Gazette:

The forum prompted serious reflection about structural inequalities and how public perceptions get shaped, which often leads to how resources are directed. “The cost of believing that something is so lethal and fatal is significant,” [Paul] Farmer said.
[Evelynn] Hammonds drew attention to how perceptions of risk about Ebola had been shaped mostly through the media, while noting that epidemics “pull the covers off” the ways that the poor, vulnerable, and sick are perceived.

These statements highlight the importance of a free press with a spine during a pandemic – instead of one that bends to the state’s will as well as doesn’t respect the demands of good health journalism while purporting to practice it.

We’ve been seeing how pliant journalists, especially on news channels like India Today and Republic and in the newsrooms of digital outlets like Swarajya and OpIndia, try so hard so often to defend the government’s claims about doing a good job of controlling the COVID-19 epidemic in India. As a result, they’ve frequently participated – willingly or otherwise – in creating the impression that a) the virus is deadly, and b) all Muslims are deadly.

Neither of course is true. But while political journalists, who in India have generally been quite influential, have helped disabuse people of the latter notion, the former has attracted fewer rebuttals principally because the few good health journalists and the vocal scientists operating in the country are already overworked thanks to the government’s decoy acts on other fronts.

As things stand, beware anyone who says the novel coronavirus is deadly if only because a) all signs indicate that it’s far less damaging to human society than tuberculosis is every year, and b) it’s an awfully powerful excuse that allows the government to give up and simply blame the virus for a devastation that – oddly enough – seems to affect the poor, the disabled and the marginalised too far more than the law of large numbers can account for.

There is more than one thunder

Sunny Kung, a resident in internal medicine at a teaching hospital in the US, has authored a piece in STAT News about her experience dealing with people with COVID-19, and with other people who deal with people with COVID-19. I personally found the piece notable because it describes a sort of experience of dealing with COVID-19 that hasn’t had much social sanction thus far.

That is, when a socio-medical crisis like the coronavirus pandemic strikes, the first thing on everyone’s minds is to keep as few people from dying as possible. Self-discipline and self-sacrifice, especially among those identified as frontline healthcare and emergency services workers, become greater virtues than even professional integrity and the pursuit of individual rights. As a result, these workers incur heavy social, mental and sometimes even physical costs that they’re not at liberty to discuss openly without coming across as selfish at a time when selflessness is precariously close to being identified as a fundamental duty.

Kung’s piece, along with some others like it, clears and maintains a precious space for workers like her to talk about what they’re going through without being vilified for it. Further, I’m no doctor, nurse or ambulance driver but ‘only’ a journalist, so I have even less sanction to talk about my anxieties than a healthcare worker does without inviting, at best, a polite word about the pandemic’s hierarchy of priorities.

But as the WHO itself has recognised, this pandemic is also an ‘infodemic’, and the contagion of fake news, misinformation and propaganda is often deadly – if not deadlier – than the effects of the virus itself. However, the amount of work that me and my colleagues need to do, and which we do because we want to, to ensure what we publish is timely, original and verified often goes unappreciated in the great tides of information and data.

This is not a plea for help but an unassuming yet firm reminder that:

Emergency workers come in different shapes, including as copy-editors, camerapersons and programmers – all the sort of newsroom personnel you never see but which you certainly need;
Just because it’s not immediately clear how we’re saving lives doesn’t mean our work isn’t worth doing, or that it’s easy to do; and
Saving lives is not the only outcome that deserves to be achieved during a socio-medical crisis.

A lot of what a doctor like Kung relates to, I can as well – and again, not in an “I want to steal your thunder” sort of way but as if this is a small window through which I get to shout “There are many thunders” sort of way. For example, she writes,

Every night during the pandemic I’ve dreaded showing up to work. Not because of fear of contracting Covid-19 or because of the increased workload. I dread having to justify almost every one of my medical decisions to my clinician colleagues.
Since the crisis began, I’ve witnessed anxiety color the judgement of many doctors, nurses, and other health care workers — including myself — when taking care of patients.

Many of us simply want to make sure we’re doing the right thing and to the best of our ability, that to the extent possible we’re subtracting the effects of fatigue and negligence from a situation rife with real and persistent uncertainty. But in the process, we’re often at risk of doing things we shouldn’t be doing.

As Kung writes, doctors and nurses make decisions out of fear – and journalists cover the wrong paper, play up the wrong statistic, quote the wrong expert or pursue the wrong line of inquiry. Kung also delineates how simply repeating facts, even to nurses and other medical staff, often fails to convince them. I often go through the same thing with my colleagues and with dozens of freelancers every week, who believe ‘X’ must be true and want to anticipate the consequences of ‘X’ whereas I, being more aware of the fact that the results of tests and studies are almost never 100% true (often because the principles of metrology themselves impose limits on confidence intervals but sometimes because the results depend strongly on the provenance of the input data and/or on the mode of publishing), want to play it safe and not advertise results that first seed problematic ideas in the minds of our readers but later turn out to be false.

So they just want to make sure, and I just want to make sure, too. Neither party is wrong but except with the benefit of hindsight, neither party is likely to be right either. I don’t like these conversations because they’re exhausting, but I wouldn’t like to abdicate them because it’s my responsibility to have them. And what I need is for this sentiment to simply be acknowledged. While I don’t presume to know what Kung wants to achieve with her article, it certainly makes the case for everyone to acknowledge that frontline medical workers like her have issues that in turn have little to do with the fucking virus.

In yet another reminder that the first six months (if not more) of 2020 will have been the worst infodemic in history, I can comfortably modify the following portions of Kung’s article…

They were clearly disgruntled about my decision not to transfer Mr. M to the ICU. I tried to reassure them by providing evidence, but I could still feel the tension and fear. The nurses wanted another M.D. to act as an arbiter of my decision but were finally convinced after I cited the patient’s stable vital signs, laboratory results, and radiology findings.
Everyone in the hospital is understandably on edge. Uncertainty is everywhere. Our hospital’s policies have been constantly changing about who we should test for Covid-19 and when we should wear what type of protective personal equipment. Covid-19 is still a new disease to many clinicians. We don’t know exactly which patients should go to the ICU and which are stable enough to stay on the regular floor. And it is only a matter of time before we run out of masks and face shields to protect front-line health care workers. …
As a resident in internal medicine and a future general internist, it is my duty to take care of these Covid-19 patients and reassure them that we are here to support them. That’s what I expect to do for all of my patients. What I did not expect from this pandemic is having to reassure other doctors, nurses, and health care workers about clinical decisions that I would normally never need to justify. …
There is emerging literature on diagnosing and treating Covid-19 patients that is easily accessible to physicians and nurses, but some of them are choosing to make their medical decisions based on fear — such as pushing for unnecessary testing or admission to the hospital, which may lead to overuse of personal protective equipment and hospital beds — instead of basing decisions on data or evidence. …

… thus:

The freelancer was clearly disgruntled about my decision not to accept the story for publication. I tried to reassure them by providing evidence, but I could still feel the tension and resentment. The freelancer wanted another editor to act as an arbiter of my decision but was finally convinced after I cited the arguments’ flaws one by one.
Every reporter is understandably on edge. Uncertainty is everywhere. Our newsroom’s policies have been constantly changing about what kind of stories we should publish, using what language and which angles we should avoid. Covid-19 is still a new disease to many journalists. We don’t know exactly which stories are worth pursuing and which are stable enough to stay on the regular floor. And it is only a matter of time before we run low on funds and/or are scooped. …
As a science editor, it is my duty to look out for my readers and reassure them that we are here to support them. That’s what I expect to do for all of my readers. What I did not expect from this pandemic is having to reassure other reporters, editors, and freelancers about editorial decisions that I would normally never need to justify. …
There is emerging literature on diagnosing and treating Covid-19 patients that is easily accessible to reporters and editors, but some of them are choosing to make their editorial decisions to optimise for sensationalism or speed — such as composing news reports based on unverified claims, half-baked data, models that are “not even wrong” or ideologically favourable points of view, which may lead readers to under- or overestimate various aspects of the pandemic — instead of basing decisions on data or evidence. …

More broadly, I dare to presume frontline healthcare workers already have at least one (highly deserved) privilege that journalists don’t, and in fact have seldom had: the acknowledgment of the workload. Yes, I want to do the amount of work I’m doing because I don’t see anyone else being able to do it anytime soon (and so I even take pride in it) but it’s utterly dispiriting to be reminded, every now and then, that the magnitude of my commitment doesn’t just languish in society’s blindspot but is often denied its existence.

Obviously very little of this mess is going to be cleaned up until the crisis is past its climax (although, like ants on a Möbius strip, we might not be able to tell which side of the problem we’re on), at which point the world’s better minds might derive lessons for all of us to learn from. At the same time, the beautiful thing about acknowledgment is that it doesn’t require you to determine, or know, if what you’re acknowledging is warranted or not, whether it’s right or wrong, even as the acknowledgment itself is both right and warranted. So please do it as soon as you can, if only because it’s the first precious space journalists need to clear and maintain.