‘Cry Wolf’ Stories Permeate Coverage of Health Hazards : Journalism: Scientists, others say alarmist accounts add to fear. Facts that mitigate a threat often go unreported.

Two weeks before Thanksgiving, 1959, minuscule amounts of a potentially cancer-causing weedkiller were discovered in some cranberries grown in Washington state and Oregon. The New York Times put the story on Page 1 five times in seven days. Other media followed suit. People panicked.

But a nationwide inspection of cranberries disclosed no contamination other than at the original sites, and not one case of illness from tainted cranberries was reported anywhere in the country.

Such false alarms were uncommon in the 1950s. Oh sure, there were scare stories about strontium-90 in milk and about fluoride in toothpaste and in the water supply, but these were isolated and largely confined to narrow interest groups.

In the 1990s, scare stories are omnipresent. The perception of risk has become so pervasive, there are now organizations, schools, institutes, journals and careers dedicated solely to its assessment.

Given the media’s critical role in setting the national agenda--especially on issues as complex and politically charged as those involving potential health hazards--many journalists, scientists and social critics are concerned about the alarmist tone that suffuses the media’s portrayal of daily life.

They say such coverage can frighten people and prompt them to take unnecessary risks--keeping handguns in their homes, going on rigid, unsound diets or avoiding necessary medical treatment. “Cry wolf” coverage may also deprive people of the ability to distinguish between serious and not-so-serious risks.

“We are in danger of surrendering to feelings of helplessness and apathy, which paralyze us in the act of coping even in situations where personal action can make a difference,” medical researchers from the Centers for Disease Control in Atlanta said in a report, “Interpreting Risks to the Public,” presented to the “Prevention 85” conference in Atlanta.

Besides, asks Paul Portney, vice president of Resources for the Future, a Washington think tank that specializes in environmental issues, “If everything is as harmful as we’re told, how come we’re healthier and living longer . . . than ever before?”

The media offer few answers to this seeming paradox.

In fact, says Cristine Russell, a special health correspondent for the Washington Post, who spent a year studying risk while on a grant from the Alicia Patterson Foundation, “The media have been a big player in widespread public confusion about risk.”

A big player, indeed.

“Studies have shown that people get more information about risk and hazard from the media than they do from their physicians or anyone else,” says Walter Willett, professor of epidemiology and nutrition at the Harvard School of Public Health.

Government decision-makers also “get their information from the media more than any place else,” says Clarence (Terry) Davies, director of the Center for Risk Management at Resources for the Future.

Thus the media are a vital link in a fragile but circular information chain that connects scientists, politicians and the public. Typically, a few anxious, often angry people say they’re worried about something--a toxic waste dump, say. The media cover the story. Other people see the story and start worrying themselves: Is the dump near them toxic? Are their children in danger? They demand answers--and action--from their elected officials.

The officials--primarily in Congress--read the same stories and listen to their constituents and respond by making funding and policy decisions for the Environmental Protection Agency, the Food and Drug Administration and other regulatory agencies created to protect the public.

“We live in a democracy, after all, and it shouldn’t surprise us that we have set policy according to what the public’s been most alarmed about,” William Reilly, former director of the EPA, said last spring on the ABC News program “Are We Scaring Ourselves to Death?”

“That has resulted in a sort of discontinuous series of crises, episodic events which got a lot of publicity, television exposure, press attention, and resulted in Congress writing a new law.”

Many of those laws have proved flawed, either in conception or in enforcement.

Writing in the Washington Post last spring, Estelle Fishbein, vice president of Johns Hopkins University, argued that the 1980 Superfund law, designed to clean up hazardous waste sites, had “failed miserably.” Only 15% of the 1,300 Superfund sites identified by the EPA have been completely cleaned up, Fishbein said, despite an expenditure of $13.5 billion--25% of which has gone to attorneys.

Daniel Puzo, who covers food safety issues for the Los Angeles Times, says overheated media coverage of pesticides has resulted in a similar waste of federal funds monitoring that risk when the government should be devoting its resources to looking for food-borne microbes such as salmonella and E. coli, which are “by far the greater danger in terms of maintaining the healthfulness of the food supply.”

The Centers for Disease Control say there are 6.5 million cases of food-borne illnesses--and 9,000 deaths--a year. But only when there’s a large-scale breakout--as happened last year when four people died and 500 got sick after eating Jack in the Box hamburgers--do the media or the government seem to take notice.

“There will be 70 to 80 reporters covering a Raiders game,” Puzo says, “but only three or four reporters in the whole country cover food safety full-time. The media don’t cover it so the government doesn’t seem to worry much about it. There are so few federal inspectors for the number of food-processing plants in the country that it’s totally ridiculous.”

Reilly says some of the government’s regulatory laws that have proved ineffective or misguided should be reconsidered. So do many others. But bureaucracies are difficult to reverse.

In an interview with the Los Angeles Times two days before President Clinton nominated him to the United States Supreme Court, federal Judge Stephen Breyer said the media are such a powerful force in risk perception and policy-making that “once a particular substance becomes a matter of such public interest that it’s written about continuously in the press, the battle is over;” the initial thrust and angle the media provide largely determine the outcome of the subsequent debate.

“What constitutes news is not necessarily what constitutes a significant public health problem,” says John Graham, director of the Center for Risk Analysis at the Harvard School of Public Health. “The bizarre, the mysterious, that which people have difficulty imagining happening”--that’s news, that’s what the media cover.

Peoples’ perceptions about risk are “definitely more closely related to media coverage than to actual statistics,” says Paul Slovic, the president of Decision Research Inc. in Eugene, Ore., and a psychology professor at the University of Oregon.

There are perhaps no better examples of this phenomenon in recent years than the public panics over the pesticide Alar on apples (see accompanying story) and the presence of asbestos in New York City schools.

In the 1960s and ‘70s, miners and other industrial workers who had worked in asbestos-laden environments 20 or 30 years earlier began to show a high incidence of lung cancer and other lung diseases. Congress and the EPA subsequently took steps to limit asbestos exposure.

But many officials failed to take into account the enormous difference between the exposure of someone working with a toxic substance all day and someone who might be exposed to it occasionally and briefly. They also failed to differentiate between the kind of asbestos that can be truly dangerous (amphiboles) and the white, chrysotile-based asbestos that is used 95% of the time in the United States and that repeated studies have shown is “not a health risk in the non-occupational environment,” as a team of international experts concluded in a study published by Science magazine in 1990.

But when crumbly chrysotile asbestos was found in several New York schools in the summer of 1993--after federally mandated reports had pronounced those sites free of such “contamination”--terrified parents, goaded on by the tabloid media and local television, demanded action. Then-Mayor David Dinkins announced that no school would be allowed to reopen for the new school year until it had been inspected anew.

Classrooms opened two weeks late for the city’s 1 million school-age children--a large number of whom may have been “in more danger on the streets than in school,” as one New York Times story noted.

The inspection, cleanup and delay occasioned by the asbestos scare cost taxpayers more than $120 million.

Some journalists say they covered the asbestos story more as an expose of incompetent and fraudulent government testing than as a health hazard. But the testing would not have been nearly as big a story if the purported hazard-- cancer-- had not been mentioned so prominently.

After all, no one would have been outraged if officials had lied about removing peanut butter from the public schools.

Even the New York Times, which did emphasize the falsified inspection reports in its generally sober coverage, used such words and phrases as “asbestos hazards” and “contaminated with the cancer-causing material” and “asbestos that posed dangers to children” in its coverage.

Although there were a few brief cautionary phrases in the early New York Times coverage, it wasn’t until almost a month after the first story on the “crisis” that the paper published a lengthy Page 1 story saying health experts and school officials thought the risks posed by a few months in schools with asbestos were “negligible”--less than the statistical likelihood of being killed by lightning.

The crumbly asbestos may well have offered some risk, but the decision to delay the opening of school was “based more on a need to reassure fearful parents than on any estimate of health risk,” the story quoted health experts and school officials as saying. As a trustee of the New York School Construction Authority told the New York Times, “Notwithstanding all of the evidence, people still have an extraordinary fear.”

The media both cover and exacerbate that fear. But the media are not the only thread in the web of fear, whether the issue is asbestos in the schools, fat in food or crime on the streets. Human psychology, individually and collectively, is also important.

“Perception of risk is a very value-determined thing,” says Davies of the Center for Risk Management. “There are people who, for whatever reasons--early . . . toilet training or genetics or whatever--are very risk-averse . . . very paranoid in some cases about what society is ‘doing’ to them.”

The asbestos scare pushed two “hot buttons” for almost everyone--dread of cancer and compassion for children--both of which far outweighed any reassurances from scientists.

Students of risk perception are not surprised by this. They say most people look at much more than scientific evidence in responding to all kinds of risks. Indeed, they often ignore scientific evidence altogether.

As Oliver Wendell Holmes, the celebrated U.S. Supreme Court justice, put it:

“Most people think dramatically, not quantitatively.”

In covering risk, most reporters--who are, after all, lay people, not scientists--generally reflect this attitude.

To many, a dramatic--often melodramatic--approach to risk seems “strikingly an American phenomenon,” in the media and the public alike, the late British journalist Henry Fairlie wrote in 1989. He said this approach is “yet another distortion of the philosophy of rights underlying the Constitution, as if the Declaration of Independence had been rewritten to include freedom from risk among the self-evident rights to life, liberty and the pursuit of happiness.”

“The idea that our individual lives . . . can and should be risk-free has grown to be an obsession, driven far and deep into American attitudes,” Fairlie wrote.

The public’s exaggerated fears, rather than scientific expertise, may increasingly be “setting priorities for regulations and research,” says Sharon Friedman, chair of the journalism department at Lehigh University in Bethlehem, Pa.

In her article “Media, Risk Assessment and Numbers” in the current issue of the journal “Risk: Health, Safety & Environment,” Friedman quotes scientists as saying that media attention and the resultant “public pressure on legislators and government agencies skew environmental decision-making.” The government may spend money trying to regulate risks that aren’t really risky, while ignoring genuine risks.

The EPA admitted as much in a 1987 report that said, “Overall, EPA’s priorities appear more closely aligned with public opinion than with our estimated risks.”

William Allman, writing in Science 85 magazine, warned that our increasing “desire for absolute certainty makes a high probability, such as 85%, seem insufficient.” The ramifications of that attitude are profound and far-reaching.

Experts say 90% of the toxic material could be removed from many waste sites in a relatively reasonable time, for example, at a relatively reasonable cost. But in an effort to provide absolute safety, many years and tens of millions of dollars are often spent trying to remove the last 10%. Or the last 5%. Or the last 1%.

“Removing that last little bit can involve limited technological choice, high cost, devotion of considerable (Environmental Protection) Agency resources, large legal fees and endless argument,” Breyer wrote in his book, “Breaking the Vicious Circle: Toward Effective Risk Regulation.”

“Experts calculate that the EPA rules, regulating sources such as benzene storage vessels and coke byproduct recovery plants, save a total of three to four lives per year, at a cost of well over $200 million,” more than $50 million per life, Breyer says.

In contrast, one study has shown that vaccinating 18-month-olds against hemophilus influenza Type B, the leading cause of bacterial meningitis, would save lives at a cost of $68,000 each.

Breyer and others warn that the resources available to regulate and combat various health risks are not limitless. What many critics call “headline hysteria” about relatively small risks often prompt the government to spend money regulating those risks, and that means money may not be available for research and for more serious social, medical and environmental problems--prenatal care, childhood immunizations, day care, housing, education, highway safety, shelters for battered women, smoke detectors in low-income rental housing, hot lunches for poor children. . . .

Environmentalists and consumer advocates disagree vigorously with the Breyer argument.

“The federal government has under-regulated or regulated too late far more often than it’s over-regulated,” says Dr. Sidney Wolfe, director of the Health Research Group of Ralph Nader’s Public Citizen organization. Wolfe ticks off a series of drugs and devices, from the arthritis medication Oraflex to the Dalkon Shield IUD, which caused serious health problems before being removed from the market.

Al Meyerhoff, senior attorney for the Natural Resources Defense Council, an environmental organization, says, “If we’ve learned a single lesson about toxic chemicals in the last decade, it’s that we cannot trust government regulation to protect us from these exposures.

“That makes risk information and communication even more important,” he says, “because in the final analysis, the public has to protect itself.”

Moreover, supporters of strict government regulation argue that it’s callous to put a price tag on human life and that it’s always better to risk wasting money than to err on the side of compromise and risk wasting lives.

It’s a “guns or butter myth . . . a smoke screen . . . very naive,” Wolfe says, to suggest that money not spent on current regulatory efforts would otherwise be spent on more important health and welfare projects. He and others worry that money saved on regulation and consumer protection would be funneled to deficit reduction or the Pentagon or other projects they think are less important.

But public policy experts say Congress could specifically earmark funds for certain health and social programs, and they complain that the media ignore this possibility as well as other economic aspects of environmentalism in their coverage of risk.

“Many economists are intensely frustrated that the media refuse to discuss the fact that environmental protection often doesn’t stand up to a cost/benefit test,” journalist Gregg Easterbrook wrote in the New Republic in 1990.

Many scientists feel the same way.

“The press hasn’t even begun to address” the cost/benefit ratio, says Lois Gold, director of the Carcinogenic Potency Project at UC Berkeley. “There’s no perspective on cost in the press.”

Conservatives have largely co-opted the cost/benefit argument, though, and since they are largely seen as being pro-business, many in both the news media and the political arena tend to dismiss their arguments out of hand, looking only at their ideology, not at their science or their economics.

Many environmental reporters not only know nothing about economics, they’re “hostile toward thinking about” risk issues in economic terms, says Rob Stavins, who teaches environmental economics and public policy at Harvard University. “A lot of people think if you take an economic perspective on the environment, that must just be worrying about business and their interests.”

But others argue that the cost/benefit argument should ultimately be a liberal argument, not a conservative argument, because government regulations that raise the cost of doing business and take money out of the economy ultimately hurt poorer people the most, eliminating jobs and raising prices for those whose cause has been most often championed by liberals.

Moreover, they argue, economic well-being is the greatest single factor in good health, a point that is rarely discussed in the mainstream media.

“The mortality rate for higher-income individuals is generally less than that for lower-income individuals,” Ralph Kenney wrote in a 1990 issue of the journal Risk Analysis. “Reasons for this relationship relate to, among other things, better nutrition, better sanitation, better health care and better education--all items that are easier to come by with money.”

Indeed, many experts in risk assessment worry that media and political emphasis on other, much smaller risks than poverty not only hurts poor people but damages the overall economy and social fabric.

The desire for a risk-free society is “one of the most debilitating influences in America today, progressively enfeebling the economy with a mass of safety regulations and . . . threatening to create an unbuoyant and uninventive society,” Fairlie wrote in the New Republic.

As Graham, the Harvard risk analyst puts it, “We all want zero risk. The problem is if every citizen in this country demands zero risk, we’re going to bankrupt the country.”

Modern technology has made it possible to detect tiny amounts of potentially harmful chemicals that would have eluded discovery in previous generations. This means the government can enact regulations to protect Americans from previously hidden dangers. But when this technological capability is combined with Americans’ zeal for zero risk, the result can, at times, both distort the political process and disrupt the economy.

Joseph Lelyveld, executive editor of the New York Times, attributes our desire for zero risk to “something in the American soul that seems to think we should all live forever, and therefore, anything that can hurt you is part of a conspiracy to prevent that.”

This, of course, plays into the peculiarly American determination to look for villains (and heroes), to fix blame, to insist on answers, reasons, solutions, no matter how random or inexplicable a given event may be. As a people, we are uncomfortable with uncertainty and ambiguity. We prefer black and white to gray.

People are sick? It must be DDT. Or Dioxin. Or secondhand smoke. Never mind that scientists say the evidence isn’t in yet. We want answers. Now.

The media feed that appetite for immediate answers. Reporters aren’t scientists--or historians--waiting for definitive findings. They have daily deadlines. Something “might” be dangerous? That’s good enough for today’s story; if there’s a new study tomorrow saying it’s not dangerous, we’ll report that story, too.

“There’s an inherent conflict between the business of news and what social scientists and others call ‘risk communications,’ ” say social scientists Eleanor Singer and Phyllis Endreny in the current issue of the journal Risk: Health, Safety & Environment.

“To communicate information about hazards and risks in a way calculated to foster rational decision-making means providing detailed and precise information and immediate and long-term consequences, to weigh the costs and benefits of a hazard and its alternatives for the individual and for society, and to discuss the issues, moral and economic, that inhere in hazardous processes and events,” Singer and Endreny say.

“But reporting about hazards is ordinarily reporting about events rather than issues, about immediate consequences rather than long-term considerations, about harms (injury, property destruction, death) rather than risks--i.e., the statistical probability of harm.

“Alternatives are almost never considered in a story about a particular hazard, and when they are considered, their risks and benefits are not. Moral or ethical issues are generally absent from news stories about hazards, and even economic issues are for the most part ignored.”

That inherent conflict between the tentative, incremental nature of science and the demands for immediate certainty in daily journalism almost inevitably leaves the public confused.

Does the anti-oxidant beta carotene help prevent lung cancer or might it contribute to lung cancer? Does margarine help fight heart disease or does it contribute to it? Does chocolate raise cholesterol or does the stearic acid in it actually lower cholesterol?

It all depends on which morning’s newspaper you read and which evening’s newscast you watch. You can’t tell the risks without a score card, and in this game, they seem to change the numbers almost daily.

In July, the New York Times published a story saying “fears about electromagnetic radiation from power lines and electrical appliances have circulated for years, but . . . scientists say there is no proof the radiation harms health.” Two weeks later, the Los Angeles Times published a story saying: “Electromagnetic fields, previously implicated in triggering leukemia, brain tumors and breast cancer, may play a far more important role in Alzheimer’s disease, a USC researcher will report today.”

Contradictions and confusion about caffeine have been even more striking.

In recent years, caffeine has been variously reported to cause cancer, to inhibit conception, to induce miscarriage, to cause birth defects, to increase cholesterol, to trigger irregular heart beats, to aggravate ulcers and to increase urination.

But caffeine has also been reported to help people lose weight, improve hand-eye coordination, increase tolerance for exercise, promote clearer thinking, diminish drowsiness, make children more attentive in school and make adults less likely to suffer bronchial asthma--or to commit suicide.

You would think that with all the advances in modern medicine and technology, we could find a simple answer to the simple question “Is a cup of coffee bad for you?” But many people are afraid of technology, and many others have lost faith in it. Indeed, people’s attitude toward technology helps explain their attitude toward risk.

Next: What we’re afraid of--and why.

Jacci Cenacveira of The Times editorial library assisted with the research for this series.

Confusion Over Caffeine

Perhaps no substance has been the subject of more conflicting media and scientific reports in recent years than caffeine. So, is a cup of coffee bad for you or not?