AMA Manual of Style - Stacy L. Christiansen, Cheryl Iverson 2020

Release of Information to the Public and Relations With the News Media
Ethical and Legal Considerations

Most people understand science and technology less through direct experience than through the filter of journalism. . . . Journalists are, in effect, brokers, framing social reality and shaping the public consciousness about science.

Dorothy Nelkin¹

Public interest in health, health care, and medical science is substantial, and there are many challenges to the effective and fair communication of scientific information to professionals, news media, and the public. The quality of this communication has traditionally begun with a journal article. Flawed, incomplete, or biased research publications in journals without editorial balance or explanation set the stage for poor communication to professionals and the news media. Inaccurate, incomplete, or exaggerated news reporting can mislead the public about the importance or even the meaning of scientific information. Major changes in the media landscape undermine the quality of news. Economic pressures from declining circulation have led many newspapers to eliminate health and science news sections, resulting in a loss of news editors and journalists with expertise in the critical evaluation of medical research and a very limited number of journalists trained as scientists or health care professionals. Increasingly, science news is provided by reporters or bloggers who may have limited understanding of science, medicine, and health. The competitive nature of the business of news delivery and scientific publication has led to the expansion of online news systems, on-demand news, blogs, social media, tabloid journalism, and sponsored and deceptive journals, news sites, blogs, and websites masquerading as credible and objective providers of science and health information. Moreover, the public is often poorly prepared to think critically about science, which makes them susceptible to inaccurate or misleading news reports.

The responsible dissemination of the results of new scientific research and information to the public is critical. However, amid the burgeoning means of conveying such information, accuracy and reliability of science news coverage in the news media are not increasing proportionately. To gain a competitive edge in the information chain, news organizations may exchange complexity, analysis, background, and perspective for immediacy, brevity, and sensationalism. Thus, the need for journal editors to develop and maintain viable, appropriate, and ethical relationships with news journalists for all types of media has become even more important.

The incomplete, inconsistent, and inaccurate coverage of health, medicine, and science in the news media is well documented.^{2,3,4,5,6,7,8,9,10,11,12,13,14,15} For example, HealthNewsReview.org evaluated reporting by major US news organizations on new medical treatments, tests, products, and procedures. Reviewers assessed and graded 1976 news stories from 2006 to 2015 (including newspaper articles, wire or news services stories, online stories, and network television stories) and rated most stories as unsatisfactory on 5 of 10 review criteria: costs, benefits, harms, quality of the evidence, and comparison of the new approach with alternatives.¹⁶ As summarized by Schwitzer, “drugs, medical devices, and other interventions were usually portrayed positively; potential harms were minimized, and costs were ignored.”^12(p1183) HealthNewsReview.org continues to regularly evaluate the quality of news stories about health according to the following 10 criteria¹⁷:

■Does the story adequately discuss the costs of the intervention?

■Does the story adequately quantify the benefits of the treatment/test/product/procedure?

■Does the story adequately explain/quantify the harms of the intervention?

■Does the story seem to grasp the quality of the evidence?

■Does the story commit disease-mongering?

■Does the story use independent sources and identify conflicts of interest?

■Does the story compare the new approach with existing alternatives?

■Does the story establish the availability of the treatment/test/product/procedure?

■Does the story establish the true novelty of the approach?

■Does the story appear to rely solely or largely on a news release?

HealthNewsReview.org also provides a toolkit for journalists with tips for understanding and interpreting studies, including commonly misunderstood and misreported issues, such as statistical significance, association vs causation, odds ratios, absolute vs relative risk, intention-to-treat analysis, number needed to treat, subgroup analysis, and surrogate markers.¹⁷ The tips also include Schwitzer’s 7 words that should never be used in medical news: cure, miracle, breakthrough, promising, dramatic, hope, and victim¹⁷ (see 11.1, Correct and Preferred Usage of Common Words and Phrases). Other organizations with useful guidance include the Association of Health Care Journalists¹⁸ and the Open Notebook.¹⁹

Scientific journal editors also have responsibilities regarding communicating scientific information to the public and their relationship with the news media^{3,20,21,22,23}:

■Publish appropriate, accurate, reliable, timely, and accountable scientific information.

■Help authors of research articles follow quality of reporting guidelines, avoid use of causal language when reporting observational studies,²⁴ report findings in an objective and circumspect manner, and minimize bias in the analysis and presentation of their findings.

■Require authors to report limitations of their studies, all sources of funding, and disclosures of conflicts of interest.

■Provide editorial balance for complex, controversial, or practice-changing reports of new research by publishing explanatory editorials or invited commentary with research articles as needed.

■Inform authors and journalists about journal policies regarding release of information in manuscripts under consideration or accepted before publication and journal embargoes prohibiting news media coverage of articles before publication (see 5.13.1, Release of Information to the Public).

■Assist the news media in preparing accurate reports of the information about to be published by providing news releases that meet explicit quality standards set by journals (see 5.13.5, News Releases), answering questions, facilitating equal advanced access to the journal articles in a controlled and consistent manner, and providing access to authors or other experts as needed (see 5.13.1, Release of Information to the Public).

■Evaluate the quality of news coverage of information published in the journal. For example, if a news organization has published an inaccurate report of a particular journal article, the journal editor should consider notifying the journalist or news editor to identify the errors in the report.

Journal editors and news journalists share a common obligation—to ensure that the public receives accurate information and is not misled.^3,20 This obligation becomes particularly important when information about risk is communicated to the public. For example, failure to describe health risks accurately and in proper perspective may be misleading, can create unnecessary concern, and may result in loss of public trust in reporters, editors, and scientists. Tensions between journalists, editors, and scientists—often driven by self-interests—can do much to confuse the public. These tensions should be recognized and mitigated, and journals should seek an appropriate balance among their duties to the community of readers they serve, the integrity of the scientific literature, and public entitlement to access to important scientific information without unreasonable delay.²⁰

5.13.1 Release of Information to the Public.

In many ways, biomedical journals and their editors act as gatekeepers for the release of scientific information to their readers and the public. However, conflicts often arise between journal editors (who have an ethical duty to ensure that the information they publish has been appropriately peer reviewed and assessed for quality) and authors and scientists (who want to disseminate their findings as widely and quickly as possible) and between editors and news reporters (who want to deliver information about new scientific developments as widely and quickly as possible). The announcement of “scientific breakthroughs” at press conferences or through press releases before the data that support the supposed advance have been evaluated and published in a peer-reviewed journal may cause confusion for the public (who may be given misleading or inaccurate information), news media (who may give undue attention to an inaccurate or incomplete claim), journal editors (who may have a policy that discourages publication of data that have already been reported in the press), and investigators (who may forfeit their chance for publication in a reputable peer-reviewed journal by choosing to publish by press conference or through news releases).^20,21,22

Journal editors have developed 2 policies to discourage premature release of information to the public. The first policy, based on the Ingelfinger rule (developed in 1969 by Franz Ingelfinger, MD, then editor of the New England Journal of Medicine), is an understanding between authors and editors that a manuscript will be considered for publication on the condition that it has not been submitted or reported elsewhere²³ (see 5.3, Duplicate Publication and Submission). The second policy is a news embargo, which is an agreement between journalists and editors that prohibits news coverage of a journal article until it is published (see 5.13.3, Embargo). Although some authors and journalists misunderstand or disagree with the intent of the Ingelfinger rule and the news embargo,²⁴ many journals have found that both, if applied consistently and fairly, effectively serve all communities interested in disseminating quality scientific information to the public. The International Committee of Medical Journal Editors (ICMJE),²⁵ the Council of Science Editors,²⁶ and the World Association of Medical Editors²⁷ recommend that journals develop and follow policies for orderly, controlled, and consistent release of information to the public, including the use of embargoes.

There are 4 general exceptions to a journal policy that precludes prepublication release of information to the public²⁰:

■Presentation of information during scientific or clinical meetings

■Release of information that is determined to be of urgent public need

■Testimony before government agencies

■Release of information that is in the public domain

A new evolving exception involves posting of manuscripts on preprint servers. Although not new to the physics and other scientific communities, preprint servers are relatively new in medical and health sciences. Preprint servers enable authors to post preprints (manuscripts) of studies for public dissemination before formal peer review and publication in a journal. Concerns about public release of research findings that could potentially cause harm to public health or patients have resulted in some journals urging caution about such posting. However, the number of preprints in medical and health sciences is increasing, and journal policies about preprints are evolving with an increasing number of funders and journals encouraging preprints (see 5.6.2, Public Access and Open Access in Scientific Publication).

5.13.1.1 Presentation of Information During Scientific or Clinical Meetings.

Presentation of findings during formal scientific or clinical meetings (via oral presentation or poster presentation) ordinarily does not preclude consideration of a manuscript reporting the complete findings for publication.^20,22,25 Authors may include abstracts of their findings in print or online proceedings published for these meetings and summaries of their research in meeting presentation slides or posters. However, authors should refrain from disseminating or publishing details in proceedings that are not included in the meeting abstract or presentation. Authors should not include a complete report of their findings (ie, a manuscript that they plan to submit to a journal) or distribute copies of their detailed findings or tables and figures that go beyond what is included in the meeting presentation to meeting attendees or journalists. Authors are encouraged to participate in discussion and the usual exchange with meeting attendees during their presentation. Video, audio, and social media summaries of meeting presentations also do not preclude consideration of the full manuscript for publication provided these are intended for meeting participants.

Authors may also answer questions from journalists about their meeting presentations, but they should limit their discussion to explaining and clarifying the findings presented during the formal meeting presentation. Authors should not discuss any related manuscripts under consideration by a journal or accepted but not yet published and should not reveal the name of the journal to which their manuscript has been submitted. When authors talk with the media about their meeting presentations related to work that they plan to submit for subsequent publication in a journal, they should acknowledge that the results are preliminary and may change after the complete report undergoes peer review, editing, and publication in a journal.

When an author is presenting findings at a meeting that are also included in a manuscript that is under consideration or has been accepted by a journal but not yet published, the author should limit her or his remarks to the findings as presented at the meeting and should not reveal that the manuscript is under consideration by a specific journal (ie, should not name the journal). In this case, the author should inform the editor of plans to present the work at a meeting before the meeting occurs and should discuss options with the editor. Many journals offer options for expedited review and early online publication of important research articles to coincide with meeting presentation of the research (see 5.13.3, Embargo, and 5.13.4, Suggestions for Authors Interacting With the News Media). News media coverage (based on these interactions) about manuscripts that are accepted but not yet published or that are under consideration by a journal occurring before the journal embargo is lifted and without prior approval of the editor may be grounds for rejection of the manuscript by some journals.

Authors of manuscripts under consideration by a journal or accepted but not yet published, as well as representatives of the authors’ institutions and funders, ordinarily should not participate in press conferences or extensive news interviews before publication of the peer-reviewed article. Thus, authors should not participate in press conferences at meetings separate from their scientific presentation or in-depth, extended news interviews, unless they have discussed this with the journal editor and have prior approval from the journal to which the full manuscript has been submitted.

As noted above, the journal editor and the author may plan to expedite review, revision, and publication to permit online publication of an important article to coincide with the date and time of the presentation of the findings during a scientific meeting (eg, with a late-breaking trial that is likely to have practice-changing implications). In these cases, news releases prepared by an author’s institution or funder that summarize information to be published in a journal should be coordinated with the journal (see 5.13.5, News Releases). Proper planning is needed among all parties (journal, author, and meeting organizer) to ensure that findings are released in an orderly manner that does not create confusion for journalists or the public.

5.13.1.2 Release of Information Determined to Be of Urgent Public Need.

Contrary to what many authors and news reporters believe, few findings from scientific and medical research have such significant and urgently important implications for the public that the information should be released to the public before it has been peer reviewed, revised, and published by a journal. Calling such circumstances “exceptional,” the ICMJE recommends that public health authorities should make such decisions and should be responsible for disseminating such information to health care professionals and the news media.²⁵ In such cases, the ICMJE notes, “If the author and the appropriate authorities wish to have a manuscript considered by a particular journal, the editor should be consulted before any public release. If editors acknowledge the need for immediate release, they should waive their policies limiting prepublication publicity.”²¹ However, an editor may recognize the public health urgency of releasing information contained in a manuscript under consideration without prompting from the authors or relevant authorities. In such a case, the editor should coordinate early release with the author. In situations in which there is an immediate public health need for the information, there should be no delay in its release. Journals should expedite the editorial and peer review process and speed the publication process to permit online publication as quickly as possible. Care should be taken that this is conducted in an orderly and consistent manner so as not to confuse journalists and the public.

5.13.1.3 Testimony Before Government Agencies.

An author’s required testimony before a governmental agency or institution (eg, the US Congress or the US Food and Drug Administration) that includes information not yet published should not preclude consideration of that information in a manuscript under consideration or subsequently submitted for publication.²⁰ Authors and editors should discuss whether consideration and publication of a manuscript with information relevant to such testimony can be expedited to coincide with or be published before the testimony on a case-by-case basis.

5.13.1.4 Information in the Public Domain.

Reports of important information from national government or international agencies published and widely disseminated or easily accessible online (eg, an urgent health alert or web posting from the National Institutes of Health or the World Health Organization) should be considered selectively for publication in a peer-reviewed journal on a case-by-case basis.²⁰ In such a case, the editor needs to determine if the information would be useful to the journal’s readers, if there is demonstrated need for an additional report (eg, additional important details or follow-up information is available), and if the initial alert did not already include the complete report. In addition, governmental legislation may require the public posting of guidelines or recommendations for public comment before a final version is released. In such cases, a journal editor should assess if additional peer review is needed and if publication in the journal is warranted.

5.13.2 Expedited Publication and Release of Information.

Many journals have policies to expedite the evaluation and publication of manuscripts deemed worthy of accelerated dissemination, including release of an article online ahead of an established publication schedule.²⁰ Editors should use consistent and orderly policies and procedures to identify manuscripts that contain such information; expedite the editorial, peer review, and publication process; coordinate timing with the authors; and, if feasible, notify and provide controlled advance access to journalists.

5.13.3 Embargo.

A news embargo is an agreement between journals and news reporters and their organizations not to report information contained in a manuscript that has been accepted but not yet published until a specified date and time in exchange for advance access to the information. Among medical journals, the embargo system may have been initiated by Morris Fishbein, MD, editor of JAMA between 1924 and 1949.²⁸

As an example, the standard embargo date and time for a regular issue of JAMA is 11 AM eastern time on Tuesday (issue publication date). The JAMA Network journals also publish articles online first and online only, and there is a standard embargo for these articles as well. Credentialed and approved journalists are given early access to news releases and journal articles via a password-protected website for the news media during the embargo period (usually 2-5 days before publication date).²⁹ During this time, the embargo is intended to provide news reporters an equal amount of access and time to research and prepare their news stories. However, those news reports cannot be released until the embargo has lifted, which is the date and time of publication. The For the Media website also provides information about the journals’ embargo policies and answers to frequently asked questions.

The news embargo has been criticized for being overly restrictive, delaying public access to information, and serving the self-interest of journals.²⁹ However, the embargo system is intended to create a level playing field for journalists to prepare accurate and complete news stories and to maintain consistency in the timing of release of scientific information to the public and help prevent confusion that may result from sporadic reporting on the same study at different dates and times. According to the ICMJE, such consistency of timing helps to minimize “economic chaos” surrounding those articles that contain information that may influence financial markets.²⁵ JAMA editors conducted a brief survey of journalists in 2017. Of the 404 respondents, 389 (96%) indicated wanting to continue the advanced embargoed release of journal content to the media, and 315 (81%) preferred the embargoed release to be 3 days in advance of publication (vs 1 or 2 days).

On occasion, a news reporter or organization may break an embargo and report on information from a peer-reviewed journal article before the embargo is lifted. In most cases, embargo breaks are unintentional (owing to miscommunication or misunderstanding) but on occasion are intentional to scoop competitors.^28,30,31 The rare intentional embargo break is a serious breach of trust and can result in the journal applying sanctions against the reporter and the news organization. Such sanctions may include barring the reporter, and perhaps the news organization, from receiving news releases and advance access to journal content and declining requests for interviews, access to authors, or other assistance. All embargo breaks, whether inadvertent or intentional, cause major problems for journals and journalists who have been abiding by the established embargo release time and may require early lifting of the embargo by the journal and modifying publishing plans scheduled by reporters and their media outlets.

5.13.4 Suggestions for Authors Interacting With the News Media.

The following recommendations are provided for interactions between authors and the news media.^20,25,32,33

■Authors should abide by agreements with most journals to not publicize their work while their manuscript describing the work is under consideration or awaiting publication by a journal. If authors have any questions about release of such information, they should contact the journal’s editorial office.^20,25

■Authors presenting research at clinical and scientific meetings orally with slides or in posters may discuss their presentations with reporters but should refrain from distributing copies of their presentations, data, tables, or figures (see 5.3, Duplicate Publication and Submission).^20,25

■Authors should inform editors of previous news coverage of their work at the time of manuscript submission (see 5.3, Duplicate Publication and Submission).²⁵

■Authors of manuscripts under consideration by a journal or accepted but not yet published should not participate in press conferences or extended news interviews before publication of their findings in the journal unless this is an approved exception by the journal editor that is done in coordination with the journal.²⁰

■Authors who receive requests from journalists for information about their research or other work reported in manuscripts that are under consideration but not yet accepted by a journal may indicate that the manuscript is under consideration but should not provide details or the name of the journal unless and until the manuscript is accepted (see 5.7.1, Confidentiality During Editorial Evaluation and Peer Review and After Publication).

■Authors should establish an understanding with a reporter before an interview about the journal’s embargo policy³³ and should ask to review direct quotations for accuracy. Note: Authors should be cautious about making comments “off the record.”

■For accepted manuscripts about to be published and those just published, authors should be as accessible to the news media as their schedules permit, keeping reporters’ deadlines in mind and setting aside time to prepare for and give interviews.³²

■During an interview, authors should take care to put the findings in context, appropriately represent the meaning and magnitude of the findings, and acknowledge study limitations and caveats. They should explain commonly used jargon and acronyms (and avoid their use if possible). They should provide easily understood statistics (eg, absolute risks for treatment and control groups) and avoid too many and exaggerated statistics (eg, relative changes without base rates, survival statistics to demonstrate benefit of screening). Authors also should avoid use of words that imply causation for findings of research that can only demonstrate association (eg, observational studies). In addition, they should avoid answering hypothetical questions and responding with “no comment” (it is better to provide an explanation for not being able to answer a specific question).^{15,33,34,35,36}

■Authors should inform reporters and news organizations of errors in news stories and request published corrections if necessary and possible.³²

■Authors who expect to be interviewed frequently by the news media should consider having training in providing informative and accurate interviews.³²

In addition, journal editors should inform authors of accepted manuscripts of the journal’s policies regarding release of information before publication and relations with the news media. For example, JAMA reminds authors of its policies on duplicate publication and news embargoes in acceptance letters, noting that authors and the news media should not release any information about the author’s accepted article until the specified embargo date and time. This embargo does not preclude authors from participating in interviews with reporters who are preparing stories; it is meant to remind authors that any news stories that result from such interviews should not precede publication of the authors’ articles in the journal.

Some journals notify authors of projected publication dates in their acceptance letters, and some journals include a notice of the publication date on the edited manuscript or page proof sent to authors for approval before publication. Editorial and publishing staff may also receive requests from authors asking about expected dates of publication. Staff and authors should not assume that such dates or their corresponding embargo dates are definite or final. Editors may rearrange the editorial content schedules of specific issues and online releases. When informing authors of the expected dates of publication for their accepted articles, editors should remind authors that publication dates may change.

If authors want to coordinate news coverage of their published articles through a press conference or news release, they should first contact the journal editor to ascertain the exact date of publication. Editors and publishers may want to help authors and representatives from their organizations coordinate press conferences and releases with the simultaneous publication of their articles. Editors and publishers can also help the news media prepare accurate reports by providing high-quality news releases, answering questions, providing access to the authors and other experts, and providing advanced access to journal articles.^21,22 This assistance should be contingent on agreement with and cooperation of the news media in timing their release of stories to coincide with the publication of the article. News releases, advance copies of journals, and journal articles released online in advance should indicate the date and time of the news embargo and be restricted to qualified news journalists and agencies that agree to honor the journal’s embargo policy.

5.13.5 News Releases.

Many journals issue news releases on selected articles determined by the editors to be of interest to the public. For example, experienced science writers prepare news releases for selected articles published in the JAMA Network journals, and these news releases are reviewed by the editors to ensure accuracy and objectivity. Some journals may also ask authors to review news releases to check for accuracy. News releases of journal editorial content should be under the authority of the editor, not the journal’s publisher or owner (see 5.10, Editorial Freedom and Integrity).

News editors, writers, and producers receive hundreds of news releases a week. Thus, a news release must attract attention, but it also must conform to a familiar format and style. See Box 5.13-1 for a guide to news release content and format and Box 5.13-2 for sample news releases from the JAMA Network journals. Journalists are taught to present facts accurately, but they may not know how to interpret biomedical statistics or understand the specific context of new scientific information.^6,16 In news releases and news stories, research findings and statistics are often cited inaccurately or out of context to support an exaggerated medical claim.^{2,5,8,10,11,12,13,14,15} To help prevent exaggerated or misleading claims, news releases must include accurate and clearly stated statistics^16,17,37,38 (see 19.1, Study Design and Statistics, The Manuscript: Presenting Study Design, Rationale, and Statistical Analysis). In addition, research findings must be placed in proper context and should include important background, summary of study methods, limitations of the methods, and information on study sponsorship and relevant conflicts of interests of authors (see 5.5, Conflicts of Interest). Care should be taken to provide balance (eg, citing a related editorial) and to avoid sensationalism (eg, use of terms such as cure, miracle, or breakthrough).¹⁷ Examples of common problems to avoid in news releases are listed in Box 5.13-3.

Box 5.13-1. Guide for News Release Content and Format

✵News releases should clearly indicate the name of the issuing organization (eg, journal, publisher, society, agency, institution, or company).

✵The name, address, telephone number, and email and web address of the releasing organization should be prominently listed (eg, under the title “News Release” at the top of the release).

✵The name, address, telephone number, and email address of the release contact person should be clearly identifiable.

✵The release should be no longer than 200 to 600 words (1-2 pages in print or PDF). For print releases that exceed 1 page, the word more should appear at the bottom of the first page.

✵The release can be structured and may include a representative table or figure (see example of a structured news release in Box 5.13-2).

✵The time and date of the release and the embargo should appear prominently at the top of the release.

✵An easily identifiable headline (eg, boldface or underlined) that provides the essence of the release should also appear at the top of the release.

✵For most news releases, the location of the issuing organization of the release should appear in capital letters before the lead sentence. For journals that issue news releases about studies conducted elsewhere, this is not necessary (see Box 5.13-2).

✵The lead sentence should contain the most important information. Details should be given in later paragraphs. The name of the journal in which the article appeared should be included in the lead sentence to help facilitate mention of the journal in the story as a source of the information.

✵Authors of the article should be clearly identified with complete names, academic degrees, and affiliations; relevant conflicts of interest should be included in the news release or noted that these are included in the article.

✵All sources of funding for the research or work should be identified in the news release or noted that these are included in the article.

✵Releases should contain simple, declarative sentences and should avoid jargon and undefined abbreviations. All medical terms should be explained. Specify the details of complex interventions (eg, “counseling consisted of 10 weekly visits to dietitians”) and translate meaning of exposure levels into ordinary activities (eg, “50 g of protein of processed meat is equivalent to 4 slices of bacon”).

✵All statistics and numbers should be properly explained and put in context.

✵A complete citation and link to the article(s) cited in the news release should be included.

Box 5.13-2. Examples of News Releases^a

Unstructured Narrative News Release Example

EMBARGOED FOR RELEASE: 11 A.M. (ET) TUESDAY, JULY 25, 2017

Media Advisory: To contact Ann C. McKee, M.D., email Gillian Smith (grsmith@bu.edu) or Pallas Wahl (pallas.wahl@va.gov).

Related material: The editorial “Advances and Gaps in Understanding Chronic Traumatic Encephalopathy” by Gil D. Rabinovici, M.D., of the University of California, San Francisco, also is available at the For the Media website.

To place an electronic embedded link to this study in your story: This link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2017.8334

JAMA

High Prevalence of Evidence of Chronic Traumatic Encephalopathy in Brains of Deceased Football Players

Chronic traumatic encephalopathy (CTE) was diagnosed post-mortem in a high proportion of former football players whose brains were donated for research, including 110 of 111 National Football League players, according to a study published by JAMA.

CTE is a progressive neurodegeneration associated with repetitive head trauma and players of American football may be at increased risk of long-term neurological conditions, particularly CTE.

Ann C. McKee, M.D., of the Boston University CTE Center and VA Boston Healthcare System, and colleagues conducted a study that examined the brains of 202 deceased former football players to determine neuropathological features of CTE through laboratory examination and clinical symptoms of CTE by talking to players’ next of kin to collect detailed histories including on head trauma, athletic participation and military service.

Among the 202 football players (median age at death was 66), CTE was neuropathologically diagnosed in 177 players (87 percent) who had had an average of 15 years of football participation. The 177 players included: 3 of 14 high school players (21 percent); 48 of 53 college players (91 percent); 9 of 14 semiprofessional players (64 percent); 7 of 8 Canadian Football League players (88 percent); and 110 of 111 NFL players (99 percent).

Neuropathological severity of CTE was distributed across the highest level of play, with all three former high school players having mild pathology and the majority of former college (56 percent), semiprofessional (56 percent), and professional (86 percent) players having severe pathology. Among 27 participants with mild CTE pathology, 96 percent had behavioral or mood symptoms or both, 85 percent had cognitive symptoms, and 33 percent had signs of dementia. Among 84 participants with severe CTE pathology, 89 percent had behavioral or mood symptoms or both, 95 percent had cognitive symptoms, and 85 percent had signs of dementia.

“In a convenience sample of deceased football players who donated their brains for research, a high proportion had neuropathological evidence of CTE, suggesting that CTE may be related to prior participation in football,” the article concludes. The authors acknowledge several other football-related factors may influence CTE risk and disease severity, including but not limited to age at first exposure to football, duration of play, player position and cumulative hits.

The study has several limitations, including that it is a skewed sample based on a brain donation program because public awareness of a possible link between repetitive head trauma and CTE may have motivated players and their families with symptoms and signs of brain injury to participate in this research. The authors urge caution in interpreting the high frequency of CTE in this study, stressing that estimates of how prevalent CTE may be cannot be concluded or implied.

For more details and to read the full study, please visit the For the Media website.

(doi:10.1001/jama.2017.8334)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

# # #

For more information, contact JAMA Network Media Relations at 312-464-JAMA (5262) or email mediarelations@jamanetwork.org.

Structured News Release Example

Is Eating Fiber After Colorectal Cancer Diagnosis Associated With Lower Death Risk?

JAMA Oncology

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, NOVEMBER 2, 2017

Media advisory: To contact corresponding author Andrew T. Chan, M.D., M.P.H., email to Katie Marquedant at Kmarquedant@mgh.harvard.edu. The full study is available on the For the Media website.

Want to embed a link to this study in your story? Links will be live at the embargo time http://jamanetwork.com/journals/jamaoncology/fullarticle/10.1001/jamaoncol.2017.3684

Bottom Line: Eating more fiber was associated with a lower risk of death overall and from colorectal cancer in patients with non-metastatic colorectal cancer.

Why The Research Is Interesting: Colorectal cancer is common and the number of people living with treated disease is estimated to grow with advances in diagnosis and treatment. Many cancer survivors look for self-care strategies, especially advice on what to eat. Fiber intake is thought to be protective against colorectal cancer. But whether fiber intake is associated with recurrent colorectal cancer and survival in patients already diagnosed and treated has not been examined.

Who: 1,575 health professionals with non-metastatic (stages 1 to 3) colorectal cancer who provided detailed diet information on food questionnaires.

When: Fiber consumption was measured beginning in the 1980s; deaths were measured until 2012; the study was conducted from December 2016 to August 2017.

What (Study Measures): Consumption of total fiber, different sources of fiber and whole grains from six months to four years after participants’ colorectal cancer diagnosis (exposures); deaths from colorectal cancer specifically and any cause (outcomes).

How (Study Design): This is an observational study. In observational studies, researchers observe exposures and outcomes for patients as they occur naturally in clinical care or real life. Because researchers are not intervening for purposes of the study they cannot control natural differences that could explain study findings so they cannot prove a cause-and-effect relationship.

Authors: Andrew T. Chan, M.D., M.P.H., of Massachusetts General Hospital and Harvard Medical School, Boston, and coauthors

Results: During a median eight-year follow-up, a higher intake of fiber and whole grains after diagnosis of non-metastatic colorectal cancer was associated with a lower risk of death from that disease and other causes. Survival improved for patients who increased their fiber intake after diagnosis compared to those who did not.

Study Limitations: Information about fiber intake and sources was self-reported without adjustment for measurement error. Detailed treatment data for the patients were largely unavailable.

Study Conclusions: “Higher fiber intake after the diagnosis of non-metastatic CRC [colorectal cancer] is associated with lower CRC-specific and overall mortality. Increasing fiber consumption after diagnosis may confer additional benefits to patients with CRC.”

Featured Image:

What The Image Shows: The image illustrates that overall and colorectal-cancer specific death appears to decline as total fiber intake increases after diagnosis.

For more details and to read the full study, please visit the For the Media website. (doi:10.1001/jamainternmed.2017.3684)

Editor’s Note: The article contains conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

# # #

For more information, contact JAMA Network Media Relations at 312-464-JAMA (5262) or email mediarelations@jamanetwork.org.

^a Note: These news releases follow AP style, not AMA style.

Box 5.13-3. Common Problems to Avoid in News Releases of Scientific Studies

✵Unfamiliar mathematical and statistical terms and numbers that are difficult to interpret should be avoided; do not confuse association and correlation with causation. See also HealthNewsReview’s Tips for Understanding Studies.¹⁷

✵Results should be reported in context, including locations and dates of the study, representativeness of the sample, and whether results are consistent with what is already known. Risks of events should be acknowledged to be common (eg, common cold) or rare (eg, being hit by lightning).^17,33

✵Highlight cautions, including limitations of the study.

✵If the results of a survey are reported, the response rate should be provided along with a caveat that the results may not be generalizable if the response rate is low.

✵Key study facts: Report duration and size of the study. If a news release mentions a specific sample that was studied or a specific number of cases, whether the number is large or small, information about the size of the total population from which the sample or cases were drawn should be included.

✵Causal language should be reserved for reports of randomized clinical trials and laboratory studies and should be avoided for reports of observational studies that can only demonstrate association between findings and study variables, risks, exposures, or other factors.³⁴

✵Avoid the word “significant” alone. Statements about statistical significance should not be quoted from an article out of context or without an explanation.²⁰ Reporters and readers do not necessarily know the difference between statistical significance and clinical significance or importance. For example, quoting a statement that there was a trend toward a statistically significant association between a treatment and an outcome may give undue importance to a treatment that has no real clinical value. If statistical significance needs to be reported, include an explanation such as “the results are unlikely to be due to chance.”

✵Absolute event rates should be reported. Care should be taken to avoid confusing absolute and relative risks because relative risks are often erroneously translated to specific risks. For example, a decrease from 2.5% to 2.0% should not be reported as a 20% reduction in risk but could be reported as a 0.5% absolute risk reduction and 20% relative risk reduction. It may be helpful to report excess or decreased risk in terms of numbers per 1000 or 10 000. However, this must be done with caution. Percentages rather than frequencies (eg, number per 1000) may be more easily understood by the public. Rates may be difficult to understand, so in some cases it may be possible to translate rates into risks, and for time-to-event analyses, percentages for outcomes for each group at a specific time may be provided along with the median time to the event.^20,39

✵Avoid reporting odds ratios, especially for common outcomes, which may overstate a relative risk.^20,33,40

✵Benefits and harms: If reporting the results of a study about an intervention, event rates for benefits and harms should be reported equally and in a balanced manner.³³

✵Check for accuracy. Before news releases are distributed, they should be proofread and the content should be reviewed by a professional familiar with the article or report covered in the release or by the editor.

Principal Author: Annette Flanagin, RN, MA

Acknowledgment

I thank the following for review and helpful comments: Howard Bauchner, MD, JAMA and JAMA Network; Deanna Bellandi, MPH, JAMA Network; Timothy Gray, PhD, JAMA Network; Iris Y. Lo, JAMA Network; and Lisa M. Schwartz, MD, MS, and Steven Woloshin, MD, MS, Center for Medicine and Media and The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.

Additional Information

This work is dedicated to the memory of Lisa M. Schwartz, MD, MS, who conducted influential research on medicine and the media and was a champion for improved communication of medical evidence, bias, and public health risk.

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