Do journalists make a difference?

A few weeks ago a young woman was admitted to the hospital with a raging fever, excessive urination and back pain. I prescribed an antibiotic for a kidney infection, and over the next several days I watched her improve and go home. As a doctor, I could see the impact that I had made.

Several months ago, I wrote a three-part series titled "Examining Physicians" for The Commercial Appeal. It was about Memphis patients rating their doctors and the report cards being publicly available online. As a writer, I was uncertain if I had made an impact with my articles.

I wondered: By what we write, can columnists reduce the obesity epidemic, stop teenage smoking or increase vaccination rates? Sitting in a classroom, as a health journalism fellow at the University of Southern California Annenberg School for Communication and Journalism, I asked my peer journalists a question. "Do reporters ever measure the impact of their writings?"

We know media messages from movies and television can have a significant impact on kids. Take the case of teenage pregnancies. A 2008 Rand Corp. study found teenagers who watch lots of sexual content on television are twice as likely to become pregnant or impregnate someone over a course of three years compared to those who watch less sexual content.

We also know that when health messages are laced in with entertainment programs, they can shift the knowledge and attitude of millions of people. Take the case of a Kaiser Family Foundation study, where a health education message was injected into the NBC TV show "ER."

In a less-than-a-minute vignette, nurse Carol Hathaway sees a teenage patient with cervical cancer and explains how this could be related to the sexually transmitted disease HPV - human papillomavirus. In a series of surveys before and after the airing of the program, "ER" viewers who could correctly define HPV and link it to cervical cancer tripled from 10 percent to 30 percent.

So to determine if I had had an impact on the Memphis community with my articles, I collaborated with Dr. Wayne Pitts and Dr. Mary Campbell at the Mid-South Survey Research Center at the University of Memphis in conducting a survey before and after the printing of the "Examining Physicians" articles. Of the 1,000 individuals the interviewers contacted, some 46 percent said they subscribed to or read The Commercial Appeal.

Among the readers we asked whether they had read or heard about the series, nearly 36 percent said they had in the post survey. Initially, this seemed quite encouraging and reassuring. "I am increasing the awareness," I thought.

However, when the same question was asked before the series was printed - just as a "dummy" question or a placebo - 33 percent said they had seen the series, even though it had not yet been printed.

Interesting, I thought, and then realized that the 33 percent was a placebo effect - that is, many of the survey responders were just saying yes, they had seen the series to please the interviewer. This is often the same rate of "placebo effect" seen in many drug trials where patients are given a sugar pill and then asked if there has been an improvement in their headache.

On other survey questions, nearly 90 percent of readers thought that report card-like data on doctors, hospitals and nursing homes was useful information, and nearly a third used the information to make a personal health decision.

Again, the numbers bumped up by just 2 to 4 percentage points after the series as compared to before.

When I shared the results with my wife and said I was going to write about it in my next column, she mused, "Why would you ever want to do that? You are basically saying that no one really reads your columns."

Though the data do not support me, I certainly believe and hope people are reading my columns. I was reassured of this after I wrote an article on Dr. Donald Berwick's recess appointment as the Medicare administrator. This generated a flurry of letters to the editor, second looks on hospital hallways and even a text message from an anesthesiologist friend from the operating room. "Hey, lots of reaction on your article at work."

So in the final analysis, I am not sure if the health columns effect change like the TV shows, but they certainly create conversation. Keep the letters coming.

Dr. Manoj Jain is an infectious disease consultant and his articles can be found on his website at mjain.net.