DO NO HARM: ETHICAL REPORTING OF HEALTH NEWS
By

Christina J. Steffy, M.L.I.S.
East Stroudsburg University of Pennsylvania
A Thesis Submitted in Partial Fulfillment of
the Requirements for the Degree of Master of Arts in Professional and Digital Media
Writing to the Office of Graduate and Extended Studies
of East Stroudsburg University of Pennsylvania
December 19, 2020

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ABSTRACT
A Thesis Submitted in Partial Fulfillment of
the Requirements for the Degree of Master of Arts in Professional and Digital Media
Writing to the Office of Graduate and Extended Studies
of East Stroudsburg University of Pennsylvania
Student’s name: Christina J. Steffy
Title: Do No Harm: Ethical Reporting of Health News
Date of Graduation: December 19, 2020
Thesis Chair: Sandra Eckard, Ph.D.
Thesis Member: Nancy VanArsdale, Ph.D.
Thesis Member: Megan Smith, M.L.I.S.
Abstract
This thesis examines the ethics of reporting health news out of context and how
this practice has primed our country for the “fake news” era as well as the implications of
this priming as they relate to information literacy and trust in science and the media. In
order to do this, the researcher reviews the basics of scientific and health news
communication, information literacy, audience behavior, and implications for the future
of information literacy and public trust in the media. In addition to this literature review,
the researcher conducted a survey to determine how people react to conflicting health
news and how much trust they place in the media. This is followed by a brief case study
of reporting during the COVID-19 pandemic in early 2020. Finally, implications for
current media behavior and the necessary information literacy and health news
communication steps to combat priming people to fall victim to the fake news era are
discussed.

TABLE OF CONTENTS

CHAPTER 1 INTRODUCTION ........................................................................................ 1
CHAPTER 2 CHARACTERISTICS .................................................................................. 7
Media, Health Journalism, and Scientific Styles of Communication ............................. 7
Audience........................................................................................................................ 14
CHAPTER 3 COMMUNICATION DIFFERENCES AND AREAS FOR
MISUNDERSTANDING ................................................................................................. 20
CHAPTER 4 IMPACT AND FUTURE ........................................................................... 24
Health Journalism and Science Communication ........................................................... 27
Technology .................................................................................................................... 29
Information Literacy ..................................................................................................... 30
CHAPTER 5 STUDY ....................................................................................................... 35
Methodology ................................................................................................................. 35
Study Population........................................................................................................ 35
Survey Design............................................................................................................ 37
Survey Distribution.................................................................................................... 37
Results ........................................................................................................................... 38
Limitations .................................................................................................................... 47
Discussion ..................................................................................................................... 48
CHAPTER 6 COVID-19 CASE STUDY ......................................................................... 52
Infodemic ...................................................................................................................... 52
Media Coverage ............................................................................................................ 55
Contextless News ...................................................................................................... 55
Misleading or Contradictory Headlines ..................................................................... 56
Misinterpretation of Science ...................................................................................... 57
Technology ................................................................................................................ 60
Impact of Treatment/Medication Coverage ............................................................... 62
Tracing Movement .................................................................................................... 64
Use of Preprints ......................................................................................................... 66
Iterative Journalism ................................................................................................... 68
Continuing the Case Study of COVID-19..................................................................... 69

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CHAPTER 7 CONCLUSION........................................................................................... 71
Custodians of Knowledge ............................................................................................. 71
How did we get here? ................................................................................................ 72
Where do we go from here? ...................................................................................... 75
Do No Harm .................................................................................................................. 84
REFERENCES ................................................................................................................. 85
Appendix 1: IRB Approval ............................................................................................. 103
Appendix 2: Survey Questions ....................................................................................... 105

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LIST OF TABLES
Table 1: What makes a health news article credible? ....................................................... 40
Table 2: Trust in media to accurately report news ............................................................ 41
Table 3: Headline and images accurately portray content ................................................ 41
Table 4: Sharing fake news ............................................................................................... 42
Table 5: How do you react to conflicting health news?.................................................... 43
Table 6: Reactions to conflicting headlines about sunscreen and vitamin d deficiency. .. 45
Table 7: Reactions to a health news article’s headline and lead paragraph. ..................... 47

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LIST OF FIGURES
Figure 1: Methods of obtaining health news..................................................................... 39

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CHAPTER 1
INTRODUCTION
The media and information landscape of the 21st century thus far has been riddled
with cries of “fake news;” however, fake news is not a new phenomenon. It has existed
since the days of yellow journalism (crude journalism based on sensationalizing
information). The term is inherently problematic because news is, by definition,
something that is factual and not fake, but the term has caught on. Society has quickly
adopted the term “fake news” to apply to all information that is false, flawed, or contrary
to personal beliefs. In fact, Putnam (2019) says this phrase has become a “catchall phrase
that describes everything from honest mistakes to intentional deceptions.” In reality, this
term describes different types of inaccurate information, and there is a distinction
between misinformation (information that is inaccurate but not intended to harm others)
and disinformation (information that is inaccurate and is intended to do harm) (p. 59).
Wardlee and Derakhshan (2018) explain another type of information that we must be
aware of that often falls under the “fake news” umbrella — mal-information, or
inaccurate “information that is based on reality” and is “used to inflict harm on a person,
organization, or country” (p. 20). Mal-information is dangerous because it blurs the lines
between what is fake and what is real by presenting information that is flawed. Flawed

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news, or mal-information, is particularly harmful because it can be difficult to distinguish
where the fact ends and the fake begins. Another terms is false news, which is a term
Facebook has adopted in the fake news phenomenon. In this case, the term is used to
describe “a specific notion of evidence-free or purposefully fabricated stories,
disseminated for profit or political manipulation” (Sergeant & Tagg, 2018, p. 184).
Unfortunately, fake news has become a term used by anyone who wants to deny
the veracity of unfavorable news coverage. Calling unflattering news “fake news” to
pander to a political base is a tactic some politicians utilize frequently. People have also
taken to commenting “fake news” on social media posts that do not align with their own
political beliefs. Also, although not discussed in studies, the researcher’s conversations
with friends, family, and acquaintances reveals fake news has also made it into peoples’
daily vocabulary as a way to jokingly downplay unflattering, friendly banter; while
humor may seem like a harmless way of coping with this fake news epidemic, it also
shows that this term has become so ubiquitous that we use it without even thinking about
its implications and actual meaning. All of this confusion over what is true, what is fake,
and what is flawed has led to what has become known as a “post-truth” era which
Bluemle (2018) describes as “a situation in which facts lose relevance and emotions
become primary” (p. 268).
Information literacy is an important tool to combat fake news and post-truth.
Head et al. (2020) define information literacy as “an integrated set of skills, knowledge,
practices, and dispositions that prepares students to discover, interpret, and create
information ethically while gaining a critical understanding of how information systems
interact to produce and circulate news, information, and knowledge” (p. 8). Part of

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information literacy is a specific focus on media and news literacy, which seeks to
provide people with the tools to critically evaluate news in a variety of media formats.
But how do we engage in effective information literacy to ensure people can effectively
navigate a digital news environment without gatekeepers? Evanson and Sponsell (2019)
admit educators do not always understand how students interact with misinformation, nor
do educators understand how to evaluate media and news literacy beyond the traditional
evaluation checklists that are no longer adequate in today’s media landscape (pp. 229230). Of course before we can understand how to help people become information
literate, we must first understand the information environment and help people
understand the environment they are navigating. This involves knowing how algorithms
work and shape what information is presented to users as well as the traits of mass media
and electronic communication that impact how information is presented to users.
These skills are critical when it comes to health news as believing fake health
news can have deadly consequences. Unfortunately, there are many barriers that exist to
helping people navigate health news. Some of those barriers are put in place, often
unintentionally, by credible media and scientific communication outlets. These barriers
include how information is communicated between science and the media and then how
that information is further distilled down into something understandable by the layperson,
knowledge of journalists covering health news, media staff sizes, publication deadlines,
and the need to cut through the media clutter. These barriers are magnified by filter
bubbles, the need for confirmation bias, and the fragmented media environment that takes
health news out of context. It is also necessary to acknowledge the vulnerable emotional
state people may be in when searching for health news; this vulnerability can cloud

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judgment and consequently impede someone’s ability to thoroughly critique health news.
Typically, when the impacts of fake news, or cries of fake news even when the news is
legitimate, are examined in the research, it is in the context of politics and how fake news
impacts elections. Fake news in the context of health news reporting is often neglected.
Unfortunately, another aspect of health news reporting that is often neglected yet greatly
impacts peoples’ ability to understand and trust health news is the media itself and the
practices it engages in to disseminate news, particularly the practice of reporting
conflicting studies out of context. This erodes trust in the media and, ultimately, enables
us to fall victim to the belief in fake news.
While there is clearly a gap in published research on the ethical reporting of
health news and its various interconnected concepts, related research in this field is
emerging. News and media literacy in general are evolving areas of information literacy,
and the fake news era has prompted reflection on how people interact with this news and
whether news and media literacy can be taught effectively or at all. Dyer (2017)
examined whether news literacy could be taught at the K-12 and higher education levels
and stressed the difficulties of retention of news literacy concepts. Head et al. (2018)
published a report for Project Information Literacy (PIL) that examines how college
students engage with the news. Although this broaches the subject of how students
interact with news, it does not specifically examine health news. These authors are
currently working on another report for PIL that examines media coverage of the first 100
days of the COVID-19 pandemic and how these media messages were received (Alison
Head, executive director, PIL, personal communication, April 13, 2020). This upcoming
report will help us further understand how students interact with news. It seems likely

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that while this will be set in the context of the COVID-19 pandemic, it may not solely be
focused on health news and the impact of the fake news era on media credibility. The
Pew Research Group and other similar organizations have conducted surveys on the
media and news literacy skills of adults as well as trust in the media, and research on how
incoming college students interact with news are beginning to be published more, but
again, this is in general and not specifically related to health news and fake news. There
are also various reports that examine news reporting characteristics and their pitfalls,
particularly Maksimainen’s (2017) detailed report about improving the quality of health
news. Finally, the convention MisInfoCon is attempting to help deal with the fallout from
the spread of misinformation. MisinfoCon is a convention that began in 2017. It was
created by a collaboration among The First Draft Coalition, The Nieman Foundation for
Journalism at Harvard, and Hacks/Hackers. The summit brings together people in
technology, librarians, academics, and others who are impacted by misinformation and
discusses ways to fight misinformation (Zindren, 2020).
Clearly research exists on various parts of this topic, but what is missing is the
bridging of these topics. This thesis seeks to be that bridge, and is the researcher’s
attempt to understand how people react to conflicting, contextless health news and how
the health media landscape and the current fake news environment have impacted trust in
the media. In order to understand these reactions and beliefs, the researcher has
conducted a thorough literature review examining media, health journalism, and scientific
communication characteristics; audience characteristics; areas for misunderstanding
between academic and lay presses; the impact of the fake news era; and ways to combat
its impact with an emphasis on the necessity of information literacy. This is followed by a

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qualitative study that analyzes a small group of participants’ health media consumption,
news sharing behavior, and trust in the media. Finally, there is a brief case study on the
current COVID-19 pandemic as an example of the negative media habits that impact
accurate, complete health news reporting. Ultimately, the information gleaned from this
thesis will be essential in helping media and information professionals understand how
much damage the fake news era and media behaviors have caused to the health news
landscape, what the chances are of recovering from this damage, and the implications this
recovery, or lack thereof, could have for the future of health news.

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CHAPTER 2
CHARACTERISTICS
In order to understand the current fake news/post-truth era, it is necessary to
understand the characteristics of the media, health journalism, and scientific styles of
communication and the characteristics of the audience consuming this information.
Media, Health Journalism, and Scientific Styles of Communication
The media landscape has changed dramatically since its inception. According to
Daly (2012), there are five major periods in the history of U.S. journalism: the
politicization of the news, the commercialization of the news, the professionalization of
the news, the conglomeration of the news, and the digitization of the news. We have been
in the digitization era since 1995 (p. 463). Since Daly’s work in 2012, the news appears
to be entering a new era, one in which journalism is interactive, fragmented, and free of
gatekeepers (people who control the flow, accuracy, and quality of information through
media outlets). The author of the present study refers to this as the social era because
news is interactive, and it is easily created by anyone. While this era democratizes the
news, it comes with consequences. Badke (2017) notes that most people are now more
susceptible to falsehoods because they have not experienced a world without media
gatekeepers. Before the internet, news sharing was limited to media sources that filtered

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out “the worst excesses of falsehood and unreliability” (p. 58). But the problem is not just
with the audience. Daly adds that in the digitization era, “news organizations appear more
susceptible to error than ever” because news organizations are laying off veteran
reporters and greatly reducing staff sizes, including making staffing reductions in factchecking departments. There is also a rush to get information out first and make
corrections later, and there seems to be a never-ending journalism weakness for “hype,
ballyhoo, and hucksterism” (p. 459).
Cooke (2018) specifically describes the consequences of the fragmentation of the
news: “Instead of the homogenous news world of the past, in which stories and reports
essentially were the same, the fragmented news era boasts a heterogeneous news
environment wherein accounts of one issue, topic, or event can differ significantly
depending on the source.” There is “targeted exposure to specific audiences” (p. 13).
Head at al. (2020) add this fragmentation, or disaggregation and redistribution, of news
through search and social media platforms is troubling because it “makes evaluation of
what used to be distinct sources” more difficult because “we do not see the same
information when we search and with original context missing, it is not obvious where it
came from” (p. 7). This fragmented news era is also iterative. According to Cooke
(2018), in iterative journalism, media personalities report things they have heard rather
than things they have actually investigated or experienced. The emphasis is getting the
news out first; it can be made right later on through “updates,” not through “corrections.”
Iterative journalism focuses more on commentary and opinion than on objective facts (p.
13). Cooke explains that the internet has created an environment that encourages this
iterative behavior, an environment in which website traffic is more profitable and

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important than accurate reporting (p. 12). In the battle for ratings, media are also quick to
point out errors in reporting by outlets on the other side of the spectrum. While it’s good
to have errors unveiled, this combative behavior also helps to erode public trust in the
media (Mason at al., 2018, p. 5). The combative behavior pits media outlets against each
other in the battle for ratings, turning the act of correcting errors into a public shaming in
which media outlets essentially claim their opponents cannot do their jobs correctly and
should not be trusted.
O’Connor and Weatherall (2019) explain there is also a novelty bias in
journalism. This means that by focusing on what they deem to be the most interesting
piece of news to report to their viewers, the journalists can “bias what the public sees in
ways to ultimately mislead, even if they only report real events” (p. 156). Basically, what
journalists choose to emphasize can impact peoples’ opinions about what is important or
pressing in the world. Other items may be more important or more urgent, but they do not
receive as much attention as items that are more novel. Health journalism appears to be
particularly prone to novelty bias as evidenced by coverage of outbreaks of diseases
common in Africa and Asian countries occurring in even the smallest of numbers in the
United States and Europe. These events receive more coverage than major issues people
in those countries have an immediate chance of suffering, like obesity or the flu, because
those issues are old and common even though they are critically important. This novelty
bias can lead to sensational headlines that do not accurately portray risk. This was the
case with the Ebola outbreak in 2013 which reached a handful of people in the U.S. in
2014. Monson (2017) says the media riled Americans up “with round-the-clock coverage
of the virus, fearmongering headlines, and frightening images of doctors in white

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protective suits and quarantined patients. A discourse of crisis and panic ensued” (p. 4).
In fact, Griffin (2015) claims if anyone was looking to become more informed about
Ebola, “accurate, responsible reporting took a back seat to sensationalist headlines,
menacing graphics and dissemination of erroneous information” (paras. 1-2). ZikmundFisher at al. (2017) explain adequate risk communication is difficult, and sensationalism
may be fueled by the dilemma of what moves people to act on health information and
take it seriously. It is often believed telling people the extreme possibilities of a health
crisis may make them take notice and take things seriously because they want to avoid
the extreme happening; however, providing the average impact could be more relatable
and fuel more action and belief.
Zikmund-Fisher et al. (2017) conducted a study and determined people respond
more to reports on the average situations that are likely to happen rather than to the
extreme, sensationalized possibilities. Zindren (2020) emphasizes the need for science
communication in general to be accurate even if it is a bit confusing because it helps stop
people from being overconfident in their own understanding of science that comes from
their filter bubbles; ideally, you must find a balance between information being engaging
and informing. This is also applicable to risk communication.
Health journalism also has other issues that impact its accuracy and completeness.
Belluz (2016) describes the following barriers to high quality health journalism: pay
walls on scientific journal articles which prevent reporters from researching claims,
scientific hype or spin in press releases from journal publishers, the amount of time it
takes to sift through research (which is time most reporters do not have), the pressure to
make stories interesting enough to generate website hits while also ensuring accuracy,

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and the need to publish new and interesting articles daily. Science is slow, and there is no
excitement in simply reporting on the accumulation of evidence ("There are hurdles...”).
Belluz does not list current staffing models as a challenge, although this is a very real
problem for all news staff, especially specialists like health journalists. Arora (2019)
explains at the local level, health news staff are thin or nonexistent. This negatively
impacts high quality health news. Schwitzer is quick to point out that while some
organizations have attempted to fill this void with rigorous health/science/medical
reporting, they are few and far between, and the gaps between the high quality, rigorous
reporting and the less than rigorous reporting are becoming wider. These widening gaps
could offset the good work done by the organizations with rigorous reporting (as cited in
Green, 2017, “What are the consequences...?”). While we are losing staff at the local
level, it is important to understand the national level news is trying to provide strong
health news coverage via alternative sources. The high-quality alternative sources that
have emerged include STAT News, Kaiser Health News, ProPublica, and the Center for
Public Integrity (Arora, 2019, pp. 2159-2160).
Short staffs lacking health journalists means generalist reporters are often
covering health news. Sometimes health journalists are not even consulted on articles.
Goldacre (2010) describes why this lack of health journalist expertise can be problematic:
Journalists are used to listening with a critical ear to briefings from press offices,
politicians, PR executives, salespeople, lobbyists, and gossipmongers, and they
generally display a healthy natural skepticism, but in the case of science, they
don’t have the skills to critically appraise a piece of scientific evidence on its
merits (p. 229).

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Goldacre uses Andrew Wakefield’s 1998 article in The Lancet about a link between
autism and the measles-mumps-rubella (MMR) vaccine as an example of the differences
in health and generalist journalist coverage. The paper, which Goldacre calls “one of the
most misunderstood and misrepresented papers in the history of academia” was poorly
written, the study was poorly designed, and Wakefield failed to disclose a conflict of
interest to The Lancet prior to publication; the article was eventually retracted from the
journal. After some initial buzz and a press conference, hype over Wakefield’s article
quickly died down even before its retraction. At that time, health journalists were
covering the story and understood Wakefield’s scientific weaknesses; thus, his claims did
not get much coverage, and the coverage they got soon fizzled out. In 2001, Wakefield
again published the same findings, this time in an obscure journal. Generalist journalists
covered it, and they focused more on the emotions of the case than on the facts; this
helped fuel the anti-vaccination (anti-vaxx) movement in England and the United States.
After 2001, nearly 80% of MMR stories were written by generalist reporters (p. 228).
Goldacre adds it was rare to find any discussion of the evidence since it was considered
too complicated. Doctors were not given the time to explain it, or their explanations were
watered down and made far too general. This lack of solid scientific information was
pitted against emotional stories of distressed parents. Then, in 2002 media coverage
included features on Dr. Wakefield (pp. 231-232). The articles did not critically evaluate
the evidence, or lack of evidence, in Wakefield’s claims.
Another major issue, and the issue that is the focus of the present study, is lack of
contextualizing health news — not explaining how individual studies fit into the broader
scientific conversation about a topic. In Maksimainen’s (2017) interviews with

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executives at eight major news outlets across the U.S. and U.K., the interviewees
admitted this reporting on a single study out of context is a problem: “This habit focuses
an undeserved amount of publicity on a study that lacks wider relevance and implies that
sciences changes every time a new issue” of a publication is released (p. 19). These
interviewees agreed that health journalists should contextualize news, and reports on
research should evaluate the evidence's significance or lack of significance, compare and
contrast it with other studies, and seek expert opinion. According to Maksimainen, “This
requires a re-evaluation of several journalistic practices,” such as dramatizing stories,
oversimplifying facts, and reporting impartially (in this case, impartiality refers to
treating opposing viewpoints as equal when science clearly shows they are not equal).
“Instead, good health journalism combines certain journalistic virtues, such as rigorous
investigation and good story-telling, with the principles of evidence-based medicine” (p.
17).
Evidence-based medicine, or evidence-based practice, weighs research studies
according to the strength of their evidence, and this means some research is seen as better
because it is more rigorous and generalizable. For example, a case study that is only
applicable to one or a very small set of people may be credible, but it is not given as
much weight in the scientific community as a large-scale, randomized controlled trial that
is generalizable to a large segment of the population. Unfortunately, this is not what
journalists do. They report all research, regardless of study type, sample size, and even
human or animal subjects, as if it all has equal weight, equal evidence quality, and equal
rigor. This stems from the journalistic framework of fairness. O’Connor and Weatherall
(2019) explain how this legal and ethical framework journalists abide by that seeks to

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promote fairness and represent all side of an issue is actually problematic: Fairness is
“extremely disruptive to the public communication of complex issues...We generally
expect evidence favoring the true belief to appear more often. Sharing equal proportions
of results going in both directions puts a strong finger on the scale in the wrong direction”
(p. 158). An example O’Connor and Weatherall use to explain how this fairness principle
is problematic is the debate over climate change. The Intergovernmental Panel on
Climate Change (IPCC) and the Nongovernmental International Panel on Climate
Change (NIPCC) both presented conflicting views on climate change. The IPCC won a
Nobel Prize for its work on climate change and had global consensus while the NIPCC
refuted the IPCC’s claims but did not have the backing of the majority of the scientific
community. Both reports received equal time and were presented as having the same
quality and the same credibility in the scientific community although this was not true.
The scientific community clearly gave more credence to the claims of the IPCC (p. 134135). This reporting has helped fuel and incorrectly inform the climate change debate for
decades, and it is leading to detrimental environmental issues.
Audience
Various audience characteristics influence trust in media and the exposure to and
ability to detect fake news. Head et al. (2020) tell us the group of college students “born
before the constant connectivity of social media, has come of age aware, cautious, and
curious about the implications of the current information landscape.” These students are
“deeply skeptical,” and many of them are conditioned to do their own research rather
than deferring to the traditional media outlets for information. Also, these students
“understand that ‘free’ platforms are convenient but also recognize they harvest massive

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amounts of personal data to target ads and influence what content they see” (p. 1). Head
et al. conducted focus groups with students and faculty at eight colleges and universities
across the United States and learned students understand algorithms exist to push
information on them even if they don’t exactly understand how algorithms work. Also,
students feel “resigned” to the existence of algorithms — if they want free applications,
they just have to deal with algorithms. They are also frustrated with filter bubbles and
echo chambers, but it often takes too much work to go outside these digital walls to learn
the truth. Essentially, this leads them to believe no news source is automatically
trustworthy. “As a whole, we found that the lack of trust in traditional authority figures
meant trust was placed in Google as the arbiter of truth, sometimes to a ridiculous extent”
(pp. 13-20). Fletcher and Park (2017) found that with some variation, people with low
trust in the media tend to prefer non-mainstream outlets such as HuffPost, Google News,
Twitter, and other “born digital” sites to mainstream outlets such as BBC and The New
York Times (p. 1282). The authors also note that, surprisingly, people with low trust in
the media are more likely to comment on news articles than those with moderate or high
levels of trust (p. 1295). This commenting behavior is important to consider because
individual factors (i.e. our own biases) as well as the people around us influence our
perceptions of journalism and our trust in the media (Ognyanova, 2019, p. 540). Also,
reading the comments of others can influence peoples’ perceptions and understanding of
science, which is troublesome since the quality and content of comments varies widely
(Flemming et al., 2017).
Understanding the influence comments play on perceptions of news is especially
important in this social era of news because of the high frequency with which people

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obtain their news from social media and news websites where you can immediately be
exposed to thousands of comments. Mitchell et al. (2017) reported that the two most
common pathways for people to obtain news are news websites (36% of the time) and
social media (35% of the time). Unfortunately, when asked to name the news source,
10% of consumers who received their news from social media said Facebook was the
outlet (pp. 5-6). According to Silverman and Singer-Vine (2016), “People who cite
Facebook as a major source of news are more likely to view fake news headlines as
accurate than those who rely less on the platform for news” (para. 2). Also, in 2017, twothirds of Americans reported getting at least some of their news through social media
(Mason et al., 2018, p. 4). A MindEdge (2019) survey found that 44% of respondents
“rank online publications among their top news sources” and 48% “rank social media
among their top three sources.” Less than half (43%) included physical newspapers in
their top three sources (“Digital literacy and the mainstream media,” para. 3).
While social media shares and comments influence our perceptions of the news,
the people making the comments and sharing items are not necessarily setting out to
influence peoples’ opinions. According to Johnson (2017), we share news to “display our
dedication to a community, feeling, or ideology,” as “a marker of identity,” rather than to
inform or persuade (p. 14). In fact, “a human being’s very sense of self is intimately tied
up with his or her identity group’s status and beliefs.” Because of this, people respond
defensively to something that challenges those beliefs, and they attempt to rationalize
their beliefs by giving credit to evidence that supports their beliefs and discounting
evidence that disputes their beliefs. This practice is known as confirmation bias (Bardon,
2020, “Denial is Natural,” para. 2). When sharing information on social media to form a

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community, people often only share what they agree with, creating their own echo
chambers; this then encourages social media algorithms to continue to display similar
information, thus forming filter bubbles. It is difficult for opposing viewpoints to
penetrate the walls of these echo chambers and filter bubbles, and it is also difficult to
stop the spread of fake or flawed news through them once it has begun. This is because
filter bubbles surround us with ideas we are already familiar with and ideas we already
agree with, making us overconfident in our knowledge (Pariser, 2011, p. 84). The filter
bubble concept is particularly troubling because it is strong and there are no signs it is
going away. In fact, Pariser says Facebook chief operating office Sheryl Sandberg
predicted that by 2016, the idea of a web not customized to its users would seem outdated
(p. 85). Thus, our filter bubbles and echo chambers will become stronger.
Although we make it easy for fake news to spread, Americans do believe fake
news is a problem. Approximately 64% of adults say, “Fabricated news stories cause a
great deal of confusion about the basic facts of current issues and events” (Barthel et al.,
2016, para. 2). Despite the belief that fake news is a problem, Americans overestimate
their ability to recognize it. Approximately 39% say they are “very confident” they can
recognize it, while approximately 45% say they are “somewhat confident” they can
recognize it (Barthel et al., para. 2). But their confidence in their ability to spot fake news
may not be well-founded. MindEdge’s (2019) survey determined 69% of collegeeducated Americans could not pass a basic digital literacy, fake news identification, and
critical thinking skills test. Although baby boomers fared better than millennials (13% of
boomers received an “A” while only 5% of millennials received an “A”), overall it is
clear that the majority of Americans regardless of age are ill-equipped to navigate the

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digital information environment (paras. 1-2). Wineburg and McGrew (2017) describe a
study in which historians with Ph.Ds, fact-checkers, and first year college students
evaluated various digital sources. Only two historians “adroitly evaluated digital
information. Their colleagues were often indistinguishable from college students in their
meandering searches and general befuddlement. Both groups often fell prey to the same
digital ruses.” Fact-checkers did not fall prey to these ruses because of their lateral
reading skills (p. 37). Also, Americans admit to sharing fake news: 23% say they have
shared it, with 14% knowing it was fake when they shared it and 16% thinking it was true
and later realizing it was fake. It is important to note that in some cases, people who
knowingly shared fake news shared satire articles from sources like The Onion (Barthel
et al., 2016, paras. 3-4). Sharing fake or flawed health news is especially problematic
because in a Pew Research Study, Mitchell et al. (2017) discovered “community and
health news spurred follow up action about two-thirds of the time” (p. 7). Acting on fake
or flawed health news can have life-threatening consequences.
Evanson and Sponsell (2019) used a mini-course to learn how incoming first year
students at Davidson College consume and evaluate news online. They discovered 82%
of students used social media in the last week for government and political news. As part
of the course, students also examined screenshots of news stories and explained whether
they trusted the sources and how they evaluated them. Researchers also asked if students
would share the items. Students correctly spotted a headline that was inconsistent with
the article text, but they had trouble determining authorship of a syndicated article. In
both cases, this lowered confidence in the sources and the desire to share the articles. A
troubling finding of this study was that 24% of students would re-tweet a tweet with an

18

impostor URL despite only 16% of students having high confidence in the tweet’s claim
(p. 237). Sommariva et al. (2019) conducted a study to explore the spread of health news
through social networking sites and the role of fake news in health communication and
education. They specifically analyzed stories about the spread of Zika virus in 2016. The
researchers discovered that, of the top 10 new stories shared about Zika, half could be
classified as rumors. There was also a “positive relationship between the popularity of a
topic and the appearance of fake news related to the same topic.” Also, several fabricated
stories downplayed the risk of Zika (p. 251). It is possible this willingness to share
something on social media despite a lack of confidence in its claims points to the desire
to share to be part of a community.

19

CHAPTER 3
COMMUNICATION DIFFERENCES AND AREAS FOR
MISUNDERSTANDING
Differences in journalistic (lay press) and scientific (academic press)
communication styles can cause problems when journalists are attempting to translate
scientific literature into information that is understandable by the general public and is
also interesting enough to cut through the clutter and capture audience attention.
Accuracy is prized in both forms of communication, however journalism has other
business needs, too. “Whereas scientists want to be exact, journalists want to be
interesting, comprehensive, and entertaining” (Maksimainen, 2017, p. 11). According to
Lois Rogers, a freelance health journalist, “The same rule applies to print and online
news: the first five words must engage the reader. There is no space for empty
expressions” (as cited in Maksimainen, 2017, p. 11). Although “science is incremental,”
when journalists attempt to cut through the media landscape clutter, their messages “often
convey scientific certainty when that certainty does not exist” (Arora, 2019, p. 2159).
This can also lead to sensationalizing stories to drive traffic to sites. Pariser (2011)
explains journalistic traffic chasing is not new, but it is magnified by the internet, and
particularly social media, because website and social media analytics can allow you to

20

see what is trending in real time and boost the post accordingly. But this practice, along
with peoples’ social media filter bubbles, is dangerous because if traffic guides coverage,
what happens to items that are important but are not interesting? It is possible news
outlets could dismiss them in favor of ratings (pp. 70-74). Dismissing news items that
will not bring in high ratings is not a practice that is unique to the digital news era, but it
is magnified by the digital news era.
The need for audience engagement is not the only reason for health journalism’s
miscommunication of science. As noted earlier, newsroom staff are becoming thinner,
and that may mean reporters covering health news do not have the requisite training and
knowledge to understand how to read a scientific article. They also may not have the
training to allow them to interpret medical jargon. One particularly difficult piece of
medical jargon to understand is progression-free survival (PFS) and reporting of cancer
treatment results. The term contains the word “survival,” but it does not tell us anything
about how long people will survive. Instead, PFS “is generally defined as the time that it
takes for tumors to grow beyond an arbitrary amount, or for new ones to appear in a
scan” (Jaklevic, 2019, para. 6). PFS rates can be impressive, and they can be incorrectly
translated as a new drug’s ability to increase cancer patient survival rates. PFS rates need
to be thoroughly explained if they are to be used in reporting health news. Another aspect
of scientific communication that is often miscommunicated is the concept of scientific
tentativeness, which “refers to the issue that the reliability of empirical research is often
uncertain and that conclusions drawn from empirical research are frequently subject to
revision and therefore [are] tentative” (Flemming et al., 2017, p. 746). Scientists often
avoid speaking in absolute terms even in the face of overwhelming evidence because they

21

understand science is not absolute and new evidence can cause things to change. An
example of this is the distinction between probability and possibility. Scientists may
admit there is always a possibility (even if it is a very slim possibility) something could
happen, but that does not always mean it is probable something will happen. Killianski
and Evans (2015) point out an example of confusion regarding this distinction with
academic and lay press reporting on airborne transmission of the Ebola virus. The authors
explain an mBio article was unclear regarding the ability of Ebola to be airborne on its
own versus being transmitted via droplets of nuclei containing bodily fluid that spray
through the air when someone coughs or sneezes. Not only was there confusion because
it was difficult for journalists to discern the exact distinctions in the airborne transmission
discussion, but there was also confusion because of the scientific tentativeness. While it
was highly unlikely Ebola would be airborne on its own — it was not probable —
scientists would not deny the fact there was always a possibility, no matter how remote,
the virus could mutate and become airborne on its own. Also, Jamieson (2017) says a
lack of clear science communication also contributed to the autism and MMR vaccine
debate when the former director of the National Institutes of Health inadvertently
“legitimized the false inference that there may be a link between autism” and the vaccine
(p. 48).
While the discussion so far has focused on the faults of the lay press, it is
important to understand that miscommunication is also the fault of the academic press.
The academic press must provide complete, accurate information to the lay press;
unfortunately, “completeness and accuracy are hard to define in the fast-moving world of
scientific knowledge” (Kieh et al., 2017, p. 2). But it is not just the speed of science that

22

makes accuracy difficult to achieve. Authors of scientific papers sometimes add spin to
abstracts, and this is further compounded by the spin present in promotional press
releases about articles and research that are distributed by the journal publishers in order
to attract attention to the research (Arora, 2019, p. 2159). In fact, Sumner et al. (2016)
discovered “a strong association between exaggeration in press releases and news” (p. 6).
This echoes an earlier study by Schwartz et al. (2012) which showed higher quality press
releases issued by journal publishers were associated with higher quality reporting in the
resulting newspaper coverage, and poor quality press releases were associated with poor
quality coverage. Fundamental concepts like absolute risk, harms, and limitations were
reported in news coverage when they appeared in the releases” (p. 4). Also, because of
newsroom staffing and paywalls making the full text of articles inaccessible, journalists
who are pressed for time and do not have scientific knowledge may rely solely on the
press release for their articles and not actually look at the original research article. Taylor
et al. (2015) examined articles from 2012 and 2013 included in a meta-analysis showing
a modest link between pancreatic cancer and processed meat. Of the 312 news stories,
approximately 113 were “derived largely or wholly” from press releases, and “only
14.4% went beyond a secondary source” (p. 8).
Clearly the differing communication styles of the presses make accurately
conveying health information to the public complicated. This is further complicated by
the desire of both presses to capture attention even at the risk of inaccurately representing
information.

23

CHAPTER 4
IMPACT AND FUTURE
These characteristics and behaviors erode trust in the media and, consequently,
lead to the media’s loss of authority in the eyes of the general public. Putnam (2019)
explains the current political climate and the application of the term “fake news” to
legitimate but unflattering news undermines journalism and creates a slippery slope to
journalists being viewed as the enemy of the people (p. 59). Sergeant and Tagg (2018)
add that cries of fake news not only undermine journalism at home, but also on the world
stage (p. 185). Unfortunately, the American public is experiencing cries of fake news as
health news about the novel coronavirus (COVID-19) pandemic is being pulled into
politics. As the pandemic was ramping up in the U.S., White House Press Secretary Mick
Mulvaney was saying the Democrats were making a big fuss over the virus in order to
bring down President Donald Trump (BBC News, 2020). At the time of this study,
COVID-19 was impacting the world to varying degrees, and in numerous press briefings
about the pandemic, President Trump was referring to the news outlets he did not like as
“fake news media.” According to Bluemle (2018), “loss of trust in traditional sources of
authoritative information” has led us to the current post-truth or post-fact era. Both of

24

these terms refer to facts being less influential than emotions, beliefs, and biases in
shaping opinions (p. 268).
“Many Americans do not see as legitimate cognitive authorities the sources of
information — especially academics, the mainstream news media, and government
organizations — that are most likely to be reliable, accurate, and credible” (Bluemle,
2018, p. 274). Brennan (2019) used Gallup Poll data to determine 41% of Americans
have “a great deal” or “fair” amount of trust in newspapers and television to accurately
and completely report the news. This is a four-percentage point decrease since 2018 and
marks the end of consecutive improvements in trust after hitting an all-time low in 2016,
when only 32% of Americans had this much trust in the media (paras. 1-2). Gallup began
measuring trust in the media in 1972, and levels of trust have risen and fallen since then.
“No more than 21% of Americans dating back to 1972 ever said they had the greatest
level of trust in the media. Currently, 13% have a great deal of trust and 28% have a fair
amount of trust” (Brennan, 2019, “Trust in Mass Media Remains Low,” paras. 2-3).
Although many adults have lost trust in the media in recent years, 69% of people who
lost trust in the media believe their trust can be restored by improving accuracy and
minimizing bias in news (Knight Foundation, 2018).
The fake news and post-truth era as well as reporting health news out of context
(which further fuels the thoughts of fake news and post-truth) is detrimental to health
journalism and, in return, to peoples’ lives. According to Arora (2019), “The relationship
that medicine and journalism have with the people they serve relies fundamentally on
trust” (p. 2159). Schwitzer explains there are a number of ways people can be harmed by
inaccurate, imbalanced, or incomplete health reporting, such as placing false hope in an

25

unproven treatment; scheduling unnecessary appointments to discuss irrelevant treatment
options with physicians; wasting time and money on irrelevant courses of action when
this time and money could be spent on legitimate, relevant, and evidence-based courses
of action; and generally losing trust in medicine and science in addition to losing trust in
journalism (as cited in Green, 2017, “What are the consequences of inaccurate or
misreported...?”). Schwitzer’s discussion about wasting time and money on ineffective or
irrelevant treatment options is important to note because people do take action on their
health based on what is reported in the news; however, the type of reporting impacts the
actions people take. According to Goldacre (2010), a 2005 Medical Journal of Australia
article showed that mammogram appointments rose 40% during peak media coverage of
singer Kyle Minogue’s breast cancer (p. 244). While this seems beneficial, it means the
tendency to place positive spin on articles can negatively impact health; in fact, Boutron
et al. (2019) conducted three internet-based randomized-controlled trials with 900
participants examining various articles about pharmacological treatments. The
researchers discovered “spin in news stories can affect the interpretation of the benefit of
treatment: participants were more likely to believe the treatment was beneficial when
news stories were reported with spin” (p. 110). This can be harmful because not all
treatments work as well as the spin leads people to believe, nor are all treatments
applicable to everyone as news without context and nuance would have you believe; thus,
people fall into the habits described by Schwitzer and mentioned above — wasting time
and money on physician appointments and ineffective treatments.
But positive stories are not the only stories with impact. Goldacre (2010) tell us
the Cochrane Collaboration “found five studies looking at the use of specific health

26

interventions before and after media coverage of specific stories, and each found that
favorable publicity was associated with greater use, and unfavorable coverage with lower
use” (p. 244). This unfavorable coverage does not just come from mainstream media;
sometimes it is fake, and sometimes it is spurred by conflicting reports. Negative and
inaccurate health information is a problem today, and social media has helped it spread
faster and further. Recently, members of anti-vaccination health misinformation group
“Stop Mandatory Vaccination” convinced a mother not to give her son Tamiflu
medication prescribed by his doctor for flu treatment. The son died as a result of not
taking the medication. Unfortunately, anti-vaccination pages are common places people
turn to for information about a wide variety of medical information, including flu
treatments (Zadrozny, 2020). Approximately one-third of parents are also delaying
getting their children vaccinated and are not sticking to the Centers for Disease Control
and Prevention (CDC) recommended vaccine schedules leaving children susceptible to
deadly, preventable diseases; these practices are fueled by a general mistrust of the
pharmaceutical industry as well as anti-vaccination misinformation (Safai, 2020).
There is no easy way to handle the impacts of the current fake news/post-truth
era, however the literature is ripe with various health journalism and science
communication strategies, technology strategies, and information literacy strategies to
ease the effects.
Health Journalism and Science Communication
Health journalism must change some of its habits. O’Connor and Weatherall
(2019) stress, “It is not, and should not be, journalists’ role to referee scientific
disagreements; that is what peer review and the scientific process are for, precisely

27

because expert judgment is often essential.” They add journalists must avoid
sensationalizing new findings, report consensus when there is consensus, controversy
when there is controversy, and also to report the reasons for the controversy. “The mere
existence of contrarian views or (apparent) controversy is not itself a story, nor does it
justify equal time for all parties to a disagreement” (pp. 160-161). Clearly it is important
to let go of this idea of fairness through representing all sides and to instead focus on
accurate representation of the facts. Health journalists can also take advantage of the
digital age of news to make their stories more complete and accurate. Belluz (2016)
reminds readers the online environment provides more space than the print environment,
thus stories can be updated as evidence evolves, and journalists can link back to the
original sources of information or to their citations (“There are Real Hurdles...”).
Maksimainen (2017) adds that headlines can even be longer online than in print (p. 31).
Arora (2019) encourages the medical community to support high quality
journalism and trust in the media by working with journalists to highlight stories of
interest to journalists’ local communities, sharing stories with journalists and being a
resource, and actively correcting inaccuracies in stories (pp. 2159-2160). Leask et al.
(2010) also suggest understanding workflow and contact journalists with news ideas
during the peak times they are seeking out stories, providing pre-prepared resources such
as fact sheets, and staying networked with journalists (p. 540).
The academic press can also make communication clearer for the lay press so
there is less confusion translating information to news articles. Methods to achieve
greater clarity include summarizing the approaches to the problem or issue so journalists
do not need to sift through the article, using statistics to show the odds of possibility

28

versus probability, providing comparisons to other similar issues that are more familiar or
better understood, and specifying if and what changes to policy or behaviors are
necessary rather than leaving all of this information nebulous and open to interpretation
(Kieh et al., pp. 22-23).
Technology
Technological solutions to combat fake news are being developed. In October
2019, Facebook launched a Facebook News section to select audiences in select cities.
This feature includes human-curated pieces, algorithmically chosen pieces, and the ability
for readers to subscribe to content they want to see (Baig, 2019). Cilella (2019) describes
various media literacy technology tools, focusing specifically on NewsGuard, a browser
extension backed by Microsoft. NewsGuard was launched in 2018 by a team of
professional journalists. There are a set of nine journalistic standards used to evaluate
website’s credibility and transparency. The ratings then determine the website’s
“nutrition label” (“Flagging, not Censoring,” para. 2). Other media literacy plug-ins and
browser extensions include TrustedNews which rates items on a spectrum of looking
harmful to looking good, FakerFact which evaluates news items based on six criteria,
Media Bias Fact Check which finds bias in articles, and SurfSafe which evaluates the
authenticity of images (“Flagging, not Censoring,” para. 5). The University of Arizona is
also working on a free browser extension to detect fake science and suggest reliable
websites on the topic (Impey, 2020). While these tools sound like the solution to the
problem, it is important to remember the people who created these tools use algorithms
that may have biases. In addition to browser plug-in tools, there are fact-checking
websites with humans doing the investigating. PolitiFact, FactCheck.org, and Snopes are

29

some examples of these sites. But as Cooke (2018) reminds us, even these sites may have
biases in what the fact checkers decide to check (p. 17). Clearly, it is important for people
to develop their own information literacy skills and, if using these tools or sites, to use
more than one of them.
Information Literacy
Although there are technological solutions arising, it is important for people to be
able to evaluate information on their own. This is because once we develop technology
tools to combat fake news, people who want to spread fake news will work to develop
more sophisticated algorithms to beat the tools (O’Connor and Weatherall, 2019, p.
1175). Rosenwald (2017) cites another example of why it is important for people to use
their own critical thinking skills rather than depending on tools and algorithms to solve
problems for you. The researcher uses an example from Jevin West’s Info198 “Calling
Bullshit in the Age of Big Data” course at the University of Washington. West gives his
students a headline about vaccines causing shaken baby syndrome and asks them to
investigate the claim. His students learn “the claim was so absurd that literally no content
existed online to refute it.” The only information students could find on this topic were
other bogus websites that repeated the same invented data (para. 6).
Head et al. (2020) remind us that when information literacy and critical thinking
were first adopted as educational outcomes, the algorithm-driven platforms many of us
use daily did not exist. Although the “fake news” crisis has led to information literacy
now including news and media literacy, there is little education about how the algorithms
on sites like YouTube, Google, and Amazon influence us and the information we interact
with (p. 1). Cooke (2018) explains librarians must help students develop greater critical

30

thinking skills. “We need to teach them [students] how to think about the production of
information and the back-end workings of their favorite information source” (p. 14).
Head et al. (2020) echo this sentiment about teaching students how information is
produced and how sources of information work: “Information literacy needs to
incorporate an understanding of ways that news and information flows are shaped by
algorithms” (p. 1). This means moving away from the CRAAP test, which is a tool
librarians have traditionally used to teach online source evaluation.
CRAAP stands for currency, relevance, authority, accuracy, and purpose. Its
emphasis is on vertical reading and staying within the website. This can be problematic
because, as Fielding (2019) explains, the dissemination of misinformation and
disinformation has become sophisticated and prolific, and staying within a website
facilitates the spread of incorrect information because a user can easily be fooled. After
all, “once a site is deemed ‘credible,’ all information on it is frequently trusted and taken
at face value.” It is very difficult to get people to change their opinions on site credibility,
even when they’re countered with facts (p. 620). This is why lateral reading is important.
As evidenced by Wineburg and McGrew (2017), even highly educated historians fail to
critically evaluate internet sources when they do not engage in lateral reading as fact
checkers do. When reading laterally, you move from looking at what is within the site
(vertical reading) to opening up various browser tabs and going outside of the site to
check the claims made and to investigate the site’s authors and publishers. This lateral
reading skills that fact checkers are adept at enables them to “take bearings,” or get
familiar with the information surrounding the topic to better judge the quality of the site.
In Wineburg and McGrew’s study, fact checkers understood websites were created and

31

financed with a purpose and specific interests, often partisan interest, in mind. Taking
bearings helped fact checkers determine these interests (pp. 37-38).
While information literacy is important, Bluemle (2018) says our information
literacy solutions must be “creative” and possibly include helping students understand the
role of emotions in reasoning as well as exploring “the relationship between evidence and
its interpretation” (p. 278). Sergeant and Tagg (2018) advocate for critical digital literacy
which “combines an understanding of the affordances and implications of digital media
with an awareness and sensitivity to the role media play in everyday social politics” (p.
179). Cooke (2018) believes metaliteracy can combat fake news issues in the future
because metaliteracy combines elements of all of the literacies and encourages people to
look at the bigger picture (p. 19).
Teaching students to check their biases is also important because, according to
Bardon (2020), your identity impacts your willingness to accept evidence on politicized
issues. This “process of deciding what evidence to accept based on the conclusion one
prefers” is known as motivated reasoning (paras. 5-6).
Librarians are implementing new methods of information literacy to help students
think more critically about the current information environment. Cooke (2018) offers the
following suggestions to help people evaluate news: triangulate the information by
checking multiple sources; check your own biases; read outside your comfort zone or
filter bubble; understand the difference between satire, news, opinions, and infotainment;
check fact checking sites; and investigate the source and its purpose (pp. 24-25). Glisson
(2019) helps students engage in Cooke’s suggestions by having them compare and
contrast articles on the same issue. Students examine headlines, content, sources, tone,

32

and visuals and how this impacts the media message. Glisson also uses fake Facebook
profiles identified from Russian troll farms to show students how easy it is to create and
spread false information and, consequently, the need to evaluate information. Fielding
(2019) presents examples from Northern Essex Community College (NECC). Librarians
in some of the English 101 and English 102 courses swapped out the CRAAP test for
lateral reading where they compared sites on asthma from drug company GlaxoSmithKline and the National Library of Medicine’s MedlinePlus. Students in the lateral
reading course went beyond looking at the site credibility to being very engaged in
discussion about Glaxo-SmithKline's troubles and the ethics of a drug company offering
health advice. Both sites were credible, but lateral reading allowed students to see how
bias could impact information.
Silva et al. (2018) explain librarians need to know how students are searching
online to determine how best to teach them about source evaluation. In their study of 84
first-year writing students at Brigham Young University, the researchers determined that,
when evaluating articles, students most frequently looked at the sources cited in (or noted
the lack of sources cited in) the article to determine source reliability. Students also
frequently used previous experience with the source and their own bias judgment when
evaluating reliability. The least exhibited behaviors were fact-checking the source, using
the domain name, and checking the publication date. Based on these findings, the
researchers suggest librarians must first teach novice students how to go beyond their
initial inclination to only examine and trust surface features; students must learn how to
go beyond the surface features and critically evaluate and corroborate the information
found in the sources. Silva et al. also suggest librarians develop lesson plans that help

33

students “understand their own biases and think critically about how this helps or hinders
their relationship to information sources...Getting students to think self-consciously
earlier in the source evaluation process is perhaps the best way to open up other healthy
research strategies” (p. 39).

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CHAPTER 5
STUDY
The researcher conducted a survey using a grounded theory approach to
determine how people react to conflicting health news, how they consume news, and
generally whether they trust the media to report accurate information. Because this was a
qualitative study, the researcher determined the appropriate number of participants once
data saturation was reached; however, the researcher wanted to see at least 25
participants.
Methodology
Study Population
The researcher used a convenience sample and snowball sampling to recruit male
and female adult participants, age 18 and older. Participants came from a variety of
backgrounds and had a variety of educational experiences. The participants came from
within and outside of the researcher’s professional network as well as from the
researcher’s English department network at East Stroudsburg University of Pennsylvania
(ESU). ESU is a university is located in East Stroudsburg, a rural borough in northeastern
Pennsylvania. The university offers bachelor’s, master’s, and doctoral degrees. It has
approximately 5,400 undergraduate students and approximately 800 graduate students.

35

ESU is part of the Pennsylvania State System of Higher Education (East Stroudsburg
University of Pennsylvania, n.d.).
The only demographic information sought was affiliation with ESU. Not
collecting robust demographic information may be an unorthodox survey procedure,
however research from this thesis’s literature review shows that while it may be
interesting to know additional information, it was not necessary for the purposes of this
thesis. Regardless of age and educational background, adults mostly seem to have the
same skill level and can fall prey to the same manipulation of information. Also, the
focus of this study is on the mass media reporting of health news. The mass media does
not narrowcast to reach a specific segment; instead, it reaches a broad population at the
same time. Since additional demographic information was not necessary, the researcher
decided against collecting it in order to make the survey shorter. Participants were
encouraged to share the survey with their networks. The researcher invited people to
participate by sharing the information on her social media accounts (Facebook, Twitter,
and LinkedIn) and via email. Participants could then share the survey via their social
media accounts or email. It is impossible to know how many people actually received the
survey because people were encouraged to share it, however the researcher’s personal
and professional networks consist of more than 500 people.
The population allowed the researcher to recruit participants with a variety of
backgrounds and media behavior, and it allowed the participant pool to be as diverse as
possible considering the sample was a convenience sample.

36

Survey Design
Survey responses were collected via the researcher’s password-protected
SurveyPlanet account. All data collected were anonymous. The survey was deemed
exempt by the ESU Institutional Review Board (Appendix A).
The survey (Appendix B) consisted of 16 questions. There was a mix of openended, select all that apply, and Likert scale questions. The only required question was
the first question which indicated consent and affirmation that the participant read the
invitation to participate and was at least 18 years old. All other questions were voluntary.
Participations could skip any questions, and participants could also end the survey at any
time with or without submitting questions they already answered.
Survey Distribution
The survey was only administered online and, as mentioned above, it was
administered via SurveyPlanet. The researcher distributed the survey in two ways —
email and social media. When the researcher directly emailed the invitation to participate,
prospective participants could click on a link to the survey that was included in the
invitation. When the researcher recruited via social media, a post was made directing
people to read the invitation to participate which was posted on the researcher’s
professional website. The invitation posted on the website was the same invitation people
received via email.
The survey was available February 24, 2020, through April 17, 2020. Initial
invitations to participate and social media posts were distributed on February 24, and
reminders were distributed on March 16. The researcher hoped to send another reminder,
but with the COVID-19 pandemic occurring later in March and throughout April,

37

tempers were flaring around politics and the media, and the researcher felt these tempers
and the extraordinary circumstances causing them could negatively influence survey
results. Also, by the end of March the researcher had already exceeded the 25 responses
desired. Because of these factors, the researcher decided against sending out another
survey reminder.
Results
Fifty-four people responded to the survey; this is more than double the number of
responses the researcher hoped to have. Thirty-six participants were not affiliated with
ESU. The remaining participants were ESU undergraduate students (16) and graduate
students (2).
Participants were asked how they consume health news, and they could select all
methods of obtaining health news that were applicable (see Figure 1). The top two
methods of obtaining health news were via social media links (46 selections) and
newspaper or news network websites (32 selections). Television ranked third (29
selections). Print newspapers only garnered 12 selections, while radio received 14
selections. Participants selected “other” nine times, and they noted sources such as
medical journal articles, TED talks, and medical professionals. One participant
specifically mentioned searching Google for health topics but did not explain what
sources they looked at in the list of Google search results. Only four participants obtained
health news via one method. Most participants (12) obtained health news via four
methods, while 10 participants obtained health news through three methods and 10
obtained health news through two methods.

38

Figure 1: Methods of obtaining health news.

*News site refers to the response “newspaper or news network site.”
When asked if they read the entire health news article before sharing it, 21
participants said they always read the article first. Twenty-two participants read it more
than half the time, and seven read it less than half the time. No one said they never read
it, and four participants said they do not share health news. Just as more participants do
not always read the article before sharing it, more participants do not always research the
health claims made in the article before sharing it. Only 11 participants said they
“always” research the health claims before sharing an article. Fifteen people research
claims first more than half the time, 15 participants research claims before sharing less
than half the time, and 10 never research the claims before sharing. In this case, three
participants said this was not applicable because they never share health news.
Regarding comments on health news articles (either comments on social media or
comments on the news website pages), 13 participants always read them before sharing
an article. Seventeen participants read the comments more than half the time, 14 read

39

them less than half the time, and six never read them before sharing health news. Again,
four participants said they do not share health news.
Participants were asked what they think makes a health news article credible.
They could list any characteristics they use to determine credibility. Responses were
coded, and the themes and the number of times they appeared are displayed in Table 1.
The three most commons themes to emerge were the author, source, or author affiliation
(appearing 34 times); reliable sources cited in the article (15 times); and evidence such as
facts, research, statistics, and study design (11). The least common theme noted was the
article’s purpose or motivation; this appeared in only one response. Two people described
relevancy of the source to themselves or friends and family as something that helps them
determine source credibility.
Table 1: What makes a health news article credible?
Theme
Author/source/affiliation
Reliable sources cited
Facts/reliable research or study design
Relevancy/applicability to self and others
Date
Content organization
Includes statements from health
professionals
Motivation/purpose of source

Number of times mentioned
34
15
11
2
2
1
1
1

Next, participants were asked if they trust the media to provide accurate health
news articles and if they trust the media to provide accurate non-health news articles.
Both responses mirror each other — most participants were either neutral, somewhat
disagreed, or disagreed with these statements (see Table 2). Participants were also asked
whether they believe the headlines and images accompanying an article accurately
portray the content of the article. In both cases, the majority of respondents were either

40

neutral, somewhat disagreed, or disagreed. In each case, less than seven people agreed
with the statement. Responses are listed in Table 3.
Table 2: Trust in media to accurately report news
Health news articles
5
17
13

Non-health news articles
4
19
17

Agree
Somewhat agree
Neutral – neither agree
nor disagree
14
11
Somewhat disagree
5
3
Disagree
Rate agreement with the statements: I trust the media to provide accurate health news
articles. I trust the media to provide accurate non-health news articles.
Table 3: Headline and images accurately portray content
Headline
5
14
14

Image(s)
6
13
20

Agree
Somewhat agree
Neutral – neither agree
nor disagree
14
10
Somewhat disagree
7
5
Disagree
Rate agreement with the statements: The headline of an article accurately portrays the
content of the article. The image(s) accompanying the article accurately portray the
content of the article.
The next two questions focused on sharing behavior in relation to article
accuracy. Participants rated their agreement with the statement, “I share articles even
when I doubt their accuracy.” This question did not refer to fake articles written explicitly
for satire or entertainment value. The majority of participants were not in agreement with
this statement (neutral = 6, somewhat disagree = 10, disagree = 28). Six participants
somewhat agreed with this statement, and four people agreed.
The next question asked participants to think about whether they shared news that
they thought was true but later turned out to be false and how they reacted. Forty-nine
participants answered this question, and their responses were coded for themes. The top

41

three themes that emerged from this question were the participants did not discover news
they shared was fake, the participants removed the post, and the participants explained
their error either in an edit to the original post or in a follow up post. Table 4 has the
complete list of themes. Of particular interest is one response indicating that the
perceived importance of the post dictates follow-up action: “If shared and untrue but
important, I have let the person know that it turned out to be untrue. If it is a very minor
subject with little importance or opportunity to follow through, I’ll just let it go.”
Table 4: Sharing fake news
Theme
Number of times mentioned
Did not discover news they shared was
17
fake
Removed post
11
Explained the error
7
Thoughts about what they would do if
6
they discovered something they shared
was fake
Yes, they have discovered something they 3
shared was fake. Didn’t provide other
details.
Shared the correct information
2
Now understands information must be
2
evaluated
I don’t share health news
1
Let it go/do nothing
1
Have you shared a news item you thought was true or factual only to find out later it
wasn’t? If you did, what did you do after you discovered all or part of the story wasn’t
true or factual?
The remainder of the survey questions focused on reactions to conflicting health
news. Participants were asked how they react to conflicting health news claims, and they
were given the option to check all reactions that applied to them. The choices that were
selected most often were “I research the claims, then decide what to do” (39), “I ask a
health professional and then make a decision,” (28), and “I ask for input and form my

42

own decision” (21). Responses indicating people changed behavior without doing
research or ignored conflicting health news each were chosen less than 10 times. See
Table 5 for a complete list of responses. It is worth noting that 21 participants chose just
one reaction to conflicting health news while 14 participants chose two reactions to
conflicting health news, and 12 chose three reactions.
Table 5: How do you react to conflicting health news?
Theme
I research claims, then decide what to do.
I ask a health professional and then make
a decision.
I ask for input and form my own decision.
I maintain my current behavior without
researching the claims.
I do what my friends and family
recommend.
I change my behavior when I hear new
claims without researching them.
I ignore conflicting health news claims.

Number of times mentioned
39
28
21
9
7
6
6

In the next question, participants were asked to examine two conflicting headlines
about sunscreen and then provide their immediate reactions; one headline stated
sunscreen could lead to vitamin d deficiency (Drayer, 2019), and one headline stated it
may not lead to vitamin d deficiency (Wiley, 2019). Participants were instructed to
explain what they think about the use of sunscreen and if these headlines impact that, and
they were also instructed not to do any research. The reactions were coded to reveal
themes (Table 6). Fifty-one participants responded to this question. The two biggest
themes to emerge were a focus on the language used in the headlines (17 occurrences)
and confusion about the safety and potential harms of sunscreen after reading the
headlines (12 occurrences). Language comments mentioned characteristics like the first

43

headline being more straightforward than the second, the tentativeness of the second
headline, the use of qualifiers in the second headline, and the alarmist tone of the first
headline. People also pointed out the first headline grabbed your attention more than the
second headline.
Some comments about the language stood out because they showed a lack of trust
in scientific tentativeness. For example, one participant said, “After reading both
headlines, I would most likely want to read more into the first headline because it sounds
more straightforward and to the point. The second headline doesn’t look very reliable and
could be a red flag for possible fake news. So out of the two I would definitely choose the
first headline to read.” Another participant said, “The first headline sounds more
knowledgeable because it sounds like a straightforward news headline rather than a webbased headline.” What is interesting about this comment is that both headlines were from
web-based news sources. The same participant goes on to say about the first headline,
“Even though it has the word ‘could’ it still sounds more sure of itself than headline two.
I’d be less likely to read this article fully because the headline seems so sure of itself I
wouldn’t necessarily think the article adds much more information. The second headline
is a little confusing in wording and is less firm in its apparent belief as well due to the
‘maybe.’ I would be more likely to read the article because I’d want to make sense of the
headline. I would be more compelled to check the sources on this one.”
There was one other notable comment that touched on the discrepancy between
trust and interest in reading an article: “Headline 1 is alarmist compared to headline 2.
One is more likely for me to read, but 2 I am more likely to trust.” This comment

44

indicates that trustworthiness is secondary to an attention-grabbing headline and a desire
to read the article.
Table 6: Reactions to conflicting headlines about sunscreen and vitamin d deficiency.
Theme
Language comments
Confusion due to discrepancies and new
knowledge conflicting with prior
knowledge
Won’t change behavior
Desire to learn more about the headlines
Must weigh risks/benefits of sunscreen
Typical of media habits/forcing a choice
Interest because of applicability to self
Yes, opinions changed

Number of times mentioned
17
12
10
9
5
2
1
1

Finally, participants were asked to provide their reactions after reading a headline
to an article about artificial intelligence’s (AI) ability to diagnose diseases (Guy, 2019)
and that same article’s lead paragraph. The headline and the article somewhat conflicted
each other. Fifty participants responded to this question. Responses were coded, and the
themes found in the responses appear in Table 7. Nineteen participants noted conflicting
information between the headline and the lead paragraph, in some cases specifically
stating the headline is misleading. According to one participant, “The headline skips out
on a key part of the information and those who do not read the content may get the wrong
impression.”
Three people who stated the information was conflicting also stated they changed
their opinions about AI’s abilities once they read the lead paragraph. They also stated that
this conflicting information would make them stop reading the article.
While most participants mentioned the conflicting nature of the headline and lead
paragraph, three respondents said the information was not conflicting because there was

45

hedging language used in the headline. These participants were not wrong. The headline
does say AI “may be as effective as medical specialists” when it comes to diagnosing
diseases, and it is an astute observation that the language itself does not conflict. What is
conflicting is that the headline, although hedging, is still misleading because it still
sounds more emphatic than the language used in the lead paragraph, particularly to
people who are not paying enough attention to the nuances of the wording.
Participants also mentioned the type of language used in the headline and the lead
paragraph nine times, stating things like the headline grabbed their attention, the language
was engaging, or that the language was unclear or made the author seem unsure. In fact,
just like with the previous question, we see the idea of scientific tentativeness working
against credibility in one response: “After reading the headline and paragraph, I wonder
how credible the source is since the intentions of the article and research seem unclear
and indecisive in the results.” Another participant strongly reacted, “My reaction would
be that it’s not 100% true since they are stating it ‘may be.’”
The desire to learn more about the topic or read the entire article was mentioned
nine times. Some participants pointed to a lack of evidence in the information, however
they were only provided with the lead paragraph and not the entire article; evidence
comes later in the article. Still, it is not uncommon for studies to be cited in the lead
paragraph, so these respondents raise a valid point. Although the question did state these
two pieces of information were a headline and the accompanying first paragraph of the
article, some respondents were confused and treated both items has headlines. This
muddied some of the responses.

46

Table 7: Reactions to a health news article’s headline and lead paragraph.
Theme
Conflicting information
Comments about language used in
headline and article (other than comments
about it being conflicting or not
conflicting)
Desire to learn more or read the entire
article
Unsure of credibility
Not conflicting information
No evidence cited
Confusion over concept
Lack of interest –not applicable to self
Not helpful to average reader
Not enough information to react to
headline and paragraph

Number of times mentioned
19
9

9
5
3
3
2
1
1
1

Limitations
Although the researcher’s personal, educational, and professional networks
include a diverse group of people from across the United States, this study was conducted
based on a convenience sample and snowball sampling. It would be better to conduct a
survey with a sample that you can be assured is random and representative of all groups.
A larger sample size would also be ideal to draw greater conclusions. Although the
literature showed that users have the same search characteristics regardless of
demographics, collecting additional demographic data from a larger, intentionally
random sample would be beneficial to draw broader conclusions. The survey also relies
on self-reported data rather than on watching people interact with the information. It is
possible the participants were answering questions based on what they thought the
researcher was looking for or that they overestimated their awareness of whether items
they shared ended up being false. Finally, the survey would have benefitted by having the
47

questions about what makes a health news article credible, the conflicting headlines about
sunscreen, and the AI article take place in a focus group rather than via a survey. A focus
group would allow for richer discussion and understanding of the participants' thoughts.
A focus group would also allow for participants to read the entire articles rather than just
headlines and lead paragraphs. The researcher could have linked to the entire articles for
the participants, however, as in the spirit of Evanson and Sponsell’s (2019) study, the
researcher thought it best to ensure all participants had the same experiences and would
not need to navigate between pages. The researcher plans to address these limitations and
revise the study appropriately prior to any professional publication of study results.
Discussion
The results of this study were generally consistent with other studies when
examining how people obtain their news. Most of the participants obtain their news from
online sources (social media and news websites) rather than from print newspapers.
These results are consistent with Mitchell et al.’s (2017) findings that the two most
common methods of obtaining news are news websites and social media. Results were
also consistent with the MindEdge (2019) survey which showed online publications were
among the top news sources. That same survey also discovered almost 50% of
respondents ranked social media in the top three sources for news. In this thesis study,
most participants used multiple methods of obtaining news. In fact, Head et al. (2018)
explain today’s young news consumers are “multi-modal” and obtain their news from a
variety of sources (p. 2).
This study revealed a general distrust of the media both in reporting health news
and reporting non-health news. Most participants rated themselves as neutral or

48

disagreeing that they trust the media to provide accurate news in either category. Also,
participants were either neutral or disagreed that the headline and images accurately
portray the content of the article. This general distrust of the media was reflected in
Brennan (2019)’s findings from the Gallup poll information that only 41% of Americans
have a “great deal” or “fair” amount of trust in the media.
Participants in this study seemed to have based article credibility on the vertical
reading skills that come from the CRAAP test, specifically authority. Most participants
said the author or source/affiliation as well as citing sources within the article and a
reliable study design made a health article credible. No one mentioned the article claims
being backed up by other researchers and in other sources or anything else that indicated
engaging in lateral reading. Also, the least common theme to determine credibility was
motivation; only one participant chose this. That is troubling as that means understanding
the reason for the content creation (such as to persuade or inform) was not taken into
account. Again, these results seem to match what other studies have shown. Wineburg
and McGrew (2017) tell us that even highly educated historians fail to engage in lateral
reading. Also, Silva et al. (2018) discovered with first-year writing students that past
experience with a source is important; in the case of this study, if participants had past
experience that led them to believe a source is credible or not credible, they were likely
applying that to their evaluation of the source. Silva et al. also determined students
frequently look at whether articles had or lacked citations to determine article credibility.
It was refreshing to see that in this study, most of the participants said they do not
share articles when they doubt the accuracy of their content. This is reminiscent of Evan
and Sponsell’s (2019) discovery during their mini-course at Davidson College in which

49

24% of students would retweet an item despite only 16% of those same students having
confidence in its accuracy as well as Barthell et al.’s (2016) findings that 23% of
Americans have shared fake news and 14% knew it was fake when sharing it. The present
study did not ask participants why they share, however other studies have pointed to
sharing to form a sense of community.
Despite understanding there are factors that make an article credible and despite
the low trust in the media’s accurate reporting, slightly less than half of the participants
said they always read the entire article before sharing. Even fewer people always research
health claims made in articles before sharing articles; you cannot evaluate an article’s
credibility without actually reading it. Conducting a focus group in the future to
determine why participants share articles they do not read would be helpful; however, it
could be that if the article comes from a trusted source, it is automatically assumed the
information will always be accurate. If this assumption is correct, it echoes Fielding’s
(2019) explanation that once a source is deemed credible, all information from the source
is typically deemed credible.
The study started to get at how participants react to conflicting health news and
whether it makes people change their habits. Results show most participants conduct
research first, then decide what to do. What should be done in future studies via a focus
group is determine what type of research participants are doing. Are they going to health
resources? Are they searching Google and just choosing something that is in the top 10
search results? And if they are searching Google, how are they evaluating the credibility
of the sources they are using to confirm the health news article? In addition to doing
research, participants in this study noted they ask health professionals and others for

50

input. Most of the people in the study do not simply ignore health news claims, nor do
they simply change their behavior based on new claims.
It is no surprise that participants explained they felt confused when reading
conflicting headlines and also when reading content that is not exactly in sync with the
article’s headline. In the case of the participants in the study, this confusion led some of
them to want to learn more about the claims rather than automatically disregard the new
articles.
It was also interesting that the idea of scientific tentativeness, which is often more
accurate than absolute language because of the changing nature of science, actually
seemed to work against a headline’s or article’s credibility. Participants in this study
noted that articles with tentative or hedging language common in science (i.e. “may be”
rather than “is”) appeared to be less credible. This would indicate that a headline with
strong language and a lack of caveats, which is more misleading and less true, is actually
seen as more credible. This is another aspect of audience interaction with health news
that could be examined via focus group in the future.

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CHAPTER 6
COVID-19 CASE STUDY
At the time of writing this thesis, the world learned of COVID-19, a novel
coronavirus; coronaviruses are common viruses causing respiratory infections. Previous
coronaviruses that have made the news are severe acute respiratory syndrome (SARS)
and Middle East respiratory syndrome (MERS). After initially downplaying the severity
of COVID-19, the US and the world succumbed to this pandemic. At the time of
submission of the thesis draft, the pandemic is still unfolding. This section presents a
brief case study on media coverage of the pandemic.
Infodemic
The World Health Organization (WHO) says the COVID-19 pandemic has
sparked an “infodemic;” there is an overwhelming amount of information circulating and,
while some of it is true, some of it is also “downright untrue.” This false information
includes conspiracy theories about the virus origin, incorrect treatment information, and
even incorrect statistics about death rate. In fact, on March 9, 2020, the virus’s death toll
was 3,800 worldwide, but false information online was putting the number at over
100,000 people worldwide (Gharib, 2020, paras. 1-2). Charlton (2020) tells readers a
report from the U.S. Global Engagement Center found around two million tweets

52

containing conspiracy theories about the virus during a three-week period in January and
February. Garlic was also offered up as one of numerous bogus solutions to guard against
COVID-19 (“Are you stocking up on hand soap and garlic?”). Impey (2020) looked at
tweets sent from December 2019 through February 2020 and discovered “people liked,
shared, and commented on posts from sites containing false or misleading information
about COVID-19 142 times more than they did information from the Centers for Disease
Control and the World Health Organization” (“Americans’ predilection for fake science,”
para. 4). In yet another tweet analysis, researchers at Carnegie Mellon University
reviewed more than 200 million tweets about COVID-19 in January and February of
2020 and discovered 82% of the top 50 influential retweeters were bots and 62% of the
top 1,000 retweeters were bots (Young, 2020, para. 2). Researchers also determined there
were over 100 types of false stories circulating about COVID-19 between January and
May 2020 (Young, 2020, para. 8). This mirrors the spread of rumors and false
information Sommariva et al. (2019) found with Zika virus in 2016.
One of the most popular pieces of false information to spread via social media
during the pandemic is the video Plandemic. In this video, virologist Dr. Judy Mikovits
makes false claims about COVID-19. These false claims lend credence to the conspiracy
theories about the virus’s origin, its use by government to manipulate people, and the
ineffectiveness and danger of masks. She also casts doubt on Dr. Anthony Fauci’s
credibility and his ability to handle the virus; Dr. Fauci is head of the National Institute
for Allergy and Infectious Disease, and he has was a key member of President Trump’s
COVID task force before he began to publicly contradict the president. Speaking out
against the president not only led to Dr. Fauci falling out of favor with the president, but

53

it also led to his falling out of favor with many of the president’s staunch supporters. Dr.
Mikovits claims Dr. Fauci engaged in unethical actions during the HIV/AIDS epidemic
and essentially says that Dr. Fauci is still engaging in unethical behavior at the expense of
the American public’s health. The claims in Plandemic have been checked and debunked
by variety of outlets (Enserik and Cohen, 2020; Varshavski, 2020; Pappas, 2020).
Although the claims have been debunked, Plandemic went viral very quickly. In just over
a week, it had over eight million views on various social media outlets (Frenkel et al.,
2020).
This infodemic has also led to viral hoaxes. An example of a viral hoax spreading
across the globe is the story that people were knocking on doors claiming to have athome coronavirus testing kits as a guise to break into homes. The story was localized to
numerous parts of the world, and it was shared by legitimate media outlets. NBC News
investigated the claim and found no evidence of this happening anywhere the claims said
it was happening. This “viral urban legend” was shared millions of times on Facebook
(Collins and Solon, 2020).
Unfortunately, it is possible this infodemic will be worsened by foreign
disinformation campaigns. A report from the European Union (EU) claims “Russian
media have deployed a ‘significant disinformation campaign’ against the West” which
“uses contradictory, confusing and malicious reports to make it harder for the EU to
communicate its response to the pandemic” (Emmott, 2020, pars. 1, 3). Although the
alleged disinformation campaign targets the EU, this information can easily spread to the
U.S. via social media and harm our efforts to fight the virus, too

54

Media Coverage
While no conclusions can yet be drawn about the appropriate level of reaction to
this pandemic on the part of the media, many of the patterns and practices discussed in
the literature review are present in coverage thus far (through August 2020).
Contextless News
Because of the severity of COVID-19, many academic scientific publishers
removed the paywalls to COVID-19 articles, providing unprecedented access to
information to fellow scientists and to the lay press. Research is developing rapidly, and
there hasn’t yet been time to replicate studies or to place studies in a larger context. This
means the media report on individual studies, again providing contextless news; this time,
however, the reason for lack of context is because the research is so new, and scientists
are still trying to figure out the context. One example of reporting single studies out of
context is a study that discussed the possibility that blood type impacted risk for
infection. The preprint was published, so it had not yet undergone peer review (Jaklevic,
2020). Although it is difficult to place such rapidly evolving science in any kind of
context, media reporting on single studies is still problematic, especially now because, as
noted by Maksimainen (2017), a large focus on single studies makes it seem like science
is changing every time a new article is released. With unprecedented, free access to
research, attempts can be made to place research in a broader context of the evidence
evolution. Of course, a better practice would be to not focus on individual studies and to
wait until there is scientific consensus on a guideline, treatment, risk factor, etc. to report
on the topic.

55

Misleading or Contradictory Headlines
There is no shortage of misleading or contradictory headlines sparking fear, panic,
and incorrect beliefs during this pandemic. Monson (2017) tells us that sensational and
sometimes incorrect or misleading coverage of epidemics is nothing new, and she sites
“germ panic” in the U.S. relating to tuberculosis and AIDS, the H5N1 avian influenza
virus that triggered worldwide panic once it hit Europe, and the H1N1 influenza strain
which was incorrectly associated with a pig farm thus leading to unnecessary slaughter of
pigs in Egypt (paras. 6-7). One example misleading or contradictory headlines during the
current pandemic comes from Bruillard’s (2020) Washington Post article. The headline
reads, “A dog has ‘low-level’ coronavirus infection.” The subhead reads, “Don’t panic
about coronavirus in pets, experts say.” Immediately we see a headline that strikes fear
and a subhead that tells readers not to fear. The article discusses a variety of scientific
evidence that talks about coronavirus in pets and humans, making it difficult to know
whether you actually do need to worry about human to pet and pet to human transmission
of the virus. Buried deep in the article, well beyond the point at which people may stop
reading, is where you learn you should not abandon your pets or fear catching the virus
from them because it is likely you are spreading the virus to your pets. While the article’s
headline was not sensational — it stressed the infection was “low level” — the fact that it
was written at the height of the pandemic means it may strike fear in people. There is also
no discussion about what a low-level infection is in animals or even why there was a need
to test this animal.
Another example of misleading headlines and contradictory information comes
from LeMotte’s (2020) article on CNN.com. The headline reads, “Do you wear contact

56

lenses? You should switch to glasses to stop spreading coronavirus.” The article content
contradicts the headline. LeMotte consulted Dr. Thomas Steinemann, a physician with
the American Academy of Ophthalmology, who explained handling contact lenses comes
with risks if you do not practice proper hand hygiene before lens insertion and removal.
Also, he adds glasses could provide an extra barrier to block particles from entering the
eyes. Ultimately, when asked if you can contract COVID-19 through your eye, Dr.
Steinemann is quoted as saying, “Theoretically, it’s possible, but we have no proof of
that” (para. 7). LeMotte then quotes another source, Dr. William Schaffner, a professor of
preventive medicine and infectious disease at Vanderbilt University. When asked for his
professional opinion about viruses, including COVID-19, entering through the eyes, Dr.
Schaffner says, “It’s possible, I guess, but I always thought that was a bit of a stretch”
(para. 8). Thus, if you only read this article’s headline, as so many people do, you will
likely think contact lenses may cause the spread of coronavirus. When you read further,
you see the journalist is conveying certainty in the headline when there really is none,
which is a tactic Arora (2019) noted as a way for journalists to cut through the media
landscape clutter (p. 2159).
Misinterpretation of Science
As previously discussed, the lay press must convey difficult scientific facts from
the academic press to the general public in language that is understandable to them and in
a manner that fits within the space and attention-grabbing constraints of the news
medium. Also, the people who do this are increasingly generalist journalists rather than
science or health writers. This may mean the journalist relaying the message lacks
adequate background knowledge to understand the subtleties of scientific

57

communication. Coverage of COVID-19 is no stranger to the misinterpretation of science
that these conditions may cause.
Cohen’s (2020) article on CNN.com is entitled “Experts Tell White House
coronavirus can spread through talking or just breathing.” The lead paragraphs tells
readers “a prestigious scientific panel” informed the White House of this finding. The
article frequently quotes Dr. Harvey Fineberg of the National Academy of Sciences
explaining the limited research on this topic is consistent with “aerosolization” of the
virus from breathing (para. 2). He later says there is a “possibility” that COVID-19 could
be spread through “bioaerosols generated directly by patients’ exhalation” (para. 7). The
article never explains what aerosolization (releasing particles into the air as happens with
saliva from coughing, sneezing, or emphatic speaking) is or that it is not the same as the
virus being airborne, which is the implication of the article’s headline. The article further
discusses how the virus can linger in the air (again, due to aerosolization which is not
clearly explained). Finally, at the end of the article, Dr. Fineberg explains, “If you
generate an aerosol of the virus with no circulation in the room, it’s conceivable that if
you walk through the room later, you could inhale the virus” (para. 15). The important
word to note in this quote is “conceivable.” It is “conceivable” this could happen, not
“likely.” The article concludes with another quote from Fineberg regarding aerosols and
the likelihood they will linger and spread COVID-19: “But if you’re outside, the breeze
will likely disperse it” (para. 15). The article headline makes it sound like the virus could
be airborne in any condition, including outside, and it waits until the end, which some
people may never read, to add these important caveats about the findings. This confusion
over airborne transmission versus transmission via aerosolized droplets is reminiscent of

58

Killianski and Evans’s (2015) aforementioned description of the confusion about Ebola’s
transmission — airborne or via aerosolization — as well as the distinction between the
probability versus possibility of something happening and the use of those terms in the
academic press.
Another example of misinterpretation and miscommunication of science was a
report that trace evidence of viral RNA of COVID-19 was found on the Princess Cruise
Ship, a ship which was quarantined due to COVID-19, seventeen days after people
finally disembarked the ship. According to Putterman (2020), when CNBC originally
reported on this information on March 23, 2020, the headline said the virus “survived” in
the cruise ship’s cabin for up to 17 days, and that is how it was reported in the article.
Politifact fact checked this story after it had spread via social media and determined the
story was not true. Trace evidence was found, but that does not indicate the virus
survived because the trace evidence was not live. Politifact quoted Dr. Akiko Iwaski,
professor of immunobiology and molecular, cellular, and developmental biology at Yale
University: “A piece of viral RNA is not the same as a living virus. In order for a virus to
be infectious, it has to have an intact membrane, spike protein and the whole genome
intact” (para. 10). On March 28, 2020, CNBC updated its headline to more accurately
reflect the findings: “CDC says coronavirus RNA found in Princess Cruise Ship cabins
up to 17 days after passengers left.” The article also noted its contents had been updated
(Feurer, 2020). Fox News also ran a story about the results. The article content is an
accurate reflection of the science, but the headline is still misleading: “Coronavirus
survived for 17 days in empty cruise ship cabins, CDC says” (Bartiromo, 2020). This

59

confusion over trace evidence versus a live virus is reminiscent of Jaklevic’s (2019)
previously mentioned discussion about confusion over the term progression-free survival.
Technology
Because of the false news being spread in this infodemic, technological solutions
have become available. Google has an SOS Alert on COVID-19 cures (Charlton, 2020).
Gharib (2020) tells readers that Facebook is also deploying fact checkers to remove the
false claims and conspiracy theories posted on the social media platform, and Twitter is
actively bumping credible sources to the top of search results for coronavirus.
Researchers from Carnegie Mellon University are also using a “bot-hunter tool” to flag
accounts that appear to be bots because they “tweet more than is humanly possible or
claim to be in multiple countries within a few hours’ period” (Allyn, 2020a, para. 7).
Twitter points out that bot behavior is not always in violation of its rules, however it has
removed thousands of misleading COVID-19 tweets, challenged 1.5 million suspicious
accounts, and has now added labels to denote misleading, disputed, or unverified tweets
(Allyn, 2020a, paras. 9-12).
Browser extensions such as NewsGuard are also helping to identify false or
misleading health information. This tool applies color-coded labels to websites to indicate
which sites are generally reliable (green) or generally unreliable (red). NewsGuard also
launched a coronavirus Misinformation Tracking Center at the end of March 2020. As of
April 23, 2020, the tracker had identified 187 sites, 80% of which have been coded red.
NewsGuard also introduced a list of 15 Facebook pages it considers “super-spreaders” of
COVID-19 misinformation. These pages have more than 100,000 page “likes”
(Schwitzer, 2020c).

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While these technology solutions are helpful, they are not a solution to the
problem, and they do not remove the need to evaluate sources on your own. According to
Bhaskar Chakravorti, dean of global business at the Fletcher School at Tufts University,
it is very difficult to fight false information because it can “jump” platforms; for example,
Facebook may take it down, but it can still show up on Twitter and other platforms (as
cited in Gharib, 2020, paras. 29-30). Also, as NewsGuard CEO Steven Brill points out,
fact checking is, by definition, after the fact. The information has been published. By the
time the social media site flags the misinformation, tens or hundreds of thousands of
people may have seen it (as cited in Schwitzer, 2020c). Kathleen Carly, a professor at
Carnegie Mellon’s School of Computer Science, adds that when it comes to Twitter bots,
“not enough is known to develop a counter measure. Blocked accounts can resurface, and
the nature of the network [Twitter] is such that you can’t just attack at individual points”
(as cited in Young, 2020, para. 15). Finally, it is important to remember these technology
solutions are not without flaws. Peters (2020) notes that in mid-March 2020, Facebook
experienced a problem with its anti-spam algorithm leading the platform to mark
legitimate news about many topics including the virus as spam.
Social media attempts to flag news without verified claims could be curtailed in
the future, though. In May 2020, after Twitter flagged two of his tweets about mail-in
ballots and voter fraud, President Trump signed an executive order to limit the
protections social media companies are granted by the Communications Decency Act.
This act allows social media platforms to regulate the content posted on their platforms.
Trump’s executive order would impair the platforms’ ability to do this, and he signed the
order because he claimed Twitter was silencing conservative voices with these labels

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(Allyn, 2020b). While it may seem to be a noble cause to ensure Twitter is not engaging
in censorship, at the time of this writing, there is no evidence Twitter is engaging in
censorship of a particular group. It is also unethical to allow false information to spread
rampantly, regardless of who it comes from. This is especially true when the information
comes from a highly influential world leader with approximately 80 million Twitter
followers.
Impact of Treatment/Medication Coverage
It has already been established that people take actions on their health based on
media coverage (Kylie Minogue’s breast cancer impacted mammogram rates, and
coverage of Andrew Wakefield’s bogus MMR and autism connection helped fuel the
anti-vaccination movement), however it is also important to note that media coverage
impacts policies and attention devoted to drugs and treatments. When politicians such as
the president of the United States tout a particular treatment, that treatment could receive
even more attention. This appears to be the case with potential COVID-19 treatment
hydroxychloroquine, as described by Wong (2020). A deeply flawed study in France
claimed hydroxychloroquine, a drug originally developed for malaria and used to treat
lupus, had a 100% cure rate for COVID-19. Prior to the publication of this report, a
lawyer appeared on Fox News falsely claiming to be affiliated with Stanford University.
This man praised the effectiveness of the drug against the novel coronavirus. From there,
President Trump began touting its effectiveness and Elon Musk even tweeted about it.
Eventually, there were shortages of the drug, overdoses due to people trying to selfmedicate, and other issues. The journal that published the results of the French study
eventually said the study did not meet its quality standards, however by then the damage

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had already been done and people were focusing on this as a cure and largely ignoring
other options. But Wong reminds readers that initially, hydroxychloroquine had not
stolen the show. Instead, Gilead’s remdesivir was initially drawing more interest as
evidenced by Google trend data that shows people were searching more for remdisivir
than hydroxychloroquine throughout most of February. Remdesivir fell behind because it
did not have a group of people publicizing the treatment and then the media jumping on
the publicity bandwagon. It is likely that this increased media and presidential attention
on hydroxychloroquine sparked the surge of interest in the drug.
A search of ClinicalTrials.gov’s trials related to COVID-19 shows that, at the
time of this writing, 54 trials involve hydroxychloroquine and only nine involve
remdesivir (U.S. National Library of Medicine, 2020). While media attention certainly
helped spark and sustain interest in the drug, the case of hydroxychloroquine exemplifies
other problems in scientific communication, not just media coverage, such as launching a
publicity campaign and adding spin to make a treatment appear successful, lack of proper
peer review prior to publication, and presidential support for research that did not actually
show what it claimed to show; in fact, as of August 2020, President Trump still claims
hydroxychloroquine is effective, and he has made claims that he has taken the drug for
prophylactic treatment against COVID-19. Hydroxychloroquine is thus a dangerous
example of adding spin to promotional information and having that public relations spin
trickle down to the media. This situation echoes Boutron et al.’s (2019) discovery that
spin in news stories impacts the interpretation of the treatment benefit (p. 110) and
exemplifies Schwitzer’s (as cited in Green, 2017) warnings about the harmful impacts of
false hope in treatments.

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Tracing Movement
During the 2014 Ebola outbreak in the United States, the media traced the steps of
anyone who was diagnosed with the disease. The New York Times immediately traced the
steps of Dr. Kent Brantly, an American physician who contracted Ebola while on a
mission trip to Liberia, when he returned to the United States for treatment. An article
retraced his steps from the time he touched down at Dobbins Air Reserve Base to his
police-escorted ambulance ride to Emory University Hospital (Blinder and Grady, 2014).
The media also traced the steps of Amber Vinson, a nurse who treated an Ebola patient
once the patient returned to the U.S. Vinson later contracted Ebola, and the media
described her activities during the time she was asymptomatic including a commercial
flight and shopping at a small bridal store while on vacation (Smith, 2015). While
tracing these steps seems harmless for the patient and beneficial for society, it helps spur
panic about the disease. In fact, in Vinson’s case, the media coverage fueled such panic
over the uncertainty and fear of Ebola that people no longer visited the bridal store in
which she shopped. It earned the reputation as “the Ebola store” and customers were
afraid merchandise purchased there would be contaminated with the disease. Eventually,
the stigma caused this 30-year-old, profitable small business to close (Smith, 2015).
Although in the case of COVID-19 the media has not been identifying people
specifically by name and the national media has not traced steps to the same extent as it
did with Ebola, local media are tracing steps in their own ways. For example, the
researcher of this thesis lives in Pennsylvania, and her local and regional media has noted
the specific locations where those who test positive for COVID-19 work as well as the
number of people who are infected. This type of coverage appears daily on television,

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internet, and in print news. Here is a sampling of headlines tracing locations of confirmed
cases and deaths in the researcher’s county and surrounding areas:
•

Enola Giant employee tests positive for COVID-19 (CBS21 News, 2020)

•

Redner’s Quick Shoppe worker tests positive for COVID-19 (69 News,
2020a)

•

Hershey Medical Center’s confirmed coronavirus cases up to 15, with 5
more under investigation (Press & Journal, 2020)

•

Berks County coroner reports 2 more coronavirus deaths of Berks
residents (Mayer, 2020)

•

East Penn advises employees of co-workers with virus (69 News, 2020c)

•

Employee at Wawa in Fountain Hill (Bethlehem) tests positive for
COVID-19, store reopens after deep cleaning (69 News, 2020b)

•

Two employees of Berks Heim test positive for COVID-19 (Lynch, 2020)

Numerous local news outlets across the country are also reporting daily on their own
local and state case and death counts.
Although national media did not go to the extreme level of detail to trace
individual movements as they did with Ebola patients in the U.S. (the sheer number of
COVID patients in the U.S. soon made this an impossible task), national media reported
almost daily on case counts in various states, especially states with high infection rates
like New York, New Jersey, Florida, Texas, and California. The Centers for Disease
Control and Prevention (2020) set up a reporting dashboard as did individual states.
Pennsylvania Department of Health’s (2020) dashboard includes totals as well as hospital
bed and ventilator capacity. The Center for Systems Science and Engineering at Johns

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Hopkins University (2020) also set up a major interactive COVID dashboard that allows
you to drill down to individual states and counties in the U.S. as well as look at cases
across the world.
In addition to dashboards to view local, state, national, and international data
updated daily, governors in many states (i.e. New York’s Governor Andrew Cuomo, New
Jersey’s Governor Phil Murphy, California’s Governor Gavin Newsom, and
Pennsylvania’s Governor Tom Wolf and Secretary of Health Dr. Rachel Levine) have
held daily press briefings to update citizens on the status of COVID, hospital bed and
ventilator capacity, and COVID mitigation efforts in their states. Many of these press
briefings were picked up by local, state, and national news outlets.
ABC News also tracked flights at the beginning of the pandemic. This tracking
didn’t trace the movements of individual people, but it showed how groups of people
flying into the U.S. from China, Italy, and Spain (virus outbreak hot spots at the time)
helped increase the spread of the virus in the outbreak hot spots in the U.S. (Kelly and
Thomas, 2020).
Use of Preprints
Because of the severity and quick spread of COVID-19, scientific publishers have
removed paywalls on all published research related to the virus. Scientists are also setting
aside their academic secrecy. According to Harvard Medical Professor Dr. Ryan Carroll,
“Big, exclusive research can lead to grants, promotions, and tenure, so scientists often
work in secret, suspiciously hoarding data from potential competitors” (as cited in
Apuzzo and Kirkpatrick, 2020, para. 20). Now, scientists are widely sharing data with
each other, and they are making preprints of their research quickly and widely available

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for free via various digital repositories. This is an unprecedented move for scientific
collaboration across the globe, but it also provides the public, including the media, with
unprecedented access to all scientific studies, even those that have not yet undergone peer
review to test the validity of their claims. Depositing preprints in open access repositories
is not new; however, journalists’ desire to utilize preprints is new.
There is nothing inherently wrong with using a preprint for an article, but
journalists need to explain the benefits and limitations of a preprint and not simply use
them to satisfy the novelty bias inherent in journalism. According to Jaklevic (2020),
these “strong caveats” are often missing from articles based on preprints. News stories
cite the preprints with little or no explanation about the quality of the work and without
the caveat that preprints have not yet been peer reviewed to check for errors and
weaknesses in the evidence (para. 10).
Schwitzer (2020b) pointed out The New York Times used a pre-print for an article
in its Well column in which it is suggested runners need 15 feet of social distancing space
rather than the commonly recommended six feet. The article does include some caveats,
but this only serves to contradict its headlines and confuse audiences. Schwitzer explains
the article admits the study used for the column was not published in a peer-reviewed
journal nor did the study specifically examine coronaviruses. Schwitzer interviewed Dr.
Adam Cifu of the University of Chicago about the NYT’s decision to even publish this
information. Cifu calls the reporting “truly irresponsible” and says there is nothing in the
research that makes this claim plausible (as cited in Schwitzer, 2020b). Thus, even when
an article contains caveats, it could still cause unnecessary confusion and panic in this
time of uncertainty.

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Iterative Journalism
The media have engaged in iterative journalism, described earlier by Cooke
(2018) as reporting on topics affiliates or other news outlets have reported on rather than
doing their own investigation. A prime example of this is a STAT News article about a
remdesivir clinical trial in Chicago: “Early peek at data on Gilead coronavirus drug
suggests patients are responding to treatment.” The article’s headline and lead paragraph
point to early success of the trial; Feuerstein and Herper (2020) explain a clinical trial of
the drug “is seeing rapid recoveries in fever and respiratory symptoms, with nearly all
patients discharged in less than a week” (para. 1). The article goes on to give an overview
of the trial, eventually offering a caveat that this single clinical trial’s outcomes “offer
only a snapshot of remdesivir’s effectiveness,” noting the same trials are happening
concurrently at institutions across the country, and telling readers, “It’s impossible to
determine the full study results with any certainty.” Eventually, the authors remind
readers that Gilead, the remdesivir manufacturer, has not released other trial data
(Feurestein and Herper, 2020, para. 6). The rest of the article describes the clinical trial.
Finally, in paragraph 17, the authors explain there is no control group in the study. More
discussion of the trial ensues, and the article concludes with quotes from patients in the
trial who recovered from COVID-19 and praise remdesivir’s effectiveness.
CNN reported on this article the next day with a headline that sounds more
certain: “COVID-19 patients recovering quickly after getting experimental drug
remdesivir” (Fox, 2020). The lead paragraph states the information comes from the
STAT News article. After 10 paragraphs, the CNN article includes the same caveats as
the STAT News article. Schwitzer (2020a) tells us that other news outlets also engaged in

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iterative journalism based on the STAT News article, and some added their own caveats.
For example, Schwitzer explains Fox News reached out to the University of Chicago
School of Medicine for its caveat that this partial data is incomplete and cannot be used to
draw conclusions about the drug’s effectiveness (“Other news organizations...,” para. 1).
Schwitzer also tells us Reuters and CNBC picked up the article, but added information to
position it from an investment standpoint. CNBC’s caveat was that the study results are
“largely anecdotal” and “should be interpreted with caution” (as cited in Schwitzer,
“Other news organizations...,” para. 6).
Continuing the Case Study of COVID-19
The pandemic is unfolding as this thesis is being written, and there are no
definitive scientific answers as to when the pandemic will cease being a major health
crisis and will be just another health issue to manage. While additional media study is
beyond the scope and timeline of this thesis, the researcher intends to engage in ongoing
media analysis and, at some point when the media coverage dies down and the pandemic
slows, conduct a more thorough analysis of coverage and peoples’ reactions to the
coverage. The researcher plans to examine periods of media coverage in the progression
of the pandemic — before it hit the United States, the early stages of virus progression in
the United States, the height of the pandemic, once the country passed the peak of the
pandemic, and finally re-opening of the country (at the time of this writing, all states have
re-opened in some capacity although there is yet no timeline for returning to pre-COVID
operations). Media coverage will be examined in two ways. The first way will consist of
an examination of coverage of themes and risk messages similar to Basch et al.’s (2014)
examination of Ebola coverage themes and risk messages, and the second will be an

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examination of peoples’ reactions to coverage based on social media article comments.
Samples of articles will be examined from each period of media coverage, and the
articles will come from traditional print news publications, alternative and digital news
publications, radio news, television broadcast news, and television cable news. Through
this analysis, the researcher hopes to learn how the media covered the pandemic from
beginning to end, how people reacted to coverage throughout the pandemic, and if there
are any themes that arise that can help us better understand how to communicate health
news and how we should report when the next pandemic hits.

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CHAPTER 7
CONCLUSION
The fake news era can have detrimental impacts for health news and,
consequently, for people seeking out health news. Now more than ever, it is critical to
examine the standards of scientific communication, both in the media and in the
academic press, and to provide a strong foundation in information literacy in order to
restore trust in the fourth estate.
Custodians of Knowledge
The media is what Jamieson (2017) calls a “custodian of knowledge.” She
impresses upon us the ethical communication standards of these custodians of
knowledge:
Custodians of knowledge tell us what science knows and how it knows it. Their
language can enhance or cloud public understanding of the underlying science.
Because language plays these roles, we need to be aware of the ways in which
audiences hear the language that is used to conceptualize scientific concepts.
When, advertently or inadvertently, linguistic choices miscommunicate the
underlying science, the policy debate becomes muddied and the credibility of the
science is more susceptible to the polarizing challenge (47).

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The media is not the only custodian of scientific knowledge, but it is the main custodian
of knowledge that directly interacts with the general public to relay important health and
non-health information for the safety and wellbeing of citizens. The fourth estate thus
occupies a very important place in society that requires it be held to high ethical
communication standards. These ethical standards can easily be manipulated by the social
era of news and the new methods of operating that the era brings with it.
How did we get here?
Unfortunately, media history is rooted in this ethical reporting conflict, a conflict
that pits the values of good journalism against the values of business profits. Since the
birth of newspapers, writers were taking sides on issues and peddling gossip. Ben
Franklin even championed an early version of the fairness doctrine and a world free from
gatekeepers. According to Daly (2012), Franklin referred to journalism as a business, and
he believed truth and error should have “fair play” and “the power of the truth would win
out in the end” (p. 24). The market was saturated with different media voices for most of
its history. While those voices had gatekeepers unlike today’s social media, they were not
always of equal quality and caliber of reporting, and they sensationalized news.
Media had been owned by individuals or families. Eventually, though, familyowned media companies became publicly traded entities. While this meant a singularly
controlled media outlet had to answer to shareholders and thus this could mitigate biased
points of view, this also meant opposing voices and unpopular but important and lessthan-profitable issues and voices were silenced. Eventually, in the United States in the
1980s, media consolidated resulting in conglomerations which placed a premium on
profits. Daly (2012) tells us that in this environment of consolidation and

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conglomerations, the basic values of American journalism — independence, truthfulness,
and diversity — were under pressure due to the “tensions inherent in trying to house a
critical professional institution like journalism inside the big modern corporation...There
was a ‘cultural contradiction’ in the news business between news values and business
values” (p. 396). This meant fewer and fewer people controlled the media messages on
various outlets, and it was a step toward creating filter bubbles outside of social media.
The 1980s also saw the birth of 24/7 cable news with Ted Turner’s CNN.
MSNBC and Fox News would later follow. While the concept behind CNN seemed like a
good way to keep people informed — providing constant access to news as it became
available — it fundamentally changed the nature of news. According to Daly (2012),
CNN changed news from being presented as a finished, polished product to being a
process with incomplete information. That incomplete, or even incorrect, information can
be updated in the next segment. Daly adds in this news process, “More of the material
that reaches the public is partial, fragmentary, often speculative, and sometimes hearsay”
and is often highly emotional (p. 408).
The 1990s then saw the rise of internet news outlets and the subsequent loss of
print ad revenue, and this led to staff cuts, both of which had major impacts on the quality
and delivery of news. Since the 1990s, news staffs have continued to be trimmed, placing
a burden on those who are left to cover the news adequately and in a way that garners the
ratings desired of conglomerates. The internet also allowed us to be inundated with news,
and this compounded the 24-hour cable news sites. But also, the digitization of news
upended all traditional ideals of journalism and news. Gatekeepers were removed, free
news outlets meant people turned away from paid news outlets, and anyone could be a

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“citizen journalist” presenting their own news. This democratization of the news did not
guarantee the quality and accuracy of news.
The internet allowed an explosion of unchecked voices to be back on the news
scene; this harkens back to the early days of journalism and Franklin’s belief that truth
and error deserve equal time, and the truth will prevail. As we see today, though, the truth
does not always prevail.
Although people could always create their own versions of filter bubbles by
choosing where to obtain their news, they still had to seek out news outlets, and what
they saw was not customized to their likes and internet activity. This changed with the
advent of social media.
In the late 1990s and early 2000s, various forms of social media entered our lives.
These platforms allowed people to interact with others who shared their views from all
over the world, but the social media filter bubble did not truly come to fruition until
Facebook was created. Facebook was created by psychology major Mark Zuckerberg
while he was a student at Harvard University in 2004. At that time, it was originally only
available to Harvard students. By 2006, it was available to anyone over 13 years old,
including businesses (Boyd, 2019). Since then, Facebook and the social media platforms
that followed have allowed people to personalize their news coverage, connect with likeminded individuals, and be served up news and information based on algorithms
customized according to their internet activity and interests. Until recently, the quality of
information on these platforms was completely unchecked, allowing people to be
inundated with information of varying degrees of quality that continued to affirm rather
than challenge their points of view, thus making it increasingly difficult to evaluate the

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veracity of information that can easily be created by anyone with an internet connection
and an internet-enabled device.
Clearly our history has led us to this point, and while we may never be able to
reverse the damage done to reporting, particularly health reporting, we are ethically
obligated to try to mitigate the damage.
Where do we go from here?
The media must address its contributions to the impacts of the fake news
environment. The 24/7, fragmented news cycle is likely not going away. It is beneficial to
provide new information when possible, however it is also necessary to ensure updates
are clearly marked and outdated information — including social media links — are
removed because, with any quickly developing issue, facts reported may be incorrect
within the hour; information that is removed should be archived for historical news
reference. This rapidly changing news makes contextualizing information even more
important so the audience can understand the changes.
Lean staffs that lack science or health journalists or even fact checkers is a
problem that impacts all types of reporting, not just health news reporting. Inaccurate
science and health reporting can be eased with evidence-based journalism; these skills
can be taught to generalist journalists if dedicated science and health journalists are not
on staff. This mirrors the concept of evidence-based practice and ignores the fairness
doctrine of journalism in favor of the evidence pyramid framework which gives more
weight, and consequently more coverage, to studies with stronger evidence. In the
pyramid, evidence is arranged as a hierarchy with items at the top of the pyramid, such as
systematic reviews, having stronger evidence than items closer to the bottom of the

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pyramid, like individual case studies. In science, all evidence is not treated equally, and
journalists should convey this to their audience. When an item with weaker evidence that
is lower on the pyramid is the only option to report, it should be presented with strong
caveats that explain the study’s shortcomings.
The use of preprints became a forceful trend in journalism as a result of COVID19, and should this trend continue, it must be continued with caution. Preprints are not
peer-reviewed or published, so while the pre-print may have a study that is at a higher
level of evidence on the evidence pyramid, the study has yet to undergo peer review to
ensure the study findings are accurate and the science is as rigorous as it should be. If
preprints are the only option available to use, they should also only be used with strong
caveats.
Adequate risk communication with health information is another issue to address.
The fairness doctrine may give people the wrong impression about the actual possibility
of certain risks (i.e. the results of treatments, reliability of testing, and possibility of
disease spread). Risks cannot be sensationalized for ratings; however, we also cannot
oversimplify and inadvertently downplay risks. The desire for simple and clear
communication must be weighed against the need for detailed, accurate communication,
especially since studies have shown that people act on their health based on what they
read or hear in the news.
Ethical reporting also requires the media to take into account audience
characteristics, particularly the characteristic of reading headlines and not reading the
article at all or only reading part of it. This means the concept of the inverted pyramid in
journalism — the style of writing where the most important details appear in the first one

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to two paragraphs — is even more critical. But it is no longer just the first one to two
paragraphs that are critical. Accurate information in the headline rather than a headline
meant to shock readers and draw them in is necessary. In fact, Zindren (2020) addresses
this when she says you must debunk myths in the headlines, not in the body of the article
(“Top 10 Takeaways,” para. 7). The reality is our audience has ever-decreasing attention
spans, and the audience cannot always be counted on to even click on the headline to read
the first two paragraphs. While the onus for consuming all of the information presented to
obtain a thorough understanding of the topic should remain on the readers, it is not
entirely ethical for the media to continue to operate as if we still function in a society
where the headline leads people to read the article before judging its veracity and sharing
the claims with others. A headline may cut through the media clutter, but it needs to also
be explicitly accurate, and evidence that supports your headline must be immediately
present in the article body.
Another area to address is the news business model. The current for-profit news
model that depends on advertising revenue is not sustainable for many local news outlets,
and it continues to be a burden for larger outlets that see dwindling ad revenues. New
business models must be investigated and refined. An alternative business model that is
already in place for some outlets is the nonprofit model which relies on philanthropy and
foundation endowments. According to Schmidt (2019), these outlets are attempting to fill
the news gaps left by the for-profit model, namely investigative journalism and local
news. Schmidt explains, “The nonprofit approach develops a closer relationship with
foundations, folks with money, and readers/people who may be inclined to give a range
of small-dollar donations to their work, rather than the corporate donors, advertisers, and

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one-size-fits-all subscribers” (para. 3). This model appears to be growing in popularity.
As Shi (2018) tells us, The New York Times reported that a month after the 2016
presidential election, “donations jumped at several nonprofit news outlets” such as
ProPublica and The Marshall Project (para. 3). While this model should continue to be
investigated and refined, it is important to understand this model comes with its own set
of obstacles to accurate and fair reporting. These news outlets must be careful not to cater
their coverage to specific interests and biases of foundations or large donors. If they cater
to donor interests, their quality of coverage will be no better than the current outlets in
for-profit models that cater to advertising dollars; the difference in business models will
not guarantee a difference in news quality if this is allowed to happen. Also, relying too
much on charitable funding is a dangerous business practice. What happens if the
donations dry up? Relying on the charitable donations of others is not exactly a
sustainable business model, and news outlets that rely on this type of funding could find
themselves in the same dire financial straits that news outlets relying on advertising
dollars find themselves now. This could also encourage coverage to be biased in favor of
donors so the money keeps flowing. Finally, Shi (2018) also notes there is a lack of
transparency related to funding with these nonprofit outlets. Although a lack of
transparency does not automatically equate to an attempt to hide inappropriate business
practices, it can lead to that situation. Because financial interests can shape coverage, it is
important to understand who is funding the news outlet and how this could impact
coverage. This is especially important with health news since financial transparency and
disclosure of any kind of conflict of interest is an ethical pillar of scientific publishing.

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Clearly a lack of transparency can create an environment ripe for biased reporting that is
ultimately no different than what we sometimes see in the for-profit models.
But the media is not the only one that needs to change its habits. The academic
press needs to reexamine its practices of adding spin to press releases to attract attention.
Academic publishing should also reconsider its paywalls that lock people out of verifying
scientific information presented in press releases. While the academic press should be
focused on providing complete and accurate information, there also must be better
communication about what constitutes completeness and how this is relayed to the lay
press. This may not be much of an issue when science is relatively stable, but the
COVID-19 pandemic has made it obvious that science does change and, when the
worldwide scientific community is in the midst of rapidly uncovering information about a
new virus, it can change quickly, conflict itself, and cause confusion. Scheufele et al.
(2020) tell us that in this fast-moving environment, “Today’s high-profile expert assertion
can be disproven by tomorrow’s events” (para. 1). The authors further explain that in this
environment, a focus on accuracy and facts is an incorrect and misleading measure of
good scientific communication. “The seductively simple directive to be ‘accurate,’ which
lies at the heart of science communication, obscures the reality that accuracy is a tenuous
notion during a crisis such as this [COVID-19 pandemic], in which uncertainty reigns.”
As we gain new knowledge, science that was considered “correct” at the beginning of the
crisis will be determined to be “incorrect” or at least “incomplete,” making it difficult to
clearly determining what is misinformation and what is part of the legitimate scientific
process. This means, “It is difficult to even define ‘misinformation,’ much less to
‘correct’ it” (paras. 5-6). Confusion over changing scientific information and what is

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accurate and what is inaccurate has contributed to the confusion over various aspects of
COVID-19, including whether masks are necessary to help prevent its spread. During the
initial months of the pandemic in the US (February and March 2020), citizens were told
masks were ineffective. By April 2020, there was research to show any kind of face
covering could be helpful in preventing the spread of COVID-19; however, people are
still unsure of mask effectiveness and the need to wear them because of conflicting
information from earlier months. This uncertainty over the effectiveness of masks has
been further exacerbated by politicians who second guess health experts in order to
pander to their political voting bases. The confusion over masks is also an example of the
academic press and the lay press not placing the information in the correct context of
evolving research. Scheufele et al. emphasize that for accurate scientific communication
in the future, there must be information about how complete scientific knowledge is —
separate what science actually knows from what it does not yet know (“Implications...,”
para. 2). Doing so and relaying updates that place new information within the correct
context of how and why the information is changing should help ease confusion over
what appears to be conflicting scientific information.
It is also remiss to ignore the fact that health information’s credibility is impacted
by forces outside of journalist and scientist control. One of these factors is lack of trust in
the pharmaceutical industry (big pharma). Another factor accompanying the distrust in
big pharma is the anti-vaccination movement. Also, Impey (2020) explains that
Americans have a penchant to believe fake science: “Americans are prone to superstition
and paranormal beliefs. An annual survey done by sociologists at Chapman University
finds...over 75% hold multiple paranormal beliefs. The survey shows that these numbers

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have increased in recent years” (“Americans’ predilection for fake science,” para. 1).
Americans may also have a penchant for conspiracy theories. According to Vittert
(2019), “At least 50% of Americans believe in at least one conspiracy theory” (“Current
beliefs,” para. 4). Fortunately, this number has not increased since 2010 (“Historical
data,” para. 5). Although this number has not increased, bots spreading false COVID-19
information on Twitter are spreading conspiracy theories. These conspiracy theories lead
to “more extreme opinions, which can in turn lead to less rational thinking” (Young,
2020, para. 13). Belief in conspiracy theories and their rapid spread via social media was
evidenced in the earlier discussion of the video Plandemic. Also, politicians may
influence thoughts about the media in general. President Trump is fond of calling certain
news outlets “fake news,” and he refers to the press as “the enemy of the people.” It is
believed Trump’s media sentiments are contributing to increased violence against
journalists in the U.S. In fact, in 2019, the Reporters Without Borders (RWB) annual
World Freedom Press began classifying the U.S. as a “problematic” country for
journalists, ranking the U.S. below Romania, Chile, and Botswana. RWB’s ranking
“follows inflammatory comments from the president and a broader hatred of the media
which resulted in the shooting of five newspaper staff at the Capital Gazette in Maryland”
(Waterson, 2019, paras. 2-3). Tension between science and politics also impacts health
information’s credibility. This tension has been evident during the COVID-19 pandemic
as President Trump has attempted to downplay the severity of the pandemic and the
measures needed to fight it while members of his task force, including Dr. Fauci as well
as Dr. Deborah Birx, the U.S. global AIDS coordinator and the COVID-19 pandemic task
force’s coordinator, have provided evidence that contradicts the president. Dr. Fauci has

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contradicted the president so much that he has stopped appearing with the rest of the task
force, and both he and his family have received death threats. Recently, President Trump
added a new physician to his pandemic task force. This physician, Dr. Scott Atlas, has no
prior experience in infectious diseases or pandemics, but he agrees with President
Trump’s desired actions to get the country back to “normal,” including no longer wearing
masks (Thomas, 2020).
Finally, information literacy is necessary. The WHO uses the term “infodemic” to
describe the current environment of information, particularly false information, during
the COVID-19 pandemic; however, we live in a constant infodemic, particularly an
infodemic of health news. Understanding how to navigate the information waters of this
constant infodemic is a hurdle, and it exemplifies the importance of integrating
information literacy throughout a person’s academic career, particularly throughout the
K-12 environment when students are learning how to navigate the world. A broad base of
information literacy should encourage students to understand how their own biases, social
media use, and internet searching habits impact algorithms and the information they see.
This information literacy should also include an emphasis on how easy it is to create and
disseminate false information and the need to understand the purpose of a piece of
information. Also, as the idea of deepfake becomes more popular and people with a
computer and internet access can digitally swap faces and even voices to create fake
videos, the ability to critically evaluate resources is imperative. In fact, Toews (2020)
explains “several deepfake videos have gone viral recently,” including videos of
President Obama describing President Trump with an expletive and videos of Mark
Zuckerberg saying Facebook aims to manipulate its users (para. 5). There was also a

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deepfake video from Belgium saying COVID-19 was the result of environmental
destruction (“When seeing is not believing,” para. 11). But in addition to deepfake videos
proliferating rapidly and becoming increasingly sophisticated, Toews also tells us their
existence means people can claim real videos are deepfake videos to cast doubt on their
credibility (“When seeing is not believing,” para. 18). This is similar to how society has
adopted the habit of calling any unflattering news “fake news.” Perhaps emphasizing
critical evaluation and information literacy skills throughout a person’s educational career
could help quell the spread of misinformation.
While an overall base of information literacy is important, emphasis should be
placed on news and media literacy. According to Dyer (2017), attempts to integrate news
and media literacy into the K-12 environment have been met with mixed results, and
some studies show the effects of individual news literacy courses diminish over time.
Dyer adds there is also debate over whether news literacy can actually be taught:
“Educators have demonstrated that, on a limited scale, they can make students a little
savvier about the media. But whether those same educators can train large audiences to
unmask fake news in the Internet age is an open question” (para. 14). It should come as
no surprise that sporadic news literacy courses have a diminishing effect. Students do not
master a concept after one course, and the ability to understand information and critically
interact with it are skills that must be developed; thus, it is necessary to emphasize this
ability throughout someone’s educational career just as you emphasize other basic skills
like reading and writing. Also, because students are likely to interact with a substantial
amount of health information throughout their lives, it is essential to include teaching
about the concept of scientific tentativeness. The literature review revealed that

83

understanding scientific tentativeness is something journalists struggle with, and the
study in this thesis revealed that accurate yet tentative language can actually lead people
to have less trust in a health news article.
Do No Harm
In order for the media to fulfill its duties of informing the public, it must be
trusted. Research has shown that trust in the media is low, and this is especially harmful
to the public in the fake news era. Lack of trust in the media means we lack trust in an
institution that should be a basic pillar of democracy that serves the best interests of the
public; this includes keeping their safety and wellbeing in mind when reporting health
news. When this anchor of credibility is gone, how are we to determine what else is
credible? The media must acknowledge its own contributions to the fake news era and the
infodemic, and it must also ensure ethical reporting that places information in the correct
context, does not politicize information, and does not prioritize ratings over accuracy.
Essentially, the media must abide by the guiding principle of the healthcare community
— do no harm.

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Appendix 1: IRB Approval
East Stroudsburg University Institutional Review Board
Human Research Review
Protocol # ESU-IRB-024-1920
Date: December 12, 2019
To:
Sandra Eckard
From: Shala E. Davis, Ph.D., IRB Chair
Proposal Title: “Do no Harm: Ethical Reporting of Health News”
Review Requested: Exempted X
Expedited
Full Review
Review Approved:
Exempted
Expedited
Full Review
FULL RESEARCH
____ Your full review research proposal has been approved by the University IRB (12
months). Please provide the University IRB a copy of your Final Report at the
completion of your research.
____ Your full review research proposal has been approved with recommendations by
the University IRB. Please review recommendations provided by the reviewers
and submit necessary documentation for full approval.
____ Your full review research proposal has not been approved by the University IRB.
Please review recommendations provided by the reviewers and resubmit.
EXEMPTED RESEARCH
__X__ Your exempted review research proposal has been approved by the University
IRB (12 months). Please provide the University IRB a copy of your Final Report
at the completion of your research.
____ Your exempted review research proposal has been approved with
recommendations by the University IRB. Please review recommendations
provided by the reviewers and submit necessary documentation for full
approval.
____ Your exempted review research proposal has not been approved by the University
IRB. Please review recommendations provided by the reviewers and resubmit, if
appropriate.
EXPEDITED RESEARCH
____ Your expedited review research proposal has been approved by the University
IRB (12months). Please provide the University IRB a copy of your Final Report
at the completion of your research.
____ Your expedited review research proposal has been approved with
recommendations by the University IRB. Please review recommendations
provided by the reviewers and submit necessary documentation for full
approval.
____ Your expedited review research proposal has not been approved by the University
IRB. Please review recommendations provided by the reviewers and resubmit, if
appropriate.
_______________________________________________________________________

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Please revise or submit the following:
PLACE IRB CONTACT IN CONSENT SECTION OF SURVEY

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Appendix 2: Survey Questions
1. I have read the accompanying invitation to participate, and, as an adult of at least
18 years old, I willingly consent to participating in the survey. I understand I may
skip questions and stop the survey at any time with or without submitting my
responses.
Yes, I consent to participating in this survey.
No, I do not consent to participating in this survey.
2. Please identify your affiliation with East Stroudsburg University of Pennsylvania
(ESU). Choose all that apply.
No affiliation.
ESU faculty
ESU undergraduate student
ESU graduate student
ESU staff
ESU alumni
3. How do you obtain health news? Select all the apply.
Print newspaper
Newspaper or news network website.
Social media links.
Television news
Television ads
Online ads
Email
Radio
Magazines
Other:
4. I read the entire health news article before I share it.
Always
More than half the time
Less than half the time
Never
Not applicable – I don’t share health news
5. I research the health claims made in the article before I share it
Always
More than half the time
Less than half the time
Never
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Not applicable – I don’t share health new
6. I read comments on the health news articles online (either the social media
comments or comments on the article website) before I share it.
Always
More than half the time
Less than half the time
Never
Not applicable – I don’t share health new
7. In your opinion, what makes a health news article credible?
8. I trust the media to provide accurate health news articles.
Agree
Somewhat agree
Neutral – neither agree nor disagree
Somewhat disagree
Disagree
9. I trust the media to provide accurate, non-health news articles.
Agree
Somewhat agree
Neutral – neither agree nor disagree
Somewhat disagree
Disagree
10. The headline of an article accurately portrays the content of the article.
Agree
Somewhat agree
Neutral – neither agree nor disagree
Somewhat disagree
Disagree
11. The image(s) accompanying an article accurately portray the content of the
article.
Agree
Somewhat agree
Neutral – neither agree nor disagree
Somewhat disagree
Disagree

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12. I share articles even when I doubt their accuracy. Please note, this question refers
to articles from sources that are not explicitly fake news written strictly for
entertainment.
Agree
Somewhat agree
Neutral – neither agree nor disagree
Somewhat disagree
Disagree
13. Have you shared a news item you thought was true or factual only to find out later
it wasn’t? If you did, what did you do after you discovered either all or part of the
story wasn’t true or factual?
14. How do you react to conflicting health news claims? Select all that apply.
I research the claims, then decide what to do.
I change my behavior when I hear new claims without research them.
I maintain my current behavior without researching the claims.
I ask for input and form my own decision.
I do what my friend and family recommend.
I ask a health professional and then make a decision.
I ignore conflicting health news claims.
15. After reading these two headlines, what do you think about the use of sunscreen
and your health? Is it different from your previous thoughts on using sunscreen?
Headline 1: “Sunscreen could cause vitamin d deficiency.”
Headline 2: “Does sunscreen compromise vitamin d levels? Maybe not.”
Please provide your initial, immediate reaction after reading both headlines. Do
not do any research on this topic to inform your opinion.
16. Below is the headline and first paragraph of a news article. After reading these
two pieces of the article provided below, what is your reaction to the reporting
and to the content?
Headline: “AI may be as effective as medical specialists at diagnosing disease.”
Paragraph: “A new scientific review has concluded that artificial intelligence (AI)
may be able to diagnose disease as successfully as human healthcare
professionals, but a lack of quality studies means the real potential of the
technology is unclear.”

107