A Candid Conversation with Jane Brody

During the 2010 Pain & Society Fellowship workshop, legendary New York Times personal health columnist and author Jane Brody surrounded herself with our newest Mayday Fellows at a local Washington, DC restaurant over dinner. The evening was filled with candid exchanges and conversation. Ms. Brody shared some common wisdom and frank advice about what she looks for as a journalist when writing stories on pain, what makes you a good source, and why you, as pain care specialists, have important stories to tell. Here is a Q&A based on that conversation.

How did you become interested in writing about health?

I was schooled in biochemistry at Cornell University, but after working in labs for three summers, realized the lab life was not for me. I also knew that I’d rather communicate about health to the general public than spend my life trying to convince individual patients to practice good health habits. So I got a master’s degree in science writing at the University of Wisconsin and have spent the last 47 years writing about science and medicine, 45 of those years at The New York Times, and the last 34 as The Times’ personal health columnist.

What are some of your main goals as a columnist?

My column covers the waterfront on health issues that are – or should be – of concern to millions, including government agencies, insurers, and physicians, as well as patients. My primary emphasis is on prevention – providing readers with the kind of information they need to stay healthy or to restore health when it is temporarily lost. My secondary goal is to help people know what to do when the goal of staying healthy eludes us more permanently. Therefore, what I write is of concern, now or in future, to everyone.

What makes pain management an important issue for you to cover?

With rare exception, we all experience pain. It is virtually a universal symptom. Thus pain is, or should be, a very easy subject to “sell” to the media – especially since there is so much confusion and misunderstanding about how and when to treat pain and so much suspicion about almost every pain remedy, especially the most potent ones, the opioids.

Perhaps most challenging is the fact that pain symptoms are not visible or quantifiable by ordinary medical exams or tests, beyond pressing or moving a body part and waiting for the patient to yelp! Even the 1-10 pain scales are highly unreliable. They mean different things to different people, and how people rate pain depends entirely on their prior pain experiences.

What are some of the pain issues that you have covered in the past?

Through the years I’ve written extensively about pain issues – on topics like coping with chronic pain, the experience of post-surgical pain, back pain, elbow pain, knee pain, arthritis, pain management in children, end-of-life pain and the potential to ease that through hospice and palliative care, as well as alternative treatments for pain, like acupuncture, biofeedback, prolotherapy, etc. I’ve also written about the importance of paying attention to pain, the body’s warning sign that something is amiss, and not – as too many athletic enthusiasts do – just “run through it” and end up with a far more complicated problem.

What are some pressing issues that you find pain care specialists confronting?

In their practices, they see pain up close and personal. They no doubt hear all kinds stories of poorly managed pain, living and work problems encountered because of pain, the reluctance of physicians to prescribe narcotics for intractable pain, and/or reluctance of patients to take narcotics for their pain. Also important is the value of morphine as life draws to a close, which many patients, families and physicians totally misunderstand.

How can a pain care specialist help you when you are writing a piece on pain issues?

As a journalist, what I’d hope from pain care specialists is a desire to share patients’ stories with the goal of informing and educating others about how best to manage pain – maybe even avoid it, in some cases. In other words, information that can help people cope more successfully with pain with the goal of living more productive, enjoyable lives. That in fact, is my goal as well. My columns are aimed at helping people recognize and acknowledge their health issues, and deal with them effectively so they can maximize pleasure and productivity.

Because you cover the medical waterfront as a writer, how do you decide what to write about?

The ideas come from a wide variety of resources:

Reports in professional literature or in a medical magazine: tai chi and genomic medicine in The New England Journal of Medicine; the prenatal influence on later health in The Lancet; health-related quality of life and gadgets to help people with arthritis function better in Arthritis Self-Management.
Events in the outside world: smoking bans; a report on vegetable consumption from a national health survey; the illness of a famous person; bedbugs taking over New York City; outbreaks of influenza; the stress of unemployment; new data on premature births.
Something health-related that I or someone I know experiences: persistent pulmonary hypertension of the newborn, which afflicted my youngest grandson; widowhood, which I and a number of my close friends have endured; plantar fasciitis, which six people I know well have had; knee replacement, which I and others I know have had; chronic cancer; hospice care; treatments to ward off threatened premature birth; a nondrug treatment for asthma; breast reconstruction. Nearly everyone I know well has been featured in my columns.
Issues people e-mail or write to me about: peripheral neuropathy, normal pressure hydrocephalus.
Issues I believe deserve public attention: the need to improve school lunch; deficits in free play for children; effects of too much electronic exposure; underuse of screening tests and overuse of some medical tests; maybe even persecution of pain doctors.

When do you choose to write about a certain topic?

A column like mine is not limited to the here and now – to “real news.” I can write about any topic, no matter how old-hat, as long as I can include new information about it.

Describe a specific piece on pain issues that you have done in the past.

One of the best read and most widely quoted of my columns were the [collection of] three I wrote following my own bilateral knee replacements, in which I discussed the failure of my surgeon to take my pain seriously and treat it effectively. I finally did the necessary homework myself and learned that, for the amount of Percocet I was taking, I’d do much better with two 20-mg Oxycontin a day, with an occasional dose of Percocet for breakthrough pain. It was my internist, not my surgeon, who finally prescribed what I needed. When I told the surgeon, he said “I hate to put patients on those drugs – they have such a hard time getting off them. To which I replied, “If you never put them on, of course you wouldn’t know how to get them off!”

How do you find your sources of information?

I look for authors of published reports, Google the topic to find others, and check my own voluminous paper files. I also ask my colleagues and the doctors I already know.

I want sources I can find, which means ready access on the web to phone numbers (including cell phone numbers) and/or e-mail addresses. I need sources who promptly return my calls or e-mail requests for interviews. Overprotective secretaries are a guarantee that I will not seek counsel from the physicians they are “protecting.” If you have been a source for various journalists and you change venues, it would be most helpful to let them know where they can find you in the future.

What are the most important things that you look for when you are choosing a source?

I want sources who speak in English, not “medicalese,” who use catchy phrases when applicable, who provide examples of the points they make, anecdotes to illustrate their message, and human interest stories that will engage the reader.
I want sources who are honest and objective. Of course, journalists know, or should know, that no one is completely objective. We all have opinions which necessarily color what we say and don’t say and how we present information. But it’s important for sources to be forthright – to let reporters know others may not share their views, perhaps even refer them to the opposition, to experts who may provide a different perspective.
Valuable sources readily provide documentation – studies they and others have done to support their views and the points they make.
We also want sources who are realistic – who recognize medicine is still 50% art, 50% science; who acknowledge that many people have limited access to the best available care, whether because of locale, money, mobility or unavailability of technology or expert physicians.
In other words, good journalists look for trusted and trustworthy sources—not egomaniacs, not advertising pitchmen or women, not sources with vested interests, unless they’re upfront about those interests. Like most medical journals, we are now obliged to ask about conflicts of interest and to publicly disclose them.

Is there anything in particular that you want when you are looking for sources on pain issues?

With regard to pain management, I’d want sources who are familiar with alternative methods like acupuncture, massage, imagery, exercise, and not just the high-priced and sometimes dangerous medicines pushed by “big pharma.”

Do you have any tips for pain care specialists who are willing to be a source for journalists?

Journalists want sources who will give us a heads-up when something really important is about to happen in their fields, like a major research study or a government or academy report. But we do not want to be inundated with relatively inconsequential developments (inconsequential to the public, not necessarily to the source), like promotions or awards.

Keep in mind, too, that there’s just so much anyone can write about a given topic, no matter how important it may be. You don’t want to be the boy who cried wolf if you want us to listen attentively when you contact us about something truly important and newsworthy.

I realize this is a tall order. But if you want to be credible, I believe you should strive to fill it.

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October 2010