In a September 17 article focused on cannabinoid hyperemesis syndrome (CHS) CNN’s coverage uses just one source (quality and gatekeeping bias) in its narrative, falling short of basic journalism standards. Additionally, the article claims that “CHS can be life-threatening” despite no one ever dying from the condition (omission bias). The article also cherry picks data from a 2019 study when describing CHS as “a national problem.”

Presence of bias:

“Between 2005 and 2014 when only medical marijuana was legal in most states, a 2020 study found nearly one in five people hospitalized for cyclical vomiting in the US reported concurrent cannabis use,” the CNN article contends. News organizations should, at the very least, find individuals from both sides to build their narrative, and while it’s no secret that news organizations have deeply cut their science staff (CNN fired its entire science team in 2008), their reporters are still responsible for being able to communicate scientific issues and stories.  

While the study that pushes their CHS narrative does state that one in five CHS hospitalizations have concurrent cannabis use, CNN does not include any context about the study (which was limited by its inability to individually review charts), uses data from an administrative dataset (which the authors note are “susceptible to inaccurately entered or missing codes”), and is a retrospective study which risks residual confounding.

“We would also like to highlight that this perceived increase in cannabis use could at least partially be due to more established guidelines in diagnosing [CHS]. Rome criteria for [CHS] were established in 2006 and knowledge about this condition has increased since then. CHS was also first described in 2004 and awareness regarding the association of cannabis with these disorders has also increased,” the study authors wrote. “Therefore, the recognition bias could be contributing to both the observed trends in the increase in hospitalizations due to CVS, as well as, the increase in the documented cannabis use in CHS patients.”

The tone of the article is decidedly prohibitionist, and we may be able to start calling CNN out soon for structural bias – the organization itself having a bias against cannabis. The coverage includes no opposing voices or even those from other researchers which limits its ability to tell a clear and honest story. Even the story’s last heading “Concerns for the future” smacks of fear-mongering.

How to remedy:

CNN needs to include other voices in its coverage, include proper context when describing previous research, and shift to a more even tone in its cannabis coverage. It is their duty to find a cannabis researcher, rather than rely on reporters who are certainly not experts in the field. With this minor change, CNN’s narrative would be more balanced and science-oriented rather than pushing their narrative which is bereft with tone, omission, and quality bias.

A Dec. 6, 2021 CNN article boasts the headline “Marijuana may make sleep worse, especially for regular users, study finds;” yet midway through provides a more accurate line that should have informed the header – that there is “no clear evidence either way” that cannabis actually makes sleep worse. CNN kind of has a penchant for skewing their cannabis coverage and that trend continues in this piece focused on a sleep-and-cannabis-related study.

Presence of bias:

From the context bias in the alarmist headline to the tone bias in the second subheader (“Still, people continue to believe that weed is helping their sleep,”) CNN is making claims it later walks back and uses a negative tone in its description of how cannabis, anecdotally, helps some people.

The statement midway through the article from lead study author Calvin Diep, a resident in the department of anesthesiology and pain medicine at the University of Toronto, noted that there is a disconnect between what cannabis consumers report and evidence behind it, which is empirically true, but most non-cannabis industry reporters seem to forget that cannabis research has been outlawed since the enaction of prohibition. The statement from Diep should not be buried midway through the article (an example of structural bias) but rather should appear in the first couple of graphs. 

The article also cites several people who were not involved in any way with the study, which can be a great way to balance study-related stories; however, CNN runs a quote from Bhanu Prakash Kolla, a sleep medicine specialist in the Center for Sleep Medicine at the Mayo Clinic, that claims cannabis consumers who stop regular use experience sleep disruptions due to withdrawal symptoms. It should be noted that Kolla is not an expert on cannabis, and the assertion about “withdrawal symptoms” should be taken with a grain of salt – and certainly not published without additional supporting evidence or context. The choice to only use medical experts who do not specialize in cannabis amounts to gatekeeping bias.

The article also makes the suggestion that cannabis is more potent now than ever before – a claim which is not backed by science, as we only know the actual cannabinoid concentrations of cannabis products now that it has been legalized. Our parents may say, “this is a lot stronger than what I smoked back in the seventies,” but the truth is there is no way to tell, honestly, whether cannabis cultivated during prohibition was weaker than what is available now. Making this claim is also an example of adjective bias.

And as usual, deep within the piece is where the chosen headline is fully revealed as clickbait. The author closes with a quote from Dr. Karim Ladha, staff anesthesiologist and clinician-scientist in the department of anesthesiology and pain medicine at the University of Toronto, who provides perhaps the most honest quote in the whole article, which would have made for a much better headline: “The studies just give us the possibilities that (marijuana) could hurt your sleep, but it may help and so we just don’t know until you try it.”

An article free of bias will never call cannabis “weed” or any other street name; second, if cannabis helps people sleep, then it helps people sleep. It’s not something they “believe” – it’s their experience as consumers. A simple baseline for quality reporting is to avoid implying something with words such as “still.” The headline is misleading; just look a few graphs into the piece and you’ll find your baseline for an objective headline. To their credit, CNN’s use of the word “cannabis” (13) outpaced “marijuana” (9) and “weed” (8) but the organization still has a lot of work to do when covering cannabis, as their clickbait-style headlines on the topic tend to tilt toward the anti-cannabis camp.

How to remedy:

CNN should avoid make sweeping generalizations, whether it be about the potency of cannabis or via phrases such as “people continue to believe.” Maybe find some people who actually use cannabis for sleep and get their take? Scientists and researchers can add balance, but they are going to try and stick to what they know (their experiences) and not including the voices of any consumers does this piece a great disservice. And enough with using “weed” as a synonym for cannabis in your reporting, especially when it’s painfully obvious that you don’t have any real familiarity with the plant.

CNN’s article, “Young adult cannabis consumers nearly twice as likely to suffer from a heart attack, research shows,” suffers from several biases, including tone, oversimplification, and omission.

Presence of bias:

Tone bias is apparent in the first graph and is meant to scare readers but the study – like the CNN article – “confuses absolute risk for relative risk and makes a huge deal out of 1% risk turning into a 2% risk,” Dr. Mitch Earleywine wrote on Facebook. This assessment may be an indictment of the study itself, but also illuminates the simplicity bias apparent in the CNN report on the study.

“’Some people assume that consuming cannabis is safe and can’t harm your body, but that is incorrect,’ said lead study author Dr. Karim Ladha, clinician-scientist and staff anesthesiologist at St. Michael’s Hospital and the University of Toronto in Canada. ‘There’s increasing evidence that this could potentially be harmful to you, both in the short term and the long term,’ he said.”

“Some people” is an over-generalization and the story fails to dive deeper on Ladha’s claims.

First of all, “some people” assume a lot of things that aren’t true. Most people know that inhaling smoke is not what our bodies were designed to do. Are there “some people” who smoke cannabis and think they are not being harmed in any way by that method of consumption? Sure, but there are also “some people” who believe that smoking tobacco and drinking alcohol aren’t harmful either. When compared with the well-known harms of tobacco and alcohol and the hundreds of thousands of deaths per year attributed to them, does the doctor’s comment actually warrant the level of alarm projected by this article, or does this comment actually refer to the widely-held (and evidence-backed) assumption that cannabis seems to be less harmful than other substances? Careful readers will also note Ladha’s use of the word “potentially.” He’s not being nearly as firm on his position as the article would lead the reader to believe.

Additionally, the article never tells us the primary ingestion method of the 73 cannabis consumers (of the 5,610) enrolled in the study who had a heart attack but the lede doesn’t take this into consideration and strikes an alarmist tone. Also, were these people smokers? Did they use any pharmaceuticals, what was their diet, any drugs, how many children?

“The study did not research how cannabis affects heart health, Ladha said, but he noted that previous research showed the drug can affect a user’s heart rate,” the article states.

Okay, where are the studies, CNN? Not including them is omission bias plain and simple. Your header says, “It can create an irregular heart rate.” Prove it.

Next, CNN shifts to the potency issue. Why? Aside from being alarmist? Did the study know the potency of the cannabis used by the 73 afflicted consumers? This is an example of simplicity bias because the narrative benefits the prohibitionist narrative that we need to keep cannabis outlawed because it is, allegedly, stronger than it was 50 years ago (which happened during prohibition, CNN).

How to remedy:

CNN included zero voices from anyone within the sphere of cannabis legalization. There are thousands of cannabis experts in the U.S. and Canada (including Dr. Mitch) that they could have reached out for comment to, but they instead relied on the study author (whose job is to defend his research) and the chair of the American Heart Association – which, it should be noted, does support removing cannabis from Schedule I under the Controlled substances act. However, their chosen expert does not speak to the study itself, but rather in oversimplified terms. The article would have certainly been fairer had the reporter included scientific voices from within the cannabis industry, referenced the health risks of other legal substances, or mentioned any of the numerous studies that have suggested potential therapeutic value of cannabis in treating a wide variety of conditions. The lede could also have been more honest, instead of implying all methods of cannabis consumption were carefully documented, which they weren’t.