Sunday, November 25, 2007

Medical Journalists-You Too-First Do No Harm!

As a physician, long before the days of the free flow of health information over the Internet, I had always believed in an educated patient as the basis of a more mature relationship with my patients. I rejected the paternalistic “guild” model of medicine with its secretive language and magic potions and magic procedures. I related as much to the model of physician as teacher as to physician as healer. Furthermore, I have always cherished freedom of the press as guaranteed by our constitution as a cornerstone of our democracy.

Yet, in recent years. I have a nagging feeling that the main stream media, in particular, has failed in several ways regarding its responsibilities as professional medical journalists and that some accountability might even be in order for what I call "doing harm".

Putting aside the Internet, which is still the “wild west”, with few if any controls on quality of information there are many reasons for the documented boom in both print and electronic medical journalism in recent decades. These include an extremely competitive “24/7” news business which seeks to enhance advertising revenues through sensationalism as its first goal of survival, a great hunger for health information among the reading, listening and viewing public-especially in an aging population and the dramatic growth in numbers of medical research papers that are published daily by health organizations and institutions all clamoring to be heard above their competitors.

There are four areas where I believe medical journalism in particular must improve

1)Confusing and Conflicting Medical Information. In Woody Allen’s classic movie Sleeper (circa 1973) upon awakening after 200 years of being frozen “everything that was good for you to eat was now bad to eat and vice–verse”. Unfortunately the public experiences these conflicting and confusing reports in a much shorter cycle time in contemporary society. I suppose the quintessential example is the diet issue but regrettably there are many other examples of this phenomena in almost any area of health and medicine. The most detrimental effect of this I that it erodes confidence and trust in the science and health communities-trust which may take decades-if ever-to rebuild.

2)“Disease Mongering” or the medicalization of all human problems.The drug companies in particular but also the medical profession and the hospital industry want you to believe you are much sicker than you actually are. This results in their selling you more of their products and services. A particularly cruel hoax is the medicalization of normal personality traits such as shyness and (no I’m not kidding) sleeping late and the medicalization of aging such as grey hair, baldness and wear and tear arthritis. Last year did a good review of disease mongering written by Stan Cox.

3)“Fear Mongering”- Reporting legitimate reasons to fear a disease is vitally important medical journalism. Providing accurate and timely information is a great public service. Conversely in recent years for many complex reasons we are unfortunately scaring people unnecessarily thus inducing anxiety and even worse panic. Both needless anxiety and panic over unproven risks actually causes harm physically to individuals and to societies. Furthermore it dangerously diverts limited and precious resources away from greater proven risks. Finally, if exposed to enough “chicken little-the sky is falling” fearmongering stimuli the public eventually becomes apathetic when the feared medical catastrophes don't take place thus rendering us woefully and dangerously unprepared for the real thing. I suppose the most recent classic example of this is the virology world’s obsession with single bird flu virus (H5N1). Dr. Marc Siegel, an internist from New York University, wrote an excellent book entitled False Alarm wherein he lays out many examples of unnecessary scares by the bio-medical community facilitated by the media.

4)"Medical Breakthroughs"- Reporting so called “medical breakthroughs” where none exist is another example of where the media can also cause direct harm. Modern bio-medicine is indeed miraculous but it is generally accepted that the single cause-single cure-"magic bullet" model for diseases like polio are not very applicable to the chronic degenerative diseases on the nervous system like Alzheimer’s and Parkinson’s disease, chronic cardiovascular and pulmonary disease, chronic arthritic disorders and most cancers. Instead it is generally accepted that bio-medical scientists will chip away at these diseases using many different strategies which will not result in dramatic breakthroughs or even cures. We will be living with these disease longer for example or might even die with them- not of them. So for the media to use the term breakthrough is a cruel hoax for those individuals suffering from these diseases proving false at worse – premature at best- hope for these individuals. The recent hype over the stem cell “breakthrough” was a good example of this exaggerated reporting.

What can we do?

Well to begin in March of 1997 – just a decade ago the AHCJ = Association of Health Care Journalists was born. I urge you to explore their website.They published an excellent Statement of Principles of their association which includes sections on Professionalism, Content and Accuracy on Independence, on Integrity and on Responsibility. They have formally endorsed the Code of Ethics from the Society of Professional Journalists. Their dilemma however, as I see it, is that these documents are not legally binding and they, like many bio-medical scientists, are employed by often large for profit-in this case- media companies which has eroded the capacity for these fine people to remain as professional as they would like and need to be.

So we as citizens must continue to be healthy skeptics of journalism and science trapped in for profit enterprises. We must demand a return to a time when journalism and medicine were indeed professions whose core competencies and values were independent of or at least sufficiently distanced directly from the profit motive.

I believe the tide is turning. I believe most scientists, doctors and the medical journalists who report their work hunger deeply for a return to professionalism.

Dr. Rick Lippin