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 AlterNet.org 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
"Blake"

11 Comments:

Anonymous topview said...

Well Doc. I am 74 yrs old and I spent 40 yrs driving truck and eating from Junk food places. At 62 I found out I had colon cancer.
I went through the normal (Cut-Burn-Poison) The Radiation Fried my Illiac arteries, after 2 yrs in a wheelchair, they did a Bylateral Aorta to femm bypass. That got me walking again. Until about 6 months ago, I started to have problems with my legs and feet.
To make it short, I found out I had Candida Albacans Fungus, That had settled in my weak areas, My legs. I tried the garlic treatment and am taking Serrapeptase and L Arginine to open my arteries and that got much more ciculation to my legs. But I still had pain.
I found out about MMS Miracle Mineral Supplement I got some and started to take it and in two weeks I got rid of the Candida and the pain is gone in my legs and i have more energy then I have had in years.
MMS is Chlorine-Dioxide when mixed with an activator (Citric Acid) it changes to Sodium Chlorite and it will kill all pathogens known to man.
I have been taking it for 3 months now and feel great.
Ron Paul also placed an article about it on God Like Productions and recommended everyone to take it
You can read about it on my website
http://www.my-healthy.info/mms.htm
www.my-healthy.info/4u Blog
So with this natural mineral product the world can be healed from some terrible diseases.
It will sure make a dent in the income of those Corrupt Drug Companies, HMO's and some Doctors also.
Check it out Doc.
Mel Smith

11:03 PM  
Blogger Blake said...

Thxs topview- glad you found help.

Rick Lippin

5:53 PM  
Anonymous John said...

Dr. Lippin, I found this through a post at DKos - I replied to this comment you had made. I just wanted you to know that I'd added to the conversation, please check your hotlist - thanks!

3:22 PM  
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12:55 AM  
Anonymous Anonymous said...

Press Release: A Well Designed Sales Pitch?

Those who release and create press releases, that are intended to offer information that is authentic and newsworthy, are possibly in collusion with various sources of the mass media who receive these announcements from others with commercial interests in mind, and instruct such media outlets with mandated authoritarian nuances, such as the press release that they created will be void of alteration of any kind of their press release as directed to the receiver by the creator and sponsor of such press releases. The sponsoring organization that composes press releases does so in order to promote their organization and its products, and this much is rather clear.
These well- constructed statements are meticulously composed and customized before they are issued to targeted editors for mass media publication at select locations and times of release by this sponsor. As this is done, the mass media outlets are again instructed on how to present their completed statements, as well as are given instructions once again not to alter these press releases in any way, others have said frequently.
Press releases are a form of public relations often utilized for those companies who create what is supposed to be an attempt to express their products that they wish to convince readers that such products are innovative or newsworthy. Press releases, historically, have been created and released to inform the readers by adding insight and related information for them regarding a particular topic that was typically complete and balanced. Today, they seem to be more or less an annotative commercial with press releases generated by corporations in particular, so it seems.
Unfortunately, and presently, press releases are often embellished, biased, and incomplete with deliberate intent in order to benefit the creator of these documents, who again develops them solely to increase awareness and usage of their products that they promote with their business, which they want to be viewed as favorable with a positive image to the public. One could suggest that the mass media who receives these press releases are transformed into mass front groups who perhaps coercively offer third party legitimacy for the content of the press release as they release this information to their readers.
The often notable if not intentional flaws at times are numerous within such press releases that reflect reckless disregard for the readers, the American Public, who believe that what they are reading is honest and complete. This, however, is not the case is certain situations.
An example is an anonymous and anonymous press release posted on the Medical News Today website (www.medicalnewstoday.com) that is dated in March of 2006. The title: "Cymbalta Safely and Effectively Treats core anxiety symptoms associated with generalized anxiety disorder." Clearly, this title itself includes words associated with relief or elation, which are subjective and not objective elements which would clearly be more appropriate, according to some, if the press release was created to inform the reader, one could say.
The first paragraph of this press release repeats the results mentioned in the title of this article, but also states Cymbalta offers relief of painful symptoms associated with anxiety, as well as improved functional impairment- also claimed to be associated with anxiety in this press release. These conclusions are speculative at best, as these inferences appear to be unexamined by others regarding the benefits claimed to exist with Cymbalta as illustrated in this press release.
Cymbalta was not approved by the FDA for anxiety or any of the symptoms associated with this condition at the time of this press release. In fact, Cymbalta was not filed with the FDA for this speculated new indication for anxiety that was desired by Eli Lilly until May of 2006. By definition, this press release may possibly be off-label promotion as well as misbranding of Cymbalta that was performed overtly in this manner of the press release, one may speculate.
As one continues to read this press release, testimonials were intentionally created and inserted into this press release that illustrated results they hope are impactful to the reader regarding Cymbalta. This testimonial was from the lead author, who expanded the claims made initially with utilizing various medical terms, which was followed by this person’s passionate optimism about the great potential of Cymbalta based on this remarkable study.
This study, by the way, was to be addressed in further detail at a National Anxiety meeting some weeks after this press release was announced to the public on this website. The second testimonial was Eli Lilly's Medical Advisor expressing his elation about what the lead author just stated, followed by how much he was encouraged by these results that will benefit so many others that have these debilitating medical conditions. Of course, profit forecasts regarding Cymbalta remarkably were not stated in this press release.
What is not included in this particular press release was any clear statements regarding the disadvantages and adverse if not toxic events associated those who take Cymbalta. Reactions from Cymbalta users include discontinuation syndrome at times, when the user stops taking this medication, which I understand can be quite devastating for the one experiencing this syndrome. Furthermore acts of suicide and suicidal ideation have been frequently associated with those who take Cymbalta as well. There have been apparent lack of efficacy suggestions by others who have taken Cymbalta. Basically, anything that may be considered negative aspects about this drug were not annotated in this particular press release as it should have been for fair balance that is standard in the pharmaceutical industry and health care journalism. The staff involved with the release and publication of such press releases as this one described should perhaps be more informed on what not to accept and what to present regarding these issues addressed.
As with any reporting by the media, objectivity and thorough completeness of the topic discussed in a press release is a necessary requirement with any publishing that is potentially exposed to so many others- more so with such medical issues in particular.

“The public has a lot at stake, and the media has a responsibility always to be aware of the source of information and the conflicts those sources might have when they report the results of clinical research. People who have financial stake in the results of clinical research can well be biased in the way research is conducted, in the way they report it, and what they say about it when interviewed by the media.” – Arnold Relman, former editor in chief of the New England Journal of Medicine

Dan Abshear

12:56 PM  
Blogger Quiact said...

This Makes Me Sick


When I was a child, I heard the phrase 'war-monger', I had to find out its definition, as I had no idea what that phrase meant.

I knew others could, and were, labeled with this phrase, as I had heard it in the past directed at others whoever said these two words.

So I felt a need to know what these words meant, and how they affected others who heard them.

Finally, I found the answer: a warmonger is one who promotes war, which is undesirable or discreditable.

In this case, one labeled this would have an affinity for what others are reasonably opposed to share the same topic, which is war:

Today, it is quite clear that others promote other things besides war.

Disease mongering is when a large pharmaceutical corporation implements various unethical if not illegal activities in order to sell more of their products by either creating or expanding a particular illness.

They do this by creating the perception that others are likely ill in some way when, in fact, they are not.

Drug companies do this by seeking more of those who should be patients in need of treatment with the drug maker's promoted medications, regardless if they are in need of such treatment or not, clinically.

How this is done by these companies will be described soon.

The drug makers clearly place the needs for their drugs to be for medical conditions whose treatment regimens are to be viewed by others as incomplete or unmet.

The companies want to let the public know of the progressive increase for the disease states and how their products treat this illness better than what is available now or has been used in the past.

How ironic it seems that drug companies, who make drugs to delay the progression of, or cure diseases with these drugs, wish for others to become as sick as possible to profit from their suffering that they create with disease mongering and sell more pills.

This disease-mongering in fact does occur often to widen the diagnostic boundaries of an illness, disorder, or syndrome by creating awareness of such medical conditions to the public.

The drug companies do this by utilizing in several ways the delivery of fabricated if not baseless information during this process.

Usually, the pharmaceutical either creates or expands a disease state by deception directly to consumers, often.

Then the consumer, who now believes that they are ill, go see their health care provider.

The health care provider, due largely to the unfamiliarity of the patient’s symptoms expressed by the patient, if not the drug the patient is requesting, usually writes a prescription for the drug requested by the patient.

First, let's take a look at this label of disease mongering. It is inappropriate in that, unlike diseases and illnesses, mongering occurs with medical disorders and syndromes as well.

It is accurate and factual, however, that disease mongering does happen with deliberate intent and reckless disregard for the well-being of others by drug companies.

There was a book written by Ray Moynihan and Allan Cassels called, "Selling Sickness" in 2005. The book thoroughly described how big pharmaceutical corporations are turning all of us into patients, and into a over-medicated society.

Disease mongering progressively continues to create patients with illnesses, disorders, or syndromes that in fact may not exist without any intervention to discontinue this behavior.

What the drug company implements to make sure this happens includes the following:

1. Paying medical journals to publish fabricated clinical trials involving their promoted medications after paying those involved with such a clinical trial to create such fabricated data. That is disease mongering to the health care provider.

2. Subjective screenings, such as those for various mood disorders.

These screenings, as well as the affective disorders, which were rare until about 1995, involve leading questions often- created by the drug company.

It was around this time that the United States was becoming more of a psychotropic nation with the amount of these drugs being prescribed to the citizens in large quantities.

These screenings that involve the leading questions responded by select groups of people.

They are asked these questions by certain disease state support groups who have been converted into front groups after being funded by those big pharma companies who produce drugs for particular mood disorders.

A- Disease creations I: Social Anxiety Disorder, or social phobia:

This condition is in the DSM IV which was published in 1994, and some were forced to delete the statement regarding this disorder that said, "Social Anxiety Disorder is not well-established, and requires further study."

Aside from what may be simply amplified introversion, social phobias are likely due to societal dysfunctions and certainly should not be labeled as a pathological condition requiring pharmacological treatment.

B- Disease creations II: Premenstrual dysphoric disorder.

I call this a mid-life crisis, yet it was entered by instruction by the APA (American Psychiatric Association) into the DSM (the psychiatrist's bible) in 1993. Anxiety about the inevitable does not require pharmacological treatment.

C- Direct to Consumer Advertising:.

Most memorable were those commercials for erectile dysfunction. Their absurdness in creating these commercials appears to have multiple psychotic components:

A healthy man who could probably run a marathon is having a decent time with his wife at some upper- middle class location.

He is smiling all the time. Because now, his marriage is secure due to his ability to copulate- which was apparently absent before this wonder drug entered his system.

Of course, it is not possible to have a happy marriage without intercourse, right?

Then there are other conditions which are entirely natural in the human lifespan, yet have been determined to be diseases by those who can profit off of these lifespan events.

Examples include osteoporosis and menopause, as well as erectile dysfunction, which was known as impotence before Pfizer coined the 'disease' erectile dysfunction as it prepared to launch Viagra.

It’s insane the FDA approves pharmaceuticals for these natural events that occur normally in a human being.

Finally, there are the required medical guidelines for various disease states, such as dyslipidemia.

Drug companies that make medications to treat this disease are more than happy to support the financial needs involved in creating these guidelines.

Dyslipidemia, for example:

Publications such as the Lipid Letter, and Lipid Management, both offered more aggressive management of the lipid profiles of the patients of the readers.

And both publications were funded completely by those big pharma companies that promote statins.

Same with cholesterol screenings that occur often that are implemented by those drug companies with drugs that treat the disorder of dyslipidemia.

A myth is something unproven. A false belief, or invented story.

Disease Mongering is not a myth. Large pharmaceutical corporations promote illness and disease- not desired by anyone and discredited by many, and these companies do this for profit and profit only.

Dan Abshear

7:02 PM  
Blogger Quiact said...

Those who design and create releases for the press, which is the print media, are designed to contain information of sufficient importance or interest to the public, historically speaking. This is what U.S. citizens are led to believe about what we may read.
Instead, those who design and release written information to the press are often sponsors of the print media who will issue the press release. Such sponsors often instruct such media outlets with mandated authoritarian nuances such as the press release that they created will not be altered in any way by the print media that agrees to release the press created by the sponsor of the media outlet.
Of course, the sponsor and creator of such a press release create such written words in order to promote the sponsor’s company, as well as its products. By doing so, they are allowed the freedom to embellish if not fabricate what may be annotated on the release they issue to the press that has now been bought by them, the corporate sponsor.
These well- constructed statements are meticulously composed and customized before they are issued to targeted editors and contacts at mass media publication locations.
The sponsor also has been known to direct the location and time of the release of their press creation that, upon direction from the sponsor, is completely un-reviewed by such a media source.
As this is done, the mass media outlets are again instructed on how to present their completed statements by who are often corporate sponsors. Furthermore, the media is given instructions once more that what has been written by their sponsor shall remain as it exists.
As a result of this collusion, press releases are presently a form of public relations often utilized for those companies who create what is supposed to be an attempt to express their products as being newsworthy to the readers.
Press releases, historically, have been created and released to inform the readers by adding insight and related information for them regarding a particular topic that was typically complete and balanced. At least, that was the intent.
Today, they seem to be more or less an annotative commercial with press compositions generated by corporations in particular, so it seems.
Unfortunately, and presently, press releases are often embellished, biased, and incomplete with deliberate intent in order to benefit the creator of these documents, who again develop them solely to increase awareness and usage of their products that they promote with their business, which they want to be viewed as favorable and with a positive image to the public.
One could suggest that the mass media who receives these press statements from certain corporations are transformed into acute front groups who perhaps coercively offer third party legitimacy for the content of the press release as they release this information to their readers.
The often notable if not intentional, flaws at times are numerous within such press releases that reflect reckless disregard with informing readers in such a way, who are the American public. Citizens typically believe that what they are reading from a respected media source is both honest and complete.
An example is an anonymous press release posted on the Medical News Today website (www.medicalnewstoday.com) that is dated in March of 2006. The title: "Cymbalta Safely and Effectively Treats core anxiety symptoms associated with generalized anxiety disorder."
Cymbalta, by the way, is a psychoactive drug often utilized for human affective disorders.
Clearly, this title itself includes words associated with relief or elation, which are subjective and not objective elements which would clearly be more appropriate- with a health care press release in particular.
The first paragraph of this press release repeats the results mentioned in the title of this article, but also states Cymbalta offers relief of painful symptoms associated with anxiety, as well as improved functional impairment- also claimed to be associated with anxiety in this press release.
These conclusions are speculative at best, as these inferences appear to be unexamined by others regarding the benefits claimed to exist with Cymbalta as illustrated in this press release.
Cymbalta was not approved by the FDA for anxiety or any of the symptoms associated with this condition at the time of this press release. In fact, Cymbalta was not filed with the FDA for this speculated new indication for anxiety that was desired by Eli Lilly until May of 2006.
By definition, this press release may possibly be off-label promotion as well as misbranding of Cymbalta that was performed overtly in this manner of the press release, one may speculate.
As one continues to read this press release, testimonials were intentionally created and inserted into this press release that illustrated results they hope are impactful to the reader regarding Cymbalta.
This testimonial was from the lead author, who expanded the claims made initially with utilizing various medical terms, which was followed by this person’s passionate optimism about the great potential of Cymbalta based on this remarkable study.
This study, by the way, was to be addressed in further detail at a National Anxiety meeting some weeks after this press release was announced to the public on this website.
The second testimonial was Eli Lilly's Medical Advisor expressing his elation about what the lead author just stated, followed by how much he was encouraged by these results that will benefit so many others that have these debilitating medical conditions.
Of course, profit forecasts and desired market growth and expansion regarding Cymbalta remarkably were not stated in this press release.
What is not included in this particular press release were any clear statements regarding the disadvantages and adverse if not toxic events associated those who take Cymbalta.
Reactions from Cymbalta users include discontinuation syndrome at times, when the user stops taking this medication, which I understand can be quite devastating for the one experiencing this syndrome.
Furthermore acts of suicide and suicidal ideation have been frequently associated with those who take Cymbalta as well. There has been a lack of efficacy suggestions by others who have taken Cymbalta.
Basically, anything that may be considered negative aspects about this drug were not annotated in this particular press release as it should have been for fair balance that is or should be a primary standard in the pharmaceutical industry and the professions involving journalism.
Acquired from Wikipedia:
According to The Elements of Journalism, a book by Bill Kovach and Tom Rosenstiel, there are nine elements of journalism [1]. In order for a journalist to fulfill their duty of providing the people with the information they need to be free and self-governing. They must follow these guidelines:
1. Journalism's first obligation is to the truth.
2. Its first loyalty is to the citizens.
3. Its essence is discipline of verification.
4. Its practitioners must maintain an independence from those they cover.
5. It must serve as an independent monitor of power.
6. It must provide a forum for public criticism and compromise.
7. It must strive to make the significant interesting, and relevant.
8. It must keep the news comprehensive and proportional.
9. Its practitioners must be allowed to exercise their personal conscience.
In the April 2007 edition of the book [2], they have added one additional element, the rights and responsibilities of citizens to make it a total of ten elements of journalism.
The staff involved with the release and publication of such press releases as this one was annotated and described should perhaps be more informed on what not to accept and what to present regarding these issues addressed. Then they may meet the requirements and obligations of what they provide the people.
As with any reporting by the media, objectivity and thorough completeness of the topic discussed in a press release is a necessary requirement with any publishing that is potentially exposed to so many other readers- with issues related to the restoration of their health in particular:
“The public has a lot at stake, and the media has a responsibility always to be aware of the source of information and the conflicts those sources might have when they report the results of clinical research. People who have financial stake in the results of clinical research can well be biased in the way research is conducted, in the way they report it, and what they say about it when interviewed by the media.”

– Arnold Relman, former editor in chief of the New England Journal of Medicine

Dan Abshear

7:03 PM  
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Anonymous Pharma in Chennai said...

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11:25 PM  
Anonymous ereticle dysfunction said...

Maybe medical journalists is good for us.

5:56 AM  

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