Health Writers Should Look for All the Vested Interests in Medicine
I realize that my doubts about disease mongering could easily be taken to suggest that I think corporate entities, patient groups or clinicians should be given a free pass. On the contrary, as an Investigative Reporters & Editors (IRE) member off and on for years, I know the value of asking the same hard questions of all sides. The issue from my professional perspective isn't determining who is right or wrong, but reporting meaningful context and not inadvertently becoming a mouthpiece for anyone’s vested interests on any side of the debate - not just Big Pharma.
For anyone who believes Big Pharma is the only vested interest in science, I have a bridge for sale.
Harvard medical history professor Allan M. Brandt discusses the conflict between medicine and public health in the essay “Antagonism and Accommodation: Interpreting the Relationship between Public Health and Medicine in the United States during the 20th Century”:
Although representatives of both fields have traditionally voiced strong commitments to health and social betterment, the relationship between public health and medicine has been characterized by critical tensions, covert hostilities, and, at times, open warfare.
News coverage often misses the context of such conflicts, fails to cover all sides equally and unequivocally accepts the notion that too many health conditions are medicalized just to boost drug company profits. Here are two examples:
1) About a week ago, several news outlets picked up an interesting graphic from the New England Journal of Medicine, comparing causes of death in 1900 to today. The Atlantic also included a paragraph from the accompanying NEJM article that made some unsubstantiated “medicalization” statements. It said, “New diseases can emerge as the result of conscious advocacy by interested parties.” It listed chronic fatigue syndrome as one of those questionable new diseases but it did not list the so-called “interested parties” purportedly advancing chronic fatigue syndrome as a disease. By including this paragraph, especially without comment, The Atlantic gave credence to the idea that chronic fatigue syndrome is a fiction created by “interested parties.” This does not reflect the reality of the scientific discussion around chronic fatigue syndrome.
2) Irritable bowel syndrome is another area of contention. New York Times columnist Jane Brody acknowledged the medicalization debate in that case and then focused on the mind-body connection and stress. What she missed, though, was the growing body of research linking irritable bowel syndrome to bacterial infections – not stress. A study by Mark Pimentel at Cedars-Sinai published in May provided even more evidence.
Jocelyn Kaiser’s recent story in Science about the paltry increase in federal research funding is one of the few pieces to engage in a conversation about why researchers have to rely on Big Pharma for support. Instead, journalists are more apt to castigate researchers who rely on that funding, often on the basis of association only. Try Googling "Big Pharma," "medicalization," or "disease mongering" and a considerable portion of the public and private conversation on the web is not even on the same map where one might find common ground. Instead, it often borders on hysteria. By unequivocally accepting that disease mongering is a big problem and that too many health conditions are medicalized so drug companies can sell more medicine, journalists help fan the hysteria.
There certainly are problems with conflicts of interest and skullduggery, but working for a pharmaceutical company or collaborating with one on a research project should not be seen automatically as a taint on the underlying science. Journalists should be able to fairly assess the strength of the science on its merits and be willing to use a variety of sources to provide readers with a full picture. If they don’t have the skills or the time to do that, perhaps they should not attempt to report on the topic.
By focusing unwaveringly on Big Pharma, journalists take the easy road. In fact, there are many financial stakeholders, including insurance companies and clinicians in various specialties. There also are many forms of conflicts of interest, including intellectual passion and academic competition. How many other financial stakeholders and forms of potential conflicts of interest other than Big Pharma are commonly mentioned in news articles or research papers? Is it possible that journalists sometimes fail to investigate because the focus is all Big Pharma all the time? Are journalists knowingly or unknowingly fighting the battle of “disease mongering” on the public health side of the war and should they?
The public deserves multifaceted reporting on these complicated issues. Here’s a reminder from The Pew Research Center’s Principles of Journalism:
The news media are the common carriers of public discussion, and this responsibility forms a basis for our special privileges. This discussion serves society best when it is informed by facts rather than prejudice and supposition. It also should strive to fairly represent the varied viewpoints and interests in society, and to place them in context rather than highlight only the conflicting fringes of debate. Accuracy and truthfulness require that as framers of the public discussion we not neglect the points of common ground where problem-solving occurs.
Image by Newspaper Warning via Flickr