A Biopsy of Health in the News

I would like to briefly revisit a previous blog: A Tracking Device on a Press Release.  A comment from Chris van Opstal made the important point that the issue with reporting stories on AIDS in Africa, is finding some new angle - a REASON - to report the story everyone already feels they know.

I am in no hurry to criticise the media for its reporting methods, and I understand market and editorial pressures place great restraints on the journalist.

The problem lies however, in my belief that there are articles-a-plenty (particularly in the health sector) where the same topic has been printed over and over again… Lose that extra weight before Summer… Winter beauty-tips… How to de-stress…

The conspicuous pattern my examples fall into is that those stories people never seem to tire of, are ’self-help’ type articles. Perhaps this is simply proof that in the health beat, readers, listeners and viewers are searching more for health advice than health news.

I think many of us would like to think however that if people are happy to read the same fitness tips over and over, a small development in the massive issue of AIDS in Africa should get a look-in at the major news organisations. This is especially important with the ever-growing use of the Internet to report the news.

In a time when running an article meant committing to one story whilst omitting another, perhaps an editorial policy that cast out articles that SEEMED to be ‘old news’ could be understood.

But news organisations today publish massive amounts of extra information on the web, with no space constraints. So why not publish a news story where US pharmaceutical firms have decided not to sell their WHO-recommended drugs in Africa and have provided a limited explanation as to why?

The Internet brings with it many great opportunities for journalism. One of these should be the opportunity to report stories in significant news firms that may not be covered in the hard copy of the publication itself. The Internet should not just be a place where alternate news sources and individuals are given a voice, but a place where those facing the greatest editorial constraints in their other mediums are given room to breathe.

Studying the reporting of health in the news and current affairs media over the past weeks has revealed an important element of this news sector - the audience of health reports seems to be different from that of other beats.

When I say “different”, I mean in purpose, rather than demographics. While many news articles are written for the primary purpose of informing their audience, readers of health articles appear to be in search of more than just information - they want to USE the information they read to improve their own health.

The audience are likely not to just read the articles, but will treat them as advice or instructions.

A perfect example of this is a series of reports featured on A Current Affair about Dr John Holt, a Perth-based surgeon, “whom many believe has the cure for cancer” through a radio-wave therapy treatment.  A Current Affair states clearly that Holt’s treatment has not been used more widely throughout the medical establishment because of a lack of scientific evidence:

“It is an unproven form of cancer treatment and it’s not part of the armoury of orthodox ways of treating cancer in Australia,” said Clive Deverill, the former boss of WA’s Cancer Council. “Equally, there are legions of patients who have been down that track who can’t say anything about their position because they’re dead.”

However the reports tended to focus on the positive side of the treatment - a potential CURE:

Elvina Johnson had a lot of living to do when she was told she had an aggressive form of bone cancer. At 18, doctors discovered she had a “galaxy of tumours”. She lost her leg and underwent intensive chemo treatment to try and stop it spreading. Her cancer was so severe that she relapsed soon after.

“It was through both of my lungs and by that stage it was pretty terminal,” she told Ray Martin.

Elvina was desperate. Quite by chance she heard about a cancer specialist with a highly controversial procedure.

“By taking the chance and finding this man, I am here six years later and probably feeling better than ever, so I have had a rebirth,” she said.

(Click here for more from that report).

Soon after the first report, A Current Affair announced that Dr Holt’s practice had been flooded with enquiries and people seeking appointments from all over Australia: “Dr Holt’s practise is fully booked until May, and he is not taking any bookings at this time.”

It is clear that some of the audience of A Current Affair used the news item not only for information, but acted upon it for personal health reasons.

Of course, the reporting of other areas such as business and finance, will meet a similar audience. But the difference is that every potential reader of a news article could be looking for health advice because health is an issue common to all people, whereas business and stock advice will be sought after by a limited audience.

Does this audience bring with it new responsibilities for journalists reporting on health issues? Or should the same news values and methods of writing apply? Should there be a general recognition that health reporting should not only be responsible journalism, but responsible advice? Or would that constrain the journalists’ role too much? Or finally, perhaps you think this audience is not so different from that of other sectors of reporting, and all readers are looking to apply all information they come across to their lives in some way.

As one of the most common forms of illness, cancer is heavily reported on within the news. The reasons for the reports are varied, and putting prominent deaths aside, preliminary studies have revealed the reporting of cancer seems to be dominated by new scientific breakthroughs that lead us ever closer to a cure, or alternately, revelations or reminders of habits, vices or part of our environment that cause cancer – in short, cancer is reported with hope or with warning.

I first saw the phrase ‘Everything Gives You Cancer’ as a headline in an article of The Private Eye – a British satirical magazine-newspaper, published fortnightly. The article was featured on the cover of ‘The Private Eye Annual 2004’, edited by Ian Hislop, and reports a spoof news event where U.S. scientists reveal everything a person has ever eaten, inhaled, sprayed onto themselves, or even brushed up against, could cause cancer.

The Private Eye is playing up to the constant stream of warnings in the media about new research that suggests yet another aspect of life or our environment can kill us.

A brief look at the reporting of cancer in the media, makes the Private Eye headline more funny perhaps, because of its element of truth.

In mainstream and alternative news sources, obesity, and of course smoking, are some of the more significant players in reports of what may cause cancer. Stress has also found itself in the mix, along with everything from passive smoking, to common viruses, to arsenictainted water, to coffee.

Electric lighting has been the point of blame for breast cancer in a report from the Globe and Mail:

The high rate of breast cancer in industrialized countries has long puzzled medical researchers, but a team of U.S. scientists has discovered a possible explanation for why women in developed countries are at high risk of developing the disease.

The answer at first glance may seem unlikely: nighttime exposure to electric lighting.

In a major breakthrough, researchers have linked exposure to light at night to the growth in breast-cancer tumours. The tumours grew because artificial light interfered with the ability of women to create melatonin, the hormone that regulates the body’s daytime and night rhythms.

The discovery holds major public-health implications because most women in industrial societies turn on lights at night in their homes and offices and may potentially be at risk from this exposure.

And even clean air is being held reponsible for skin cancer in an article in Bloomberg.com:  

New Zealand’s clean air and the thin southern hemisphere ozone layer are contributing to one of the world’s worst rates of skin cancer, according to a study by government scientists and the University of Colorado.

The article continues with information about the disease, emphasising the danger New Zealanders could potentially face:

Skin cancer kills about 300 people annually in New Zealand, a nation of 4.1 million people, and costs about NZ$33 million ($23 million) a year, according to a University of Otago study in 2000. About 75 percent of the deaths are from melanoma, the most-deadly type, which occurs in the population at three times the rate in the U.S.

Not surprisingly, with so many different things being blamed for causing cancer, contradictions arise. A critical article about this type of reporting in the sector of health was run in The Times online, and again in The Australian. Lois Rogers writes about the contradicting warnings issued through the media about what causes cancer, particularly in regards to sunlight versus Vitamin D deficiency.

Like many other consumers Jennings is baffled: the more health advice that we receive, the more confusing, if not downright contradictory, it can seem.

In the past few months, for example, scientific journals have reported that coffee might cause fatal heart disease — and that it is full of cancer-preventing antioxidants.

Milk, which contains calcium, is good for the bones — but its fat is bad for the arteries. Red meat is bad for the heart — but high-protein diets, claim some, can help to avoid obesity. A high-fibre diet is good — except that an American study now says that it does not, after all, prevent cancers of the digestive system.

Within days of each other last month, one study was published claiming that an aspirin a day reduced heart disease in women by 25% — but another said that one in 10 of those who take aspirin is at risk of intestinal bleeding and a possible early death.

Science is complex and good health involves balancing one risk against another. But for ordinary consumers, sifting the plethora of different advice is becoming an ever more complex task.

With all of these contradicting reports, Rogers asks if health advice is actually doing us harm?

It may be so, but then what is the alternative? Perhaps the excessive amount of reporting on what causes cancer is a positive thing, because the gatekeepers of news don’t appear to be keeping much from us. No ideological pattern in the reporting of cancer causes has become apparent, and as cancer research continues within so many different organisations, their differing findings appear to be given opportunities to a public voice.

Maybe the claims that you could get cancer whether you breathe polluted or clean air, stay in or out of the sun, and drink coffee or not, are so widespread they are almost farcical, but surely a media that presents all the points of view – even the contradicting ones – and allows us to make up our own minds, is an ideal one.

On December 8 Doctors Without Borders released a press release announcing the newest available AIDS drugs are remaining unavailable in Africa because the involved pharmaceutical companies are choosing not to sell them in the region, and generic versions of the drugs do not exist. These drugs were laid out in the recommendations of the World Health Organisation (WHO) at the International Conference on AIDS and Sexually transmitted infections in Africa (ICASA) in Abuja, Nigeria.

The drugs mentioned in the release include the antiretroviral (ARV) medicine Kaletra, marketed by the US pharmaceutical firm Abbott. Abbott has not indicated any intentions to export the drug to Africa despite its potential to be of significant use as it requires no refrigeration. The success of Kaletra was detailed in a press release from Abbott on November 18 of this year. The WHO also recommends Tenofovir in its guidelines. This drug allegedly has significantly fewer side effects than other treatments, and while Gilead, the company that markets the drug, claims that it is available at a discounted price in 98 countries, the WHO states it is only registered in six developing countries and not available in Africa at all.

Public Relations is an increasingly important element of the news-making process, so it is important to track the progression of a press release through international media organisations, and observe whether or not any of the big fish have taken the bait.

The Doctors Without Borders press release has been featured in a number of websites. The number of times it was picked up is relevant to a degree, but it is probably more interesting to look at the nature of these publications, in an attempt to gage the potential impact this particular news made.

The following table looks at the region in which the site is based, originated or registered and the nature of the publication. The information below is based on that found on the official websites. I invite any corrections or clarifications if necessary.

Of the twelve times the press release was picked up, six were in the African region, two from Asia and four from ‘Western’ countries. It is interesting to note that none of the private publications or newspapers which ran this story were from ‘Western’ media, but were centralised in Africa and China. To access this story through Western media sources, people need to visit Reuters’ humanitarian news network or a site for medical or health news and research.

The possible reasons for omitting news about African countries being unable to access AIDS medication are endless and complicated, and it would be unfair to abruptly criticise news organisations for not running the story, particularly with such limited research.

It can be noted however that there is a distinct difference between the services that used the press release in different global regions. The lack of any major private news organisation reporting this issue through Western media is notable. Although this story is an African problem, both Abbott and Gilead –the pharmaceutical companies which have made the decision not to make the drugs available – are American. Coverage therefore in the US press could find the same level of proximity as that in African media, but only in Africa did any major news organisations pick up this press release.

A Sydney Morning Herald article has detailed a new method of making important decisions that affect the community in the health sector – let the citizens make the choices:

The concept is simple. Select jurors at random from the electoral roll and present to them vital statistics for their area: the health of the population, the budget of the area health service, and the difficult choices that need to be made each year about the provision of services.

For Woodhouse, decisions came easily once he had the facts. “We have got 17 hospitals, some costing $1.5 million to run for the year, and they have very few patients. As a taxpayer my antenna went up when I heard that.”

The tiny Augusta Hospital, south of Bunbury, has only enough staff to care for 12 patients at a time. “The question arises: is that facility justified?” Woodhouse asks. “Should you not centralise it, move those staff to another place and run a community health centre there that will be able to treat a lot more people instead?”

Of course, not everyone in the community agrees with this policy, (Woodhouse says “I had people from the public ringing up and asking me what kind of qualifications I had that enabled me to make these decisions.”) but it is undeniably a creative approach.

This new policy of placing important strategical decisions in the hands of a randomly chosen jury of citizens implies that together, citizens will come to the best decision, based not on their qualifications or experience, but common sense.

A key issue in the NSW health system is the existence of small local hospitals that are under-funded and under-staffed, and which not only remain open, but even continue to fund emergency wards. These hospitals are often the result of election promises, and so are not likely to use funds as effectively as other solutions might.

The jury of citizens follows the same approach as that of law – where justice will supposedly prevail. But should the same idea be applied to the NSW health system? If indeed, common sense can lead citizens to the ‘right’ decision after being presented with all the facts, then why do our political leaders have such a problem attempting the same task? The obvious answer is political pressure. However, is it not pressure from the citizens in the first place for expensive and ineffective solutions like poorly funded small emergency wards, that lead politicians to make promises that are unproductive? So why would a jury of the same people that have been creating this pressure, come to an alternate conclusion?

The only apparent difference between the citizens on the jury and those casting their ballot, is the energy put into making them understand the complexities of the situation. Perhaps if the whole community had ready access to such information, the election promises we hear would be different, because the demands would have changed.

Doctors hit the headlines last week as seventy prominent nurses and clinicians formed the Hospital Reform Group – a consortium aimed to push for sweeping changes in the public hospital system, and stoke public debate about NSW’s health services. The Sydney Morning Herald has labelled it a “hospital revolution”, describing romantic scenes of a dozen conspirators in a busy restaurant, surrounded by the blissfully unaware as they prepare to unveil their secret plan…

The group calls for an end to the NSW Government’s “bandaid solutions”, making specific reference to a need for reclassifying jobs in hospitals and the possible closure of small emergency departments.

Two interesting issues have been raised in this episode. Firstly, through some of the press’ colourful imagery in describing the doctors, and the amount of publicity they have received (this story was featured in most of the radio news bulletins on the day of its release,) the NSW public seems to be craving some sort of valiant crusader to rescue the health system from its demise. Perhaps people see a Brutus in gastroenterologist and Sydney University emeritus professor Kerry Goulston, and a Caesar in the Australian Medical Association.

Probably more fascinating though, is seeing how media savvy these doctors are. The medical establishment knows how to get its agenda into the public arena, and force NSW Premier Morris Iemma and NSW Health Minister John Hatzistergos to comment on the issues they have forced into the spotlight. Indeed, if an event fails to make the evening news, it may as well have never existed. This media utilisation (not manipulation) in the health sector, should be an interesting area to track over the coming weeks.

Health has veered into the realm of politics this week with the resignation of former Queensland Health Minister Gordon Nuttall from his post as Minister for Primary Industries and Fisheries. It follows a long line of incidents that have placed the Queensland health system in the spotlight of news and interrogation for months. Sean Parnell’s article in The Australian points out that with Nuttall’s resignation, not only has he become the “highest-profile casualty of the Dr Death scandal” but Queensland Premier Peter Beattie now faces his fourth reshuffle in nine months. The former Bundaberg Base Hospital head of surgery Dr Jayant Patel earned himself the nickname ‘Doctor Death’ through his connection with more than 80 deaths – 13 of which his were directly caused by his negligence, and the dominance of the story in the news has almost turned him into the face of Queensland health. But Patel hasn’t  been the only person copping the flak. The Queensland police were accused of taking too long to make an arrest (click here for more details) and the Queensland CMC is preparing to prosecute Bundaberg health service district manager Peter Leck for official misconduct. (More details here­) It was a damning report from the CMC that led to Nuttall’s resignation and almost his prosecution, had the Parliament not have accepted his apology for lying to them.

The report raises two important issues in the Australian health system. Its criticisms of Nuttall lie in his failure to address problems that may arise with overseas-trained doctors.

This problem is not unique to Australia. Similar issues abound in the US, UK, Canada and New Zealand also, and are detailed in a Medical Journal of Australia publication about the Integration of overseas-trained doctors into the Australian medical workforce. The paper highlights the importance of overseas-trained doctors (OTDs) in the Australian medical healthcare system, pointing out that it has become “increasingly reliant on OTDs to sustain our medical workforce”, as it faces escalating strains.

This strain is seen particularly in outer metropolitan and rural hospitals and general practices, where workforce shortages result in significant numbers of OTDs whose background training, communication skills, clinical skills and orientation to the Australian healthcare system can vary markedly.

Such issues may be identifiable in the case of Dr Jayant Patel practising at Bundaberg hospital. For example, there are many concerns that for many OTDs, conditional registration to practise in “area of need” positions and geographic “districts of workforce shortage”, does not involve standardised assessment processes, and may “COMPROMISE PATIENT SAFETY”. If Patel failed to receive any standardised assessment of knowledge and skills, then this Dr Death case may actually be a result of the failure of the system, rather than simply the incompetence of one man.

ABC radio’s PM program raised a further concern of Commissioner Davies in a recent report: 

COMMISSIONER DAVIES (read by actor): The question whether free hospital services may be limited in any significant way may be one which can be and should be addressed only on a whole of Australia basis.

MELANIE CHRISTIANSEN: Mr Beattie is urging the Federal Government to respond to that.

PETER BEATTIE: And the reality is this: Unless we get a national summit or a national inquiry or some national reform in relation to health, what’s happened in Queensland will happen in another state in Australia in the next 10 years.

Davies questions Australia’s capacity to continue to provide the same level of free hospital care.

In Online Opinion, Hughes argues that Australia’s healthcare system must be better integrated. On the one hand he writes, while Medicare “retains popular support”, it is “structurally incapable” of meeting demand for health services, while private insurers are “unable to curb health treatment costs, and remain unable to attract significant new members.” Hughes’ solution lies in Integrated Health Care, a consortium working in health insurance and reform.

This may or may not be the answer. But if any good can come of the Jayant Patel ‘Dr Death’ case, it would be in the stoking of public debate over the inadequacies of Australia’s healthcare system and the policies affecting it.