In a free society, a free media is a key part of that freedom. Health care is a high profile political issue. With the advent of 24-hour news channels, there is a need to fill the available time slots. Such channels often run themed weeks and focus on a particular subject. The health care system is a favourite topic.
This can lead to pressure to find health care stories and this in turn can give stories of limited news worthiness a higher profile than they may deserve.
In general, the publication of such material is justified on the grounds of either public interest or to help an individual patient gain access to care that they are currently being denied.
However, there are some distinctive caveats to this justification. The number of cases highlighted is often a tiny proportion of the patients requiring and receiving treatment. For many of those patients who will receive treatment promptly and successfully, there may be significant harm caused by the anxiety induced by such reporting. Whilst the harm may be less than the benefit which may be derived from the case reported, it may be done to many more people. Further harm may be caused by raising expectations that the specific treatment is effective, when it may only apply to a subset of patients with a particular subtype of the disease to be treated, eg herceptin.
The second caveat reflects the finite nature of resources. There is a danger that the prioritisation of treatment will follow those who can shout the loudest, or the most articulate, or those who have the most emotive case, rather than on clinical need. A news report recently reported that clinicians felt pressurised by political and public opinion. Far from occupying the moral high ground, the media are complicit in this pressure.
The media reporting is placing regulatory authorities under increasing pressure to approve treatments more quickly. Whilst this may be beneficial, it raises the risk of an unforeseen risk factor or side effect being missed. One of the sobering facts about thalidomide was that even in pregnant women, the harmful effects could have been separated from the therapeutic effects if it had been possible to separate two different forms of the drug, in this case, the optical isomers.
The most serious risk is in reporting of cases where there are direct harmful effects arising from the public changing their behaviour as a result of the report. The most dramatic example of this in recent times has been the MMR story. Even now, MMR vaccination rates have not returned to historical levels prior to the publication of stories linking MMR with autism. The apparent evidence for any link was always not sufficient to justify the stories published. The impact has been the return of measles. Claims by the media that the crisis could have been averted by permitting single vaccinations is no defence: there was no evidence that single vaccinations were safer and some evidence that it increased risk to children.
Freedom brings responsibility: a free media has a responsibility to follow the ethical of “first do no harm”. It may not sell papers and gain viewers, but it doesn’t conmtribute to suffering or death, either.
Tags: Ethics, free speech, health reporting, non-maleficience
