Are we simply victims of hope and hype?

Scanning the Washington Post today, I ran across an opinion column by Shannon Brownlee on the manner in which medical information is conveyed to the public by the mainstream media. The piece is highly critical of the way journalists report so-called medical 'breakthroughs' giving false hope to patients.

The ads aren't selling a product; they're selling hope.

Now there's a commodity that seems to be in great abundance these days, at least in the fields of medicine and biomedical research. Magazines are chocka-block with full-page ads such as the one for a New York hospital that reads, "Another day, another breakthrough," and so-called advertorials, tricked-up advertising for hospitals and drugs that is practically indistinguishable from the editorial content of the magazines in which they appear, except for the requisite word "advertisement" that's printed at the top of the page in small type. The headline on one recent eight-page advertorial on heart disease: "From Cause to Cure." Oh, really? If there's a cure for heart disease, I'd like to know what it is.

I would have to agree with the author on the point that to truly find out if a particular medical treatment is effective, the mainstream media is not the best source of information. However, the column is indicative of another troubling aspect to the culture of medical care in this country - the dumbing down of the patient.

The stories tended to follow a formula guaranteed to tug at readers' heartstrings: Tell the tale of a frightened patient, preferably a young one with children, who has exhausted all other options and is fighting her insurance company for a shot at life. (Many companies refused to pay for high-dose chemotherapy, which initially cost $150,000 and up.) Most reporters threw in a warning or two about the fact that the treatment was still unproven -- clinical trials didn't get underway until 1992. And it was extremely risky, killing 20 percent of patients in the early days. But the risk was part of the drama, and I think it's safe to say that many if not most breast cancer patients skipped right over the caveats about the lack of scientific evidence. The upshot was that we in the media helped sell a pricey, unproven, vile treatment to some of the most vulnerable readers imaginable.

The patient is portrayed as a passive victim of his surroundings, unable to absorb information related to his health care on his own. He is seen as incapable of analyzing data, making distinctions, and coming up with a treatment that best suits him. Easily falling prey to media hype, he needs to be protected from false hope. Drug companies, doctors, and journalists are criticized, but the patient remains immaculate. The notion that he should be an active agent seeking his own solutions never enters the debate.

All too often, patients themselves buy into this view of health care.

The problem is that most people do not know how to critically analyze scientific data. Being able to read and understand a scientific journal article is a skill every single person on the planet should have. Unfortunately, most people lack it. Having been brought up and educated in government schools, I did not know how until my senior year of college when mostly serendipitously, a lightbulb clicked in my head as to what science, the method, truly is.

As a proponent of the free market, I fully embrace the specialization of medical expertise among physicians. The doctor can give the patient information about his health in an efficient, knowledgable, and caring manner. However, given a basic set of informational constraints about a particular disease, options for treatment, risks associated with and without treatment, and long term implications, the decision of which path to pursue is a deeply intimate and personal one. Only the individual can determine for himself the best course of action. No matter what the medical schools teach, there is no single right way, as each of us is unique in our needs and circumstance. Human ends are subjectively unique, and human action to pursue those ends only happens at the individual level. It is this aspect of care that places a burden on the patient himself to be able to critically analyze the scientific literature.

Rather than rely on the Washington Post or Time magazine for medical information, the patient should be go directly to the source. He should be able to perform a Medline search on his condition, find relevant journal articles, critically analyze those articles, and arrive at meaningful conclusions. The physician can serve as an informed aid to help in this process, and of course bring specialized skills such as surgery and diagnostic image interpretation to the patient. But ultimately, it is the patient that has to make the final decision, and as such, he should have the ability to rationally and skeptically analyze the medical literature.

Then he will be truly empowered, not simply a victim of 'greedy drug companies' or 'media hype'.

Share this