EDITORIAL

Volume 1, Number 4
October-December 1996

Vol. 1, Num 4: Contents | Editorial | Up Front | Abstracts

Editorial
Scott C. Ratzan

During the initial volume year of the Journal, an international event instigated by the release of "scientific information" in the United Kingdom provides a quintessential example of the need for effective health communication.

The means by which decisions are reached by individuals, communities, and society at large challenges health communicators to examine risk, public perception, economic/political interests, social and cultural values, as well as attitudes, behaviors, and beliefs so that we can effectively communicate and make for a better, healthier world.

The "mad cow disease -- bovine spongiform encephalopathy (BSE) -- beef crisis" has been intriguing from a health communication and negotiation perspective, providing a stark example of the need for leadership in informing and educating the public about health issues.

The evidence of any link to death from ingestion of beef is weak, and the silence from those who possess the knowledge to explain that fact could be considered "malpractice." European Union and the future of farmers throughout the world. It is clear that value placed on the quantity and peed of communication to a public hungry for sensationalism harbors great risks.

In this case, BSE -- a viral-like disease that makes the cow's brain turn into "a spongy Swiss cheese" -- has purportedly been linked to a disease with an unknown infection agent called Cretzfeldt-Jacob Disease (CJD), a rare dementia of middle age. CJD affects fewer than one person in a million, and there has bot been a single case in which transmission from cattle infected with BSE to humans has been documented.

But recently in Britain, 10 people were diagnosed with CJD, eight of whom died. There is no evidence that these people had direct contact with the "mad cow" or ingested any contaminated products. nonetheless, in an era when the public's hunger for information yearns for explanations and reasons, reporting scientific and medical uncertainty presents a dilemma. Hence, the announcement using scientific terminology that mad cows "could" theoretically be linked to human disease is offered as an explanation for the public. In fact, the New York Times (August 9, 1996) perpetuated misinformation five months into the crisis by wrongfully referring to the issue in the lead as "the 'mad cow' disease that has killed eight people in Britain." When the New York Times was contacted, the editor of the section agreed that they were wrong, but said that no one "would leave with a false impression when taking the whole story in context." The view was that the government had creased the problem, and if the people at the Times were perpetuating the problems with the government's proclamation of the 'postulated link" so be it. This begs the observation that some stories would be better left unreported, rather than misreported.

Similar theories have cause hysteria in the past. Consider the fear of AIDS. It was wrongfully termed a disease of Haitians in the early 80's, then it was believe that one could get it from sharing eating utensils or even by playing basketball with an infected player.

During the past year, there was fear of the flesh-eating bacteria -- necrotizing fascitis -- which caused no real threat but also caused hysteria. When we communicate about issues of health, we have a greater responsibility to communicate ethically. For example, while it is accurate to report that approximately one in eight women in the United States will develop breast cancer during her lifetime, it is misleading. Using statistics of lifetime estimates does not lead to appropriate understanding of the issue.

When truly communicating data and statistics to the public, the onus lies with the sender and disseminator to present information ethically and accurately. in the case of the incidence of breast cancer, a 20-year old today faces a 1 in 2,500 risk over the course of a decade. A 40-year old has a 1 in 65 change of getting breast cancer during her 40s. A 60-year old has a 1 in 29 chance during her 60s. the only time a woman's risk is 1 in 8 is if she is 85.

These issues are no new to physicians or the media. In his quintessential essay, "On Magic in Medicine," Dr. Lewis Thomas reminds us of the challenge. "it is much more difficult to be convincing about ignorance concerning disease mechanism than it is to make claims for full comprehension."

Similarly, William F. Buckley added his concern in an address at Harvard's Kennedy School of Government: "The politics of free society suffers from the failure of the press to correct factually incorrect misperceptions."

An editorial in the New England Journal of Medicine addressed the issue of health coverage in 1994: "The problem is not in the research but in the way it is interpreted for the public."

realizing the importance of communicating issue of health, the Centers for Disease Control and Prevention continues to enhance an Office of Health Communications to "promote the health of individuals and communities." While this effort is heralded as an important step forward to advance the public's understanding of what it takes to make the United States a better, healthier place, it becomes relegated to yet another governmental office if it doesn't get the appropriate support.

With the surgeon general's office empty, the medical establishment focusing on managing money, and the media striving to garner ratings with "infotainment," we must prepare to make the best decisions about health. It is time that leadership from the government and from people in education, medicine, and the private sector restore trust in information regarding everyone's most precious commodity -- health.

In this election year, we should demand from government a stronger commitment that will present articulate leadership guiding Americans toward a proper response to health. While recognizing mammoth advance in diagnosis and treatment, there is neglect and stagnation in disease prevention and health promotion despite the communication revolution's superhighway and new direction in medicine.

Absent any changes in government in the short-term, we need to lobby the media to act as our ethical compass in their coverage and delivery of health information. By crafting messages that reach various parts of the public, while also becoming the depository for information that can enhance our health and well-being. health communicators can not only fill the gap of government, but advance their power as community servants in contributing to the civility of our rapidly shrinking global village.

this issue of the journal provides unique models for ethical health communication, presents guidelines to reach unique populations, and offers challenges for involvement in addressing the "welling of death" with tobacco. The second volume year will address similar areas and include further examination and discussion of the mad cow incident.