SCOTT C. RATZAN
Decision-making about health issues differs among well-informed,
well-intentioned, and well-meaning consumers. While we all would like
to be as healthy as our global neighbors, we often differ in our definition
of health-quality vs. quantity of life, collective vs. individual
rights, and behavioral vs. biological interventions.
Regardless of whatever orientation and variables we consider, we
are all subject to the limits of medical progress and the mechanisms
that communicate such information.
Recent events in different regions of the world highlight the fragile
nature of 21st century progress. While there have been great strides
in saving the lives of millions with vaccines, vitamin supplements,
and medicines, at any juncture, years of progress can be undermined
with the spontaneity and reach of the modern media that can create
doubt and develop unhealthy social norms.
A recent event heralded by the media in India began at the same time
that rumors of dozens of children dying from Vitamin A supplements
delivered in concert with polio eradication efforts began. This helped
halt a Vitamin A campaign that reached 35 million children. The scientific
community and donor organizations had supported Vitamin A as it reduces
the chances that many malnourished children in developing countries
will die
from diarrhea, measles, and other disease. It also helps prevent blindness.
Over 200 million children worldwide have benefited from Vitamin A.
The India incident made international news as six reported deaths
occurred following the polio vaccine/vitamin A campaign. The BBC even
reported the deaths might be due to the vaccine. When the facts were
determined, it was clear the deaths were not due to the vaccine or
the vitamin. Nonetheless, the campaign has not been restored. The
Associated Press later reported that parents were staying away from
the polio campaign due to fears of side effects. The unfounded rumors
translated into only 47% of the targeted children showing up for the
vaccine. This mirrors the global waning of vaccination campaigns.
In neighboring Nepal, the Human Services Association reported that
60 year-old students who received a capsule of 200,000 IU of vitamin
A from their school began to have severe abdominal pain and vomiting.
Scientifically, the likelihood that vitamin A caused the symptoms
reported is nil. Another group of 60 children from the same school
who got the same dose of vitamin reported no such symptoms. The infectious
media reports threaten both vitamin supplementation and vaccination
efforts; it has also spread to Thailand.
Other areas of misinformation concerning risk abound. In China, despite
years of scientific research, policy decisions, and fervor regarding
bovine spongiform encephalopathy (BSE; commonly known as mad cow disease),
the Chinese government has decided to ban cosmetic products made from
bovine sources where BSE has been reported. There is no risk to humans
using such products even if there were BSE endemic when the product
was manufactured.
In the United Kingdom, the epicenter of the mad cow crisis, recent
debate on the risk of the measles, mumps, and rubella vaccine (MMR)
continues to fuel uncertainty related to many health events, presaging
another measles outbreak in the UK.
In Jordan, the public suspected the government of contaminating drinking
water. The mistrust generated by the idea that ``they are trying to
poison us’’ spilled over into the next public health crisis
related to an outbreak of vaccine-associated events.
Finally, a retrospective analysis in the United States published
in the Journal of the American Medical Association examined
the coverage of rotavirus vaccine, a vaccine that could save over
500,000 children lives annually throughout the world: in the initial
12-year period, rotavirus vaccine was portrayed positively by the
media ad adverse events were rarely mentioned. Once the CDC published
preliminary data concerning 15 cases of the adverse effect of vaccination
among those who received the rotavirus vaccine - intussusception -
media portrayal of the vaccine changed abruptly to negativity. The
authors reviewed 280 newspaper, 49 wire service, and 257 television
stories related to the risk of rotavirus vaccine and concluded: ``The
early idealization-sudden condemnation sequence seen with the rotavirus
vaccine, [suggests that] scientists and health officials have an obligation
to learn to work effectively with the media to assure that the public
is informed about both vaccine risks and benefits, particularly since
the media may be the public’s principle source of such information.
Balanced portrayals of vaccines can help avert abrupt shifts in media
and public reaction that can undermine the success of vaccination
programs.’’ (JAMA. 2002; 287:1455±1462)
The media is often the principal purveyor of (mis)information with
powerful messages that sway policymakers. The reporter creating the
story is looking for high interest stories and wants to present at
least two sides of the issue. Generally, the two points of view are
presented on the same subject as if they are more or less equal in
merit. In most situations, the scientifically validated and supported
side is balanced by a rogue scientist’ s
perspective and presented as equal. In the case of vaccines, too often
the standard medical view (the fact that vaccines and/or medical intervention
is safe and effective and saves millions of lives) is balanced against
the opinion or view of an individual that a particular event might
be caused by a vaccine.
To the reader or viewer, whether a concerned consumer or a politician,
these polarized views may appear more or less equal in merit. In reality,
these two options are wildly unequal, with hugely different levels
of certainty. Nonetheless, the media often have the reach and an audience
that cannot be countered by the current health system.
One approach to advance public health understanding has been developed
by the European Office of the World Health Organization. This systemat
ic networking approach with a European Health Communication Network
was the brainchild of Dr. Franklin Apfel, who proclaims the ``pen
as mighty as the surgeon’s scalpel .’’ Even with such
emphasis and development of guidelines and ethical communication links,
these approaches take time. The events mentioned above are among a
series of others to come. It is not a question of ``if (an event will
happen), but when." The following five elements might assist
those practicing health communication be better prepared to address
future events:
-
Conduct communication surveillance - examination of media trends,
professional deliberations, Internet rumors, cultural myths, etc.
-
Educate at all levels - develop social norms, reiterat e key
messages, and develop a health literacy.
-
Advocate with key leaders including the media, academic, and
government communities, not just the health sector.
-
Create dialogue opportunities for public understanding of science/health
in the media and public settings.
-
Integrate scientific knowledge and ``truth’’ in sustainable
systems (media, academia, government, etc.).
These suggested ethical elements can advance public health rather
than contribute to a mass sociogenic illness due to misinformation.
Whatever nomenclature we use to describe the pitfall s of unethical
health communication, we must be scientific and ethical in responding
to develop a health-competent society. The progress we have made in
public health with vaccination and supplementation is too important
to lose to media mal-practice. The health and well-being of the global
public demand that we use each and every available means to advance
public health.
__________
Scott C. Ratzan MD, MPA is Editor of the Journal of Health
Communication: International Perspectives.
