What You Should Think About Medical News

October 25, 2007

“The only way to keep your health is to eat what you don’t want, drink what you don’t like, and do what you’d rather not.”

–Mark Twain

Rarely a day passes without some new proclamation about the nature of a healthy diet. In some households this can produce grumbling about the overconfidence of doctors. Usually medical researchers are not at fault. It just happens that as the story passes through layers of intermediaries, it becomes distorted. Researchers publish with an eye toward being critiqued by peers. Popular medical journals borrow from this and publish with an eye toward keeping professionals up to speed. By the time someone involved with a general media organization decides to do a story about new findings, the emphasis is much more on storytelling than relating the actual findings.

In fairness, this is not just because original medical papers would be unpopular items in daily papers and television newscasts. Most readers would also find raw research uninformative. Competent dutiful science journalists build a bridge between general audiences and the original research. They assess it with expert eyes, then parse it in such a way that their own work is the most accurate and informative retelling their abilities permit. Generating interest with this model involves having some passion for the subject and being exposed to enough research as to have no shortage of genuinely fascinating topics.

I believe the emphasis on cutting corners does even more damage here than crass commercialism. Like a children’s soccer team, reporters in any given niche seem to act as a mob in pursuit of a single thing. After all, why stick your head in academic papers day after day when it is possible to skim somebody else’s report, perhaps glance at another document or two, put it in your own words, and still look like you’ve done the job of a diligent professional? When someone completely fabricates a report (or in Dan Rather’s case, when someone lets one fabrication slip into a report,) the result is scandal. Yet the “do just enough not to get fired” paradigm generates plenty of work that borders on scandalously poor quality.

On the other hand, commercialization is not blameless in all this either. It probably has much to do with a tendency to decontextualize statistics. For many conditions, risk of mortality is less than 1%. If eating a particular food causes a 0.08% chance of mortality to become a 0.17% chance of dying from that same condition, that food is far from toxic. Yet many editors would be much happier to oversee a report claiming “problem food doubles your chance of dying from <insert cause here>” than something like “this food may increase your risk of <insert condition here>.”

A difference like that may seem subtle. Yet a subtle difference in language combined with a dramatic difference in tone can turn a humdrum observation into an alarming report. I dispute the idea that alarming reports make for more popular news than fascinating observations (especially when the alarm is rooted in trivia.) However, I do understand production of fascinating science journalism is hard work, while making people scared of everything but their own shadows can be an easy day at the office.

Medical journalism in mainstream venues is especially problematic because it easily plays into a common misconception — immortality. Sure, everyone on the tall side of puberty should be well aware that death is a human inevitability. Yet how many people really think about it? How many people have come to accept the weight of such a thing? For many young adults, death is something that happens to other people. Even as the years take loved ones from most and provide personal close calls for some, this profound matter is still often left on the fringes of awareness. No doubt this is sensible and healthy — a constant preoccupation with death is generally regarded as one sign of a troubled mind.

Thus, in between the bombastic music and dramatic graphics, an ominous report about how this habit or that diet might have a 2% chance of causing your death is not typically met with the thought, “well, something’s got to do it.” The lack of context transforms new findings that only deserve a little consideration among those intent on a healthy lifestyle into some sort of dramatic threat to which all decent self-loving Americans must be strongly averse.

Of course, basic common sense has some say in the matter too. As legitimate information is transformed into unnecessarily dire warnings, the general public only develops a thicker skin as applied to medical risks. “So what if oil-based paint causes cancer when it seeps into groundwater? Last month ‘they’ said fried chicken could kill you!” goes the final interpretation of a story. The abstract “They” responsible for all expert opinions increasingly fades into background noise.

Commercial media then must strive harder to succeed in efforts to attract audiences through hyperbolic alarmism. The mechanism reinforces itself. This not only wastes people’s time by failing to provide more informative content; it also minimizes the impact of medical expertise when something that truly deserves alarm comes to light. Be it an obesity epidemic, overmedicated children, undermedicated hospice patients, etc. the medical issues of the day that should be a big deal sometimes get lumped in with the noise made about fresh research of trivial consequence.

One way to address this is simply to lose interest in those types of stories. If you go to the media to have an emotional reaction, both broadcasters and publishers offer up no shortage of excellent drama (or reality shows, for the shallow folks.) If you go to the media to become more informed, consider filtering out alarmism even if that means ignoring the majority of “health news” items. Of course, that approach is not for everyone.

In the alternative, get in the habit of digging the facts out of whatever journalistic coverage happens to encase them. Distinguish between research that quantitatively assesses risk and research that manages to establish a mechanism of causation. When practical, try to find out whether reports related to risk factors were normalized or based on raw data.

I would never deny that smoking is an unhealthy habit, but in a broad sample the higher mortality rate of smokers would be significantly attributable to a range of other factors from childhood nutrition history to occupational hazards. Without knowing what efforts have been made to factor out other influences, it is difficult to formulate any context for health risks ranging from the pesticides on apples to the tannins in Zinfandel. If you can get down to the facts without being moved by an emotionally charged presentation, then there is still much that can be learned from medical research . . . even after it percolates through the filters of commercial media.

What You Should Think About Socialized Medicine

October 4, 2007

“Children are like wet cement. Whatever falls on them makes an impression.”

–Dr. Haim Ginott

Of all the episodes of American history that might be preserved by nostalgia, it is downright tragic that the Red Scare should survive into the 21st century. Not even the actual “Reds” Americans were made to fear lasted as long as the negative emotions inflamed by the likes of Joe McCarthy and Richard Nixon. Yet even now we see the most progressive public figures with a shot at the White House running scared from latter day redbaiters.

The term “socialism” is lobbed about like a grenade. It causes panicked flight with comparable haste too. While the rest of the civilized world becomes healthier, taller, more productive, etc.; my own people expose millions of children to risk of lifelong disadvantage simply to honor the lottery of birth. While the rest of the civilized world takes (mostly) sensible measures to reduce workplace absenteeism, preventable disability, and preventable death; the unthinking hatred of socialism that pervades our political culture generates huge obstacles to similar progress here.

These discussions bring to mind the truism, “there is no choice that is not a choice.” Such a statement goes beyond ironclad fact and into the realm of truth emergent from logic alone. Of course every choice is a choice, but what does that mean? Well, I would be surprised if most Americans in the upper income ranges actually would choose to live in a society with more contagion, more misery, and more death . . . all in the name of reduced taxes.

A false narrative holding that America’s wealthy are of one mind in opposition to socialized medicine feeds into the popular lie by which such policies are characterized as oppressive. To obstruct these initiatives has every bit as much impact on the freedom of people who want to live in a healthier society as supporting health care reform may impact the freedom of people who desire lower taxes. What I mean by “there is no choice that is not a choice” is that inaction thwarts the will of those who desire action no less than action thwarts the will of those who desire inaction.

All too often, critics of socialized medicine carry on as if secret police and state sponsored torture were at the bottom of some slippery slope that begins with taxpayer funded treatment for pediatric cancer patients. Now that recent history shows us the sort of personalities and policies that actually do nudge free peoples in the direction of fascism, a “tyranny of the majority” critique condemning social justice in medical care becomes all the more bizarre. Yet that criticism remains strong today, with far-reaching implications.

Both Hillary Clinton and Barack Obama have chosen to craft their health care proposals with an eye toward protecting the parasitic profiteers of the insurance industry. Because the existing situation enables many organizations to generate gargantuan piles of revenue without contributing any good or service of identifiable value to society, to challenge the status quo is to guarantee zealous lucrative support for one’s electoral rivals. Bribing a do-nothing industry into going along with overdue social change may not be as costly as maintaining a large scale military presence in Iraq, but it is still much more costly than taking direct action to address the medical needs of American citizens.

You don’t need your own car to be glad we have public highways, and you don’t need to be a plaintiff to be glad we have civil courts. Why then do so many people seem to swallow the argument that society as a whole would not benefit from measures that would much improve our standards of public health? Like so many other problems with a political dimension, a contributing cause is deliberate misinformation. When a patient has a long wait for an American doctor, it is accepted as good the physician was industrious enough to book a tight schedule. When a patient has a long wait for a Canadian doctor, it is regarded as a snafu “proving” the inferiority of government bureaucracy.

Yet American health care is already entangled in layer upon layer of complex bureaucracy. Corporations and governments are both organizations. I so wish the past several years had deprived all Americans of the myth that “government ought to be run more like a business.” The private sector has no monopoly on effective management, and federal programs are only run as badly as the leaders charged with operations or oversight manage to run them. If anything, people still enamored with a warped “corporations always do better than government” philosophy should be kept far from the halls of power, because that belief is a barrier to sound thinking in those jobs.

The purported advantages of the private approach — consumer freedom, self-optimizing efficiency, resources concentrated in the hands of the most effective healers — are largely phantoms of rhetoric. Shopping around is downright stupid in an emergency medical situation, and little enough of it occurs in matters of routine or elective health care. Market oriented thinking fails us in large part because the nature of illness and injury combine with the complexities of modern medicine to squelch the kind of unconstrained behaviors that drive a truly free market. Then there is the old saw about corporate research, as if producing yet another brand name cholesterol reduction pill or heartburn remedy was the alpha and omega of medical innovation.

The recent veto of a federal effort to better unite America’s children with America’s health care resources may be a bold stance based on principle, if one assumes irresponsible ignorance pervades the White House. In the alternative, it was a cruel stance based on the notion that sicklier American children are a small price to pay for perpetuating bogus narratives born out of the Red Scare. In the end, the entire nation pays dearly. Lack of access to preventative care creates additional need for curative care while lack of access to curative care promotes disability and death.

In light of all this, what should you think about socialized medicine? If you are actually thinking, then you will compare what is real over here to what is real abroad and recognize the opportunity for huge gains in public morale and public health. Long term economic growth tends to follow from sustained gains in those areas. The insurance industry funds robust misinformation campaigns that go far beyond financing the political campaigns of today’s redbaiters. If you remain rational and do not succumb to the fear they spread, there is much good to see in this idea.

I personally advocate socialized medicine because I believe a measure of taxation is reasonable for the purpose of alleviating preventable misery amongst America’s working poor, not to mention children of poverty as well as indigent folks. I understand pragmatic questions about the importance of caring for those who are not likely generate much future personal income. I find it distasteful to place such a low value on human life, but I also offer a better response than distaste.

Even someone who was fanatically dedicated to overall growth should align somewhere near my position. Proper treatment for children means a more capable workforce in the next generation. Proper treatment for today’s workers means more productivity in the near future. Even proper treatment for retirees, prisoners, and vagrants will tend to be less costly than cleaning up the public messes unchecked desperation or tragedy tend to produce. Like it or not, the reality is that we are all in this economy together. The sooner we recognize that reality, the sooner we can take action to capitalize on opportunities for a better future.