Category Archives: Health Issues

Ottawa Public Health, Risk Communication & the Endoscopy Infection Scare

In a hastily organized media conference on Saturday, October 15, 2011, the City of Ottawa’s chief medical officer of health, Dr. Isra Levy, announced that a local, privately owned “non-hospital” medical clinic failed to follow proper infection control measures, resulting in the potential exposure of 6,800 patients to Hepatitis and HIV.

According to Dr. Levy, there was no evidence that a single patient had been infected as a result of treatment, and following consultation with infectious disease specialists he confirmed that the estimated rate of possible infection was “very low”:

  • 1 in 1 million for Hepatitis B
  • 1 in 50 million for Hepatitis C
  • 1 in 3 billion for HIV

On his Twitter feed Dan Gardner, author of the critically acclaimed book, Risk: The Science and Politics of Fear, described the risks cited in this case as “indescribably tiny…dwarfed by the risk of driving to the corner store.”

Despite the exceedingly low possibility of infection, the announcement by Ottawa’s health authority predictably generated outrage and intense public and media scrutiny.

Situation summary

Ottawa Public Health (OPH) first became aware of this clinic’s problems in July 2011, when the Ontario Ministry of Health and Long Term Care advised that an inspection by the College of Physicians and Surgeons of Ontario discovered infection prevention and sanitation protocols had not always been followed. It was then that OPH began its own investigation to assess the risk to public health and identify all patients who might be affected.

This involved a lengthy process of tracing several thousand patient records over a 10-year period. This volume of patient records, combined with restrictions on patient confidentiality set by Ontario privacy laws, made the task of informing those affected extremely difficult.

The final list of patients who may have been exposed to infection was not confirmed until Thursday, October 13th. On Friday, October 14th, OPH put its risk communication plan into effect. The first step involved finalizing the preparation of registered letters that would be immediately sent to all 6,800 patients. This included coordinating with the physician at the centre of the health scare, a professional obligation involving medical errors. Second, it involved notifying local physicians to ensure they would be able to address public demand for information and requests for blood testing. And it involved training as many as 50 public health nurses who would be redeployed from other units (e.g., sex education, home visits with new parents, etc.) to staff a call response hotline.

This plan was developed over the course of the health department’s three-month investigation. Given the possibility of an information leak, only a select number of key individuals were involved in the investigation and planning process.

A threatened media leak

Ottawa Public Health originally intended to hold its media conference on Tuesday, October 18th, at which time all information about the findings would have been disclosed. By this point, all affected patients would have been informed directly about what had occurred, physicians would have been prepared to respond to demands for information and testing, and the call response unit would have been up and running.

On the morning of Saturday, October 15th, Dr. Levy’s office was informed that a national news organization had become aware of the investigation and was preparing to break the story on the basis of inaccurate information.

This placed the public health authority in a difficult situation: the risk that a news report containing misinformation was real—certainly not unprecedented—and had the potential of creating vastly more harm than good.

OPH was faced with three options:

1.  Do nothing and respond to the report and the fallout that would ensue after the fact.
2.  Provide full disclosure of the situation, including identifying the name and address of the clinic and physician and the types of procedures which had placed patients at risk.
3.  Provide partial disclosure that would strike a balance between patient needs, the public interest and the capacity of the system to absorb increased demand for information, testing or treatment.

Communicating risk

The risks that kill people and the risks that upset people are completely different.Sandman, 2007

The health department scrambled to organize a media conference for later that afternoon. At this time, Dr. Levy announced what had occurred, confirmed that there were no known cases of anyone becoming ill and reported the very low numerical probability of infection. He acknowledged that some people might feel anxious or nervous about the announcement, and offered an explanation about what actions his office had put into place and would be following in the coming days, including a promise for new information early in the week.

To this extent, he acted in a manner consistent with the basic tenets of risk communication. He did not over-reassure, acknowledged that people would feel anxious about the announcement and described the discovery and response processes.

However, when pressed by journalists for a fuller disclosure of information, Dr. Levy refused to identify the name or location of the medical facility, the physician who operated it, or details about the patient population affected (i.e., children, adults, seniors, etc.).

This was a risky move for two major reasons.

First, it guaranteed that the health department would clash with the media over competing values: whereas the health department values only pertinent information in the interest of protecting public health, journalists value full disclosure, immediacy and thrive on controversy and outrage. Second, the decision to provide only very general information risked intensifying ambiguity and uncertainty, where the objective of risk communication is to lessen it. People aspire for control over their lives, even if they cannot change what might happen.

Ottawa Public Health called a second media conference on Monday, October 17th, where Dr. Levy disclosed all of the known information about:

  • where the breach had occurred (a private health clinic operated by Dr. Christiane Farazli on Carling Avenue in the city’s west end)
  • what caused the lapse in infection control (improper sanitation of equipment associated with the performance of endoscopies)
  • what patients should do next (contact their physician or the public health department’s call response centre to discuss whether they should be tested)

Media response

The news media’s framing of risk has more to do with its reproduction of moral outrage than with “scientific” notions of calculable risk. —Brown, Chapman & Lupton, 1996

Ottawa Public Health and Dr. Levy in particular, came under fire for the decision to provide only partial disclosure in its first media conference.

In a post to his Greater Ottawa blog on October 17thOttawa Citizen reporter David Reevely initially described Dr. Levy’s shift from partial to full disclosure as a “volte-face” move, a “classic emergency communications error,” and mused about whether the public health unit might be “sitting on something more shocking.” (He later revised his position, explaining the full context of Dr. Levy’s shift in tactics, characterizing it as a “judgment call…that makes a whole lot of sense when viewed from inside.”)

In a story published on October 18th, the Ottawa Sun did not report the low levels of infection risk but did note the “potentially fatal” nature of Hepatitis and HIV and cited demands from evidently uninformed patients for full disclosure: “You can’t keep the public in the dark…We have the right to know— it’s not fair…. Especially HIV, when there’s no treatment.”

On CTV National News, public relations consultant Barry McLoughlin characterized Dr. Levy’s decision to not release all of the information at once as “a mistake” that intensified public anxiety.

And in an October 18th editorial, the Ottawa Citizen blamed Dr. Levy for causing “undue public concern by mismanaging the release of the information.”

Risk communication: normative and situational perspectives

These criticisms and the demand they represent regarding full disclosure are consistent with normative recommendations for risk communication.

The World Health Organization defines risk communication as “an interactive process of exchange of information and opinion” among authorities, citizens, news media and other stakeholders.

In the past authorities typically acted on the basis of what they believed was the best course of action. Oftentimes this meant shielding the organization itself from blame. Risk communication hinges on therecognition that citizens deserve to be treated honestly, respectfully and with a view to enhancing their autonomy. The objective is to reduce uncertainty so that people will be capable of making informed decisions that affect their lives. Organizations achieve this objective, in part, by communicating as openly as possible.

Notwithstanding the normative appeal of full disclosure, the ability to report all information needs to be considered against a variety of situational factors, including the seriousness of the threat (i.e., the scientifically measured level of hazard or harm), the organizational resources required to manage the response that full disclosure will produce, and the conflict between patient rights to privacy and the public and media’s right to know.

Focus assessment

The focus on whether the release of partial information was sufficient needs to be determined in light of the probability of harm and in relation to the ability of the health system to absorb the effects of full disclosure.Given the low hazard for harm and the state of system readiness, and the fact that this event was not caused by the public health department itself, it’s not unreasonable that OPH proceeded cautiously in its first communication with the media and public.

The problem, however, is that this limited the flow of information to journalists, whose occupational values—more information is always better—and “nose for outrage” positions them in opposition.

According to the U.S. Centers for Disease Control and Prevention, “scientists want data to be released when it’s ‘seasoned’—the media want fresh data now.” Consistent with previous cases of low hazard/high outrage events, the Ottawa health department and media differed not only in their treatment of information, but also their definitions of how to define what’s in the public interest. The health department’s partial disclosure not only strained its relationship with the media; it also kept the wider public under-informed and in a state of uncertainty.

Risk communication conclusion

The question of when to release risk information is a serious one, not to be taken lightly. It is vitally important to communicate openly and to communicate early. As the CDC advises, public health authorities need to “be first, be right, be credible.” And according to the World Health Organization, “the benefits of early warning outweigh the risks,” even when faced with uncertainty and the possibility of error.

Although prescriptive recommendations such as these are important in guiding decision-making about disclosure, such decisions cannot be made by virtue of normative standards alone.

Rather, as argued here, they must be made in relation to situational factors. They need to be made in a context that acknowledges:

  1. It guaranteed that the health department would clash with the media over competing values.
  2. The resources that will be required to manage the system impacts such announcements tend to produce.
  3. The legislative environment that balances patient privacy rights against the rights of the public to know

In this case, it’s possible that a full disclosure of all available information in its first media conference would have created undue pressure on local physicians, public health clinics and hospital emergency rooms. Keeping in mind that risk is about both uncertainty and possibility, the scenario of an overwhelmed healthcare system surely played out in the health department’s decision making.

It’s important to note that this risk event was not caused by the health department itself, but by a private clinic regulated by the province of Ontario. Ottawa Public Health responded to an investigation by the College of Physicians and Surgeons of Ontario, and to an alert by the Ontario government. It proceeded with its own investigation and a strategy of public disclosure only when it became evident that the other agencies involved would not do so. The decision to provide only partial disclosure was made on the basis of the health department’s interpretation of the scientific evidence relating to infection risk. That this decision wasallegedly forced by a news organization threatening to break the story with erroneous information, is significant in terms of assessing the response.

Ottawa Public Health acted appropriately in balancing the needs of patients in relation with system capacity, but only to the extent that this event involved infinitesimally low levels of health risk. Had the probability of infection been higher, or had there been evidence of patients who had actually been infected, its response (and this assessment) would likely have been different.

Response problematic in one area: social media

The OPH response is problematic in one other way.

In the most recent edition of his book Ongoing Crisis CommunicationW. Timothy Coombs describes the “increasingly important” role of social media for issues management and as a channel for responding to public questions and sharing information. It’s unclear to what extent social media sites are used by Ottawa Public Health to scan or monitor media and public discourse; but for the dissemination of public information sites have been used only sparingly.

For example, (at the time of writing this post) the health department’s under-used Tumblr account does not contain a single update about the infection scare, although it’s been used for other health information purposes during this time. And while its Facebook page and Twitter account have posted synced updates to a low number of fans (363) and followers (5,000+), the fact that both were dormant in the 36-48 hours following the initial media conference suggests social media outreach represents a low priority within the health department’s communication plan.

Given that the period immediately following a public announcement is a critical time when reporters and members of the public are discussing an event and forming their initial impressions, social media platforms present an important space not only for assessing the tone of the public conversation, but for also correcting misinformation if and when it occurs.

Risk events such as the Ottawa endoscopies infection scare can be disorienting because of the intense feelings of uncertainty, anxiety and fear they produce. But to the extent that these situations are potentially destabilizing, they also afford unique opportunities to think critically about how we discuss and practice risk communication.

** This post originally appeared as a guest column on PR Conversations. I thank Judy Gombita and Heather Yaxley for the invitation and their community of readers for the excellent comments and feedback.

Leave a comment

Filed under Crisis Communication, Emergency Communication, Everyday Life, Health Issues, Health Promotion, Public Health, Public Relations, Risk, Social Media

H1N1 and the “crisis in the clinics”: Apathy, risk, and the problem of communication

Aristotle famously stated, “It is equally unreasonable to accept merely probable conclusions from a mathematician and to demand strict demonstration from an orator.” He also wrote that virtuous behaviour is accomplished when one finds the mean between excess and deficiency. “Where adherence to the mean preserves perfection, excess and deficiency destroy it.”

In normal times, we expect a lot from the news media. In emergency or crisis, our expectations intensify. If hazards or risks are underreported or played down, the media face accusations of indifference; if they are amplified to the point of excess, charges of sensationalism inevitably follow. For journalists and health communicators, the goal is to find virtue in the mean. It is an extremely difficult task.

The goal of this column is to offer some reflections on the dynamics in how the media report on health emergencies and risks, and to address the implications for public health communication. The case of the novel H1N1 virus provides a compelling illustration.

Observation No. 1: In times of crisis, people want information quickly. Although the vast majority of us continue to receive news and information from traditional sources, social media such as YouTube, Twitter and Facebook are supplementing our information-gathering activities. Their decentralized nature allow them to relay commentary, opinion, speculation and even thoughtful analysis faster. Most importantly, they provide a mechanism for citizens to bypass traditional media and communicate directly with one another.

Yet, the nimble and flexible nature of social media is also a weakness. The lack of sourcing, review and professional norms compromises its integrity. The fact that we live in a globalized media environment has undoubtedly expanded our horizons, but it has also created a lot of “noise” that makes it hard to convince people that health officials have the best evidence and are acting in the public interest.

Observation No. 2: News media don’t just mirror what’s going on in the world, they actively contribute to shaping our understanding of it. For this reason, they are recognized by health communicators as assets in crisis and risk situations. Competency in crisis and risk communication are thus expected to be a key element in the public health official’s toolkit. Yet, a review of the media’s H1N1 coverage suggests that the rollout of one of the most ambitious immunization initiatives in Canadian history might have been more effective had officials been attuned to lessons learned from previous events.

For example, they claim they were caught off guard by the surge in demand for the H1N1 vaccine. They shouldn’t have been. Although surveys indicated Canadians were ambivalent about the need for inoculation, research indicates this is an entirely predictable response. Indeed, the most common reaction of citizens to situations involving high levels of health risk is not panic, as many mistakenly believe, but apathy. Communication expert Peter Sandman argues that the mainstay of a health communicator’s job is to determine how to make people recognize that a risk is serious, to become concerned about it and to take action: “If people are apathetic, we try to get them more concerned – sometimes by arousing fear.”

Observation No. 3: News values are a central consideration in how the media report health emergencies and are thus a key component in any communication plan. Attitudes can shift dramatically if a famous or featured person becomes the public face of the crisis. Evan Frustaglio, the hockey-playing teenager, became the high-profile face of the H1N1 virus. His death was heart-wrenching evidence that while the virus may place some segments of our society at greater risk, no segment is immune. The media attention heightened fears among Canadians.

Mr. Sandman reminds us that the goal of risk communications in such circumstances “is to help your public bear its fear, rather than try to persuade your public not to be afraid.” Some officials have gone overboard by overamplifying the risk of serious illness; many others have responded by arguing that we really have little to fear. The problem is that neither side is attuned to what citizens actually feel or believe. This shows a profound lack of empathy and compromises officials’ ability to build trust with the public. And a foundation of public trust will be critical when the next health emergency or crisis occurs.

Observation No. 4: Media interest in a public health crisis is itself viral. As coverage about H1N1 increased, story angles mutated: Sports pages reported that professional athletes had been granted special access to the vaccine; business pages considered the impact on economic recovery; the society pages speculated about the proper etiquette for dinner parties. Policy debate about two-tier health care was given an H1N1 angle with news that some private clinics had access to the vaccine, implying that the wealthy enjoy special privileges.

Each of these narrative developments was predictable. News accounts were shaped by an “accountability frame” and conflict that surfaced between political jurisdictions. How risks are understood and how people respond depends on the “circuit of communication” within which institutional relationships are embedded. The H1N1 case has revealed a remarkable lack of co-ordination in the risk messaging from public health officials at different jurisdictional levels, as well as a lack of clear political leadership, especially at the federal level. In other words, the circuit of communication has been repeatedly short-circuiting.

Pandemics inflict devastation on individuals and families, communities and nations. They affect us biologically, psychologically, spiritually and culturally. As we have seen, they also impose significant burdens on our public infrastructure. Pandemics are also democratic in the sense that they do not respect the social divisions of race, class, gender or nationality – yet the burdens they present do not affect everyone equally. We process and come to understand the meanings of these challenges through communication, and it’s critical to use the best tools and research available.

**Note: this column is co-authored with Bill Fox from The Gandalf Group, an issues management consultancy. It originally appeared as a web exclusive column in The Globe & Mail.

Leave a comment

Filed under Crisis Communication, Health Issues, Public Health, Public Relations

Global Warming and the Problem of Public Opinion

We hear references to “public opinion” all the time but we rarely reflect on what it is, and why it’s important.

Political thinkers have struggled over the meaning of public opinion since antiquity. Plato was deeply distrustful of the public, while Aristotle believed “the many … may yet taken all together be better than the few.” To Macchiavelli, “public opinion” had no moral value, yet strategically it was crucial for political leaders to pay attention to it as a failure to do so could imperil one’s rule.

Around the turn of the 20th century, the political commentator and journalist Walter Lippmann argued that public opinion has little conceptual utility because most citizens have neither the time nor interest to truly understand issues in their complexity. The philosopher John Dewey disagreed, arguing that citizens are perfectly capable of understanding their world – nevertheless, their ability to do so is subjected to different forms of “organized manipulation” (i.e. advertising, PR, etc.).

All of these thinkers were writing about “public opinion” long before polling became a ubiquitous feature of the political and media landscapes.

Whether we are talking about environmental issues, foreign affairs, health-care reform or national security, actors on all sides commonly deploy “public opinion” as a weapon to advance their arguments, as if to proclaim that they speak on behalf of “the public” where others do not. Most agree upon the strategic benefits of such an approach, but has anyone considered the consequences?

Take the issue of climate change.

In 2008, Health Canada commissioned the polling firm Environics to survey Canadians about their understanding of climate change. The resultant report suggests that climate change will have a direct effect on the health of Canadians. Given that “most Canadians” believe climate change is taking place and that “a significant proportion” can see evidence of it in their own communities, the time for the agency to act is now.

Such findings are routinely challenged by others claiming to speak for the public. The Globe and Mail’s Margaret Wente argued recently that citizens are “cooling” to the notion of global warming and that politicians ought to carefully pay attention to public opinion in advance of meeting to discuss binding international agreements. Wente cites several polls that show, for example, how concern for the environment in Canada has fallen relative to other issues (e.g. crime, the economy). She then proceeds from the national to the international scale, arguing that citizens around the world have acquired weak appetites for action, especially for endorsing what she calls “Kyoto-style” international agreements.

The environmental community also uses “public opinion” for its side. Take for example Jim Hoggan, a well-known Canadian PR professional, environmentalist, and author. In March 2009, Hoggan argued that “over 90 per cent of Americans agree that the U.S. should act rapidly to combat global warming, including 34 per cent who feel the U.S. should make a large-scale effort even if it costs a lot of money.” The David Suzuki Foundation (on whose board of directors Hoggan serves as chair) reported in 2006 that Canadians were totally confused about the causes of climate change, attributing the problem to the hole in the ozone layer more than any other factor. A big part of the problem with public understanding about climate change, Hoggan asserts, is that citizens get unreliable information and no longer know whom they should trust. In his recent book, Hoggan reports survey data that shows that 82 per cent of people polled trust scientists, while 66 per cent trust environmental organizations and television weather reporters equally. By contrast, only 47 per cent trust the mainstream media. For Hoggan “the media—print or broadcast—have not succeeded in transmitting even the most rudimentary explanation of the actual cause of climate change.” Hoggan also notes that a whopping 81 per cent of people believe that PR experts deceive the public. Surely this can’t be good news for a PR man on a mission to change public perceptions about environmental issues.

What is one to do in the face of such competing claims about the state of public opinion? I suggest that the best thing we can do is ignore the polls altogether. Indeed, the fundamental problem with the debate about public opinion is that it’s a zero-sum game that only leads us down a path to ambivalence.

In a provocative critique, the French sociologist Pierre Bourdieu argued, “public opinion does not exist.” By this he did not mean public opinion does not come to have objective qualities – rather, his instructive point was that public opinion is a social construction, and a dangerous one at that. Bourdieu’s chief concern was with how polls are reported and the fact that they often carry more weight than they should. This happens, he argues, not only because the media are incapable of dealing with complexity, but also because we do not reflect carefully enough on how “public opinion” is shaped and represented. In other words, his concern is not with the inherent worth of polls but with how they are used. For Bourdieu, “public opinion” is at best a projection of what the media and political elite think about. At worst, it is a rhetorical tool that organized groups (in politics, the economy, and civil society) wield in their respective efforts to exert power and control over public discourse and policy.

I do not believe that polls have absolutely no role to play in how we talk about urgent issues like climate change. Nor do I endorse a nihilistic argument that we ought to just tune out entirely and let the chips fall where they may. The problem is that “public opinion” has been invested with a scientific power that obscures its social and political context – it has been granted far more value and authority than is deserved.

As the sociologist Earl Babbie might have put it, the idea of “public opinion” is probably useful in the context of scientific research, but in the world of culture and politics it could only ever be a “figment of our imaginations.” He did not mean that such concepts are entirely useless, just that we need to remember that the important question is: what do we do with our concepts?

Rather than assenting to what “public opinion” data tell us citizens want our political leaders to do, I think we desperately need to generate new forms of public expression, to raise critical questions about climate change instead of simply responding to those questions posed by others. Until we do so, we are liable to be governed only by the polls, and by those who sponsor them.

** Note: this column also appears under a different title in The Mark News here

Leave a comment

Filed under climate change, Health Issues, Health Promotion, Politics, Public Health

Healthy Cities, Governable Subjects

Ever wonder what it would be like to live in a city where everyone was healthy, wealthy and wise? A city where there were no Big Macs, where everyone rode their bicycles to work and people just seemed to be in better spirits? If you are looking for such a utopia, Manchester England may be your Xanadu.

The newswires were abuzz yesterday with reports that Britain’s National Health Service has cooperated with local authorities in Manchester to provide incentives to citizens to eat more fruit, spend more time at the gym, engage in more preventative health measures and just lead a more productive and healthy lifestyle. Manchester is hoping to fight the fat with a reward system that will operate, for all intents and purposes, like a retail loyalty card program. But rather than earning credit for opening their wallets only, citizens will earn points for spending their hard earned dollars on fresh fruits and veggies and their leisure time doing pilates.

According to a report in the Associated Press, Manchester residents will be able to “swipe their rewards cards and earn points every time they buy fruits and vegetables, use a community swimming pool, attend a medical screening or work out with a personal trainer. Points can be redeemed for athletic equipment, donations to school athletic departments and personal training sessions with local athletes.”

It’s a public health craze that appears to be gaining traction in the UK. Tower Hamlets, the third most deprived London borough, will be undergoing an extreme makeover of its own — according to a report by the BBC, almost £10 million of government and local money has been earmarked for a “Healthy Cities” initiative that will turn the community into a place where people will find it easier to exercise and choose healthy food: walking and cycling routes will be extended, food co-ops will be established and fast food outlets will be enlisted in a campaign to offer more healthy meals on their menus.

With below average life expectancy, low exercise rates and unhealthy eating habits, the people of Tower Hamlets are thought to be at the centre of what the local primary care trust calls an “obesity epidemic.”

Beyond Manchester and Tower Hamlets, towns in other countries have tried similar programs. Varallo, a small town in northern Italy, offered cash rewards for residents who lost weight and kept it off for 12 months. Some U.S. companies wanting to keep health care costs down have also established reward programs for their staff through what HR types would call value-added employee assistance programs. For example, the Michigan-based Freedom One Financial Group sent 21 employees who met weight-loss goals on a four-day Caribbean cruise in 2005.

What does all of this tell us about the politics of public health today?

In The Politics of Health in the Eighteenth Century, Michel Foucault accounts for the emergence of a medical services market, the professionalization of medical practitioners, the development of benevolent associations and learned societies concerned with the observation of social conditions and innovation in medical techniques, among other things. While the state plays a variety of roles in relation to these developments, he argues, the ways in which health and sickness became matters of problematization ‘beyond the state’ contribute to an awareness of them as elements of population management.

Central to the politics of health in this period is the emergence of concern for the well-being of the population as an essential objective of political power – this is a view of power that concerns itself not with the capacity to dominate and repress but to produce things, to manage conduct and coordinate new ways of thinking and behaving. This shift towards policing the social body that Foucault argues was peculiar to the 18th century was related to the broader consequences of the industrial period’s demographic transition, in which an urgent need arose to rapidly integrate increasing numbers of people into the apparatus of production and to control them closely. It was these forces, he argues, that made the notion of “population” appear not just as a theoretical concept, but “as an object of surveillance, of analysis, of intervention, of initiatives aimed at modification.”

The cases of Manchester and Tower Hamlets, Varalla, and many others illustrate not only Foucault’s argument that the exercise of power is concerned increasingly with managing and channeling human conduct (rather than dominating or repressing it) but it also show that while non-governmental bodies play a key role in contemporary health politics, the state also plays a fundamental role in terms of ensuring that “the state of health of a population as a general objective.” Whether this is a good thing, a bad thing or something more dangerous remains to be determined.

Leave a comment

Filed under Health Issues, Health Promotion, Lifestyle Risks, Public Health, Surveillance

Vaccines, Autism and the “Liberal Media Conspiracy”

In a media release dated November 11, the Center for Medicine in the Public Interest (CMPI) accused CBS Evening News, and singling out its lead anchor Katie Couric, for leading a witch hunt against vaccine makers and perpetuating a myth that there is a link between vaccines and autism. According to the CMPI, “CBS Evening News has aired six stories over the past two-and-a-half years that included extremist views of vaccines and autism.” The Center’s President and Director of Programs, Dr. Robert Goldberg, also alleges that CBS intentionally ignored an announcement by the California Department of Public Health that cited a lack of peer-reviewed scientific evidence supporting the link between thimerosal (a preservative found in vaccines that are commonly given to children) and autism. According to a report published in the New England Journal of Medicine, more than 5,000 U.S. families have filed claims through the Vaccine Injury Compensation Program alleging autism was caused by vaccines containing thimerosal; the majority of these claims are still pending.

There are several noteworthy observations to be made here, but I’ll restrict myself to three: 

First, there is no question that the national media in the United States has given considerable attention to claims that vaccines may be linked to autism, whether in fact there is unquestioned scientific evidence to support their claims or not (since when has media coverage of health issues ever been based on the principles of science!). Although autism advocates and parents of autistic children have long crusaded for more media publicity and federal resources to better understand autism and provide meaningful supports to autistic children and their families, it took Jenny McCarthy, a mother of an autistic child, but also a former playboy bunny, actress and now best-selling author, to thrust the issue into the media spotlight. The clip below is an excerpt from McCarthy’s interview on CNN’s American Morning, but was part of a much bigger media tour in which she also appeared in a 20-minute spot on Oprah, Larry King Live, WWE Smackdown (a professional wrestling show) and several other high profile news programs. 

McCarthy was and remains an effective advocate not just because of her lived experiences but also because of her status and reach as a Hollywood celebrity. She joins a long list of tinseltowners who have leveraged their access and appeal to both political elites and citizens to influence public opinion and policy. But while the moral commitments of some celebs have been questionable, those with the capacity and willingness to engage in the cut and thrust of political argumentation have succeeded in not only keeping the issue alive but in actually influencing hearts and minds. This is the case whether they are correct or wholly inaccurate in their claims making activities. McCarthy’s appearances have included not just media but also medical and associational conferences.

Second, CMPI’s accusations of a liberal media bias against news corporations is nothing new, certainly not to communication researchers. In 1986, political scientists Robert Lichter, Stanley Rothman and Linda Lichter published their seminal book The Media Elite: America’s New Power Brokers, which reported survey data about the political leanings of journalists at such national media outlets as The Wall Street Journal, The Washington Post and New York Times, plus several broadcast networks (including CBS Evening News). A review of the book can be found here. In general terms, Lichter et al. found that most journalists were Democratic voters whose attitudes were well to the left of the general public on a variety of topics, including abortion, affirmative action and gay rights. The researchers then compared the journalists’ reported attitudes to their coverage of controversial issues such as the safety of nuclear power, school busing to promote racial integration, and the energy crisis of the 1970s, and found that coverage of controversial issues reflected the personal attitudes or reporters, and because political liberals were dominant in newsrooms that helped to explain why news coverage tilted in a leftist/liberal direction. The study was embraced mainly by conservative columnists and politicians, who adopted the findings as scientific proof of liberal media bias. It’s clear from the recent election campaign in the U.S. that many Republicans still believe these results to be true, or at least feel that their base believes this to be true (for similar findings in a Canadian context, see Barry Cooper’s Sins of Omission: Shaping the News at CBC TV (U of T Press, 1994) and Lydia Miljan and Barry Cooper’s Hidden Agendas: How Journalists Influence the News (UBC Press, 2003)).

And third, those who have tended to pitch accusations of a liberal media bias or conspiracy tend to operate from a position of political or material self-interest. Canadian political scientist Barry Cooper is reported to have deep ties to the Conservative movement in Canada and its financiers in western Canada’s oil and gas sector. Conservatives and those in the fossil fuels industry have consistently maintained that Canada’s liberal media (led by the state-supported CBC) is driven ideologically by a socialist agenda to steal hard-earned money from the western provinces to subsidize the myriad social engineering projects (e.g., Kyoto Protocol) supported by the vote-rich regions of Ontario and Quebec. In Cooper and Miljan (not to mention many others) they have the institutional credibility and legitimacy that academe sometimes affords.

Lichter and Lichter parlayed their academic careers into a business of providing research and consulting support for some of the most influential conservative organizations in the United States when they founded the Center for Media and Public Affairs (CMPA). According to Media Transparency, CMPA received 55 grants totaling almost $3 million between 1986 and 2005, the majority of which came from three donors all with deep ties to the religious right in the U.S. 

The Center for Medicine in the Public Interest, finally, describes itself on its website as committed to discussing, debating and demonstrating how “exponential and accelerating technological progress coupled with smart public policy will enhance and advance 21st century health care by predicting, preventing, diagnosing, and treating disease with greater speed, more precision, and less cost.” This may very well be true; yet, according to PBS News, it is funded by some of the biggest pharmaceutical corporations in the world, many of which make the very vaccines it has recently come out publicly to defend. This too shouldn’t come as much of a surprise given that CMPI was established by The Pacific Institute, a think tank founded in 1979 whose mandate is the promotion of “the principles of individual freedom and personal responsibility … through policies that emphasize a free economy, private initiative, and limited government.” 

Center for Medicine in the Public Interest may have a compelling case for media bias. The news and entertainment media in the U.S. may very well be guilty of providing insufficient attention to the scientific debate about autism. On these grounds many advocates and parents of autistic children, and public health advocates in general, may actually find some common ground. Nevertheless, when an organization like CMPI sets out to accuse media organizations of supporting what it describes as extremist and partisan views it will need to open its own practices and positions on issues to similar scrutiny.

********

Update: See this New York Times editorial (13 February 2009) exonerating the medical and pharmaceutical establishment from the claims by McCarthy and others of a causal connection between vaccines and autism

1 Comment

Filed under Health Issues, Public Relations