Archive for the ‘ Health ’ Category

Abortion

I recently supported my wife through a pregnancy and birth with some, but by no means terrible, complications. My wife was largely immobile in the weeks beforehand, and my son took 36 hours and a caesarian section to be born. Since then he has mostly fed and slept quite well, after a testing few days when he wasn’t getting enough milk and we weren’t topping up with formula milk. I love them both very much, and am very proud and pleased to be a father.

I know Kung-Fu

Clearly the best baby

 

And it all made me think a little bit about abortion. My view hasn’t changed, but has been strengthened. I am even more strongly pro-choice than I was.

Having seen how difficult pregnancy, childbirth and very early parenthood are, it is strikingly clear that women should be allowed to abort unwanted or problematic pregnancies. Our baby was planned, we are secure in our relationship, housing and finances, my wife was lucky enough to have a healthy baby, and has been supported (hopefully well) by me and a wonderful set of family and friends. And still we struggle. Because it is *hard*.

Forcing this on someone against their wishes is awful, and a hugely disproportionate punishment for carelessness, changes to circumstance or worse.

I don’t think that early stage abortions should be restricted at all, by which I mean before the foetus is likely to have developed a nervous system. Until that point, it can’t even feel basic sensation, so can’t suffer, and so I don’t think has intrinsic value. It is literally no different from any other lump of cells, except it is parasitic and disruptive, with massive mid and long-term consequences if left unchecked.

However, that doesn’t mean that women should just be left to it. I suspect women who have an abortion without being significantly impacted are few and far between, and with abortions should come support. It is difficult to make sure this role doesn’t get taken over by organisations with an anti-choice agenda, but I think it’s important that support is offered.

I am not particularly well versed on baby development, and can’t say anything about how they experience sensation in the early stages of neural development or when they start to develop a sense of self, and I’m not particularly interested in viability as a criteria for parental responsibility. The main consideration for me in this sort of situation is suffering, of all parties, and for all decisions.

I think I would take a fair bit of convincing that a foetus suffers sufficiently at most points in development to make a case against abortion when there is a serious disability or health risk to either party.

I am still a little conflicted about elective late term abortions. Theoretically I think there should probably be a cut off in intentionally killing a foetus at the point where it could, by an equivalently traumatic or invasive procedure, live. So, for example, a woman carrying a 30 week old baby would likely have to give birth to the baby or have a C-section, and whether the baby is dead or alive would not affect that process much. At that point, I think the woman should still be allowed to terminate the pregnancy, but perhaps not by killing the child.

The complexities really come in the time between viability as in ‘could just about survive but with high risk of long term problems‘ and viability as in ‘could survive in the wild on its own‘. How reasonable is it to ask that a woman at 28 weeks pregnant, carrying a baby that may well be viable, but with a higher risk of health problems, carry to at least 34 weeks, making it very likely that the baby could survive just fine? I suspect that the additional few weeks would be a toll on the mother, but I am not sure how this weighs against the likelihood of long-term effects on the baby.

 

What the result of all this, and how that would be enacted legally I have no idea. Translating principles based on theoretical limits like the point of sentience into laws for society is basically impossible, and there are a million practical problems that I haven’t thought about. I don’t have a massive problem with elective abortions only being allowed up until a certain point in normal cases, although I think there should be room for exceptional circumstances such as diagnosis of complications and, perhaps most controversially, not knowing they were pregnant.

Of course this might then start a rash of babies being delivered early by mothers that don’t want them, but A) I very much doubt it would be in any real numbers and B) aren’t there loads of gay or infertile couples after small babies to adopt?

Facts as the basis for media regulation in health

Today I went to an event organised by the Democratic Society to discuss regulation of the media. This is the penultimate stage in their ongoing project, whereby a number of writers have contributed posts on particular aspects of the subject. I wrote a draft piece making the case for change, based on the harm arising from the misrepresentation of science in healthcare.

A lot of interesting discussion was had around how we can encourage the public to participate in the production of the media, how the culture of journalists can be changed for the better, and what oversight and regulation can and should be put in place.

One point of discussion today was the basis on which cases presented to a regulator should be judged. To me, the obvious imperative is to ensure that what is reported is true, or at least not clearly known not to be true. I understand that this is a difficult criteria on which to legislate, for a number of reasons. I also know, having been to a couple of talks by legal blogger and onion knower David Allen Green, that the basis of British law is not the finding of facts, but the determination of liability.

If my understanding is correct following todays discussion, the current system for complaints in the press arena, outside of clearly illegal activities, is based largely on the harm to the individual complainant. The complainant has to demonstrate that the particular story was either an invasion of their privacy, harmed their reputation through implication, or made false statements about them. This is a practical solution to the difficulties of resolving disputes between parties, and could be made to protect parties of lesser power and wealth, although it currently does not.

It seems that much of what was discussed revolved around the manipulation of public perception and the reporting of private lives of individuals. What I feel this misses, though, is the direct protection of the public from directly harmful untruths; it only protects us from untruths that are likely to be harmful to parties that are able to bring the kind of action required, and even then only minimally. I feel it is very important to protect people from wider, currently largely unchallenged untruths that can lead to people making the wrong healthcare choices, and causing unnecessary suffering or death.

It is clear from the large sets of scientific data that there is no link between the MMR vaccine and autism, that drinking alcoholic increases cancer risk, and that homeopathy does not protect against malaria. To say otherwise is both clearly factually inaccurate, and dangerous. My position is that publications that make claims like this should not have to be challenged by an individual that has been directly and demonstrably harmed by that particular article, but should be made to retract claims that are counter to the body of evidence and everything we have learned about healthcare.

Exactly what the mechanism for this would be I do not know, and I am not sufficiently versed in the formations of political and regulatory bodies to speculate on the best fit. However, I am unsure where the significant difference is between the case being brought on the grounds that the claim is wrong or that the claim is potentially harmful. If a claim in the health field is harmful, it is because it is factually wrong. If a healthcare claim is factually wrong it is therefore potentially harmful. These two cannot be clearly distinguished in this instance, as the potential to harm is a necessary property of incorrect health claims – if it doesn’t harm relative to alternative claims, it is not wrong.

What I want to be clear about, though, is a key distinction I would draw. I am convinced that people should be protected from dangerous untruths and that to allow them to be printed unchallenged is a threat to public health, but I do not wish to suppress innovation, new ideas and challenge within science. As long as the facts are presented fairly and accurately and the distinction between fact and speculation is clear, I am positively happy to see people thinking about new forms of treatment based on cutting edge technology, genetic discoveries or refined drugs. It is through innovation and challenge that we make the great breakthroughs.

The best ideas should then be tested thoroughly using appropriate trial designs, to see what is likely to work. These tests will produce a new set of data to add to the pre-existing, on which further theories and speculations can be based. Once again, though, having done the testing, it should be required that the results are accurately described – the facts are the immutable foundations on which any theory should be built. Often several competing ones can be reasonably developed, at least until further testing discriminates between them.

However, in the more developed areas, there tends to be little room for controversy in the evidence, as these controversial areas are the first to get further research to provide clarity on what it is that is happening. The simple facts of the trials to look at the supposed link between MMR and autism are available – no well designed study, of which there have been several, has found evidence of a link. This does not logically prove that the link is not there, but provides a very robust level of evidence – certainly greater than much evidence used to convict people of crimes.

Based on this, I believe the statement ‘there is no link between MMR and autism’ is acceptable as a reasonable summary of the evidence, whereas the statement ‘there is a link between MMR and autism’ is not. It is inaccurate and dangerous, and is exactly the sort of statement that any worthwhile media regulator should be tackling.

The details of how a particular statement is deemed a reasonable summary of the evidence is not clear to me in all cases. Those areas that have live, genuine scientific debate should be allowed to work themselves out through the scientific discourse. Individual facts resulting from experiments should of course never be manipulated or misrepresented, but there will be occasions where there is more than one summary of the available evidence that is reasonable, and the interplay between these is where the interesting science will happen. There is no crime in being wrong when it was a reasonable position to take based on the knowledge available, but continuing to promote a disproven hypothesis in medicine is dangerous.

All the above is simply an expansion on the famous observation that you are entitled to your own opinion, but you are not entitled to your own facts. I think more than that, the media are entitled to give us their opinion, but they are not entitled to give us their own facts. In many areas this is problematic, but in healthcare it leads directly to poor health decisions, and avoidable suffering and death. This must be a priority for a regulator.

NHS, more fury, the media and activism

Oh dear, I’ve gotten quite angry again.

These last ten or so days have seen some massive stories – let’s just describe a few of them.

Look at all that. That’s just the stuff I thought of while eating my noodles at lunchtime, and each one is massive.

And what have been the two stories of the week? VAT got standardised to include pasties, and there isn’t a strike happening. That’s right, 20p on a £1 food item and people going about their regular job is bigger than everything above.

I have seen it suggested that the pasty tax accounts for somewhere between 0.02% and 0.03% of the economy, which, given the recent budget and the cost of healthcare is peanuts. We know that Cameron either lied or got confused about eating a Cornish pasty at Leeds. I can easily imagine misremembering where and when I ate a pasty, so I’m happy to be charitable on that. Hell, even if he lied I’m not particularly bothered as it’s so inconsequential, and we know he lies about much more important things already.

The strike that was discussed was, on the face of it, horrifically handled, initially by Francis Maude ably supported by the tabloid press. Telling people to top up and to keep some in a jerry can at home, to be on the safe side, is the equivalent of shouting fire in a crowded theatre – the only predictable outcome was massive queues and empty petrol stations, and sadly people getting hurt. And after all that, the strike isn’t even going ahead. Without wanting to sound like a conspiracy theorist, the boost to a weak economic quarter may well be a good thing for the government when those first quarter financial figures get announced. However, this story is one of poor politics and mismanagement. On the grand scheme, the fact a strike was discussed does not warrant higher billing than the stories I mentioned up front.

So, why have these two relatively minor stories won the day? Why have we largely ignored the damage being done to those most in need in favour of those with the greatest privilege, with the whiff of corruption looming?

I don’t know, but the mainstream media certainly has a role. The rolling and allotted news programs seem to focus on really simple, easy to tell stories, spending ever more time telling us ever less news. There is also an expected turnover period, meaning that once a story has been told there isn’t space for going into the same area in more depth – I noticed a tweet (sorry, I’ve lost the source) that said a BBC staffer preparing the audience for BBC Question Time said, this week, that the questions had to be topical, and so the NHS shouldn’t be raised. This in the week the Risk Register was leaked.

I sat and watched the ITN News while I was folding letters for the NHS pledge campaign. I saw politicians of all flavours trying to look comfortable and natural while ordering pasties and sausage rolls, while clearly bullshitting about how many they have each week. I saw government ministers telling people to top up their cars and keep jerry cans in the garage. I saw fearmongering about the pace at which drilling technology is being implemented. Nothing about the Risk Register, the economy or increasing social inequality.

These editing decisions, not putting the NHS above the pie tax or the economy above petrol buying, on the nations main news source are either laughably incompetent or criminally biased. Sadly, although I am not a consumer of that many news sources and haven’t monitored them that closely, I understand the problem is across the board. The stories get mentioned, but have not been investigated and examined in the way they should. People should be shown, or at least have easy access to, a clear picture on the important stuff: what is happening to the health service, what is happening to the economy, and how wealth and services are distributed between those that need them and those that can afford £250k to eat with Cameron and Osborne.

In part, the politicians are at fault here. Cameron and the Conservatives should be very pleased overall, as people talking about pie tax is massively preferable to people explaining why he has taken actions that will cause people to die because they are poor, and allowed his friends and business partners to profit from it. I don’t know how the Liberal Democrat leadership should feel, but then I haven’t cared even slightly about that for a while now.

The real political culprits here are Labour. They have had a week of open goals, and there have been occasional scores, but for the Eds to spend a day out and about eating sausage rolls, rather than pointing out the damage Osborne has done and continues to do to the economy, is barmy. They should be publicly pledging to repeal the NHS Bill.
But we can’t just blame politicians or the media, they are both built to give us what we want. We just aren’t aware or interested enough. The politicians literally get their jobs through a series of popularity contests. The media outlets are set up to ensure they maximise their profits – that’s why idiots like Delingpole and Mel Phillips are around – they draw huge numbers of clicks. This means that what they give you is what they think you want. I wrote a bit about media and healthcare reporting here, which looks at the tension between profit and quality healthcare reporting, and there has been a series of articles on media regulation at www.demsoc.org. So in addition to good regulation, we need to be savvy consumers if we want good media coverage of real political arguments. As a consumer, you should be demanding that you get critical analysis of the important issues.

After my rant on the day the Health and Social Care Bill was passed, lots of my Facebook friends got angry and wrote things on their walls. They largely hadn’t realised that they’d missed it, that the process had gone on for over a year, three readings in each house, and a pause for consultation. I am pleased that they felt a bit of outrage, and hope that some of them decided to do something with it; it’s just a shame they hadn’t been up to speed earlier. Writing on your Facebook page, or a blog like this unless you have a very wide readership, is useful in mobilising a small number of people, but largely it isn’t my Facebook friends or twitter followers that make the important political decisions. You need to tell MPs what you want and you have to tell media companies that you expect high quality factual reporting. When they balls it up let them know, and when they get it right let them know.

We are missing out on debate about the biggest decisions of our time, and everyone is gawping at fucking pies. I despair sometimes, I really do. Get on it people, or you will continue to get the media and debate you deserve.

Pledge to the NHS, Ed

Dear Ed Miliband,

I am writing to make a request. Publicly pledge to repeal the Health and Social Care Bill when you get into government.

The past few days, weeks and months have seen the Health and Social Care Bill go through both Houses, without MPs or Lords being shown the Risk Register despite the court ruling. As you are aware, this Bill was passed against the recommendations of the great majority of the governing bodies and unions of health professions, despite the largest public petition since the introduction of the epetition system and without any political mandate. My immediate, guttural response was written up yesterday – apologies for the swearing.

I understand, of course, that you cannot use the sort of language I have done in previous posts. But you are in a position to do something that no-one else is. As a potential Prime Minister, you can:

  • pledge to undo the move toward the two-tier, insurance based health system that this Bill embodies
  • pledge that public spending decisions are taken by public bodies, with the public interest at heart

The most effective way to do this, both in terms of setting up legislation and institutions, and selling it to the public, would be to repeal the bill in its entirety. This is what you should pledge to do.

Andy Burnham in particular made efforts to prevent the Bill passing and has said that he would repeal the Bill if in government. As Shadow Health Secretary, this is excellent news. However, he needs the support of the party leadership to ensure that this is carried out and to make the message sound credible. Will you lend him this support?

I feel that this would be an excellent political move, as there are a number of once Liberal Democrat voters in particular that want to see the NHS continue as an egalitarian system. Many on the left, centre-left and centre would prefer this to the overly expensive and less effective systems we see elsewhere in the world. There are many arguments in favour of a publicly funded and managed health service – value for money for the public, security in open and immediately accessible quality healthcare, minimal conflicts of interest and basic human decency.

If you pledge to ensure the Bill is repealed, I for one, would campaign for Labour for the first time. As it stands, I am an entirely inactive member, with serious concerns over the previous Labour government record, particularly around civil liberties, willingness to enter foreign conflicts unnecessarily and without proper planning, and light touch financial regulation. However, these reservations would be put aside for the sake of rebuilding arguably the greatest achievement of living memory – the NHS.

Please, publicly state that you will ensure that healthcare will never be two-tiered, run by private for profit organisations. The only way to get this message across succinctly would be a commitment to repealing the Bill.

I will be contacting your colleagues, both sitting MPs and parliamentary candidates, before elections to ask them to commit to the same pledge. I will also keep a public record of any correspondence I receive here, or possibly a dedicated blog, unless specifically requested otherwise. I will keep a running tally of those politicians that openly say they would repeal the bill, those who refuse, and those who do not answer given fair opportunity.

Of course, I do not wish this to be a partisan affair and I will be asking the other parties’ members the same question.

Kind regards,

pixie359

NHS, fury and activism

I am furious. Absolutely furious. And I don’t know what to do about it. So I am going to rant here.

Arguably the greatest achievement of mankind is in its death throes, because a small number of incredibly privileged people stand to gain.

This paragraph is taken from the BMJ analysis published a couple of weeks ago (hat tip to Ben Goldacre):

“Entitlement to free health services in England will be curtailed by the Health and Social Care Bill currently before parliament. The bill sets out a new statutory framework that would abolish the duty of primary care trusts (PCTs) to secure health services for everyone living in a defined geographical area. New clinical commissioning groups (CCGs) will arrange provision of fewer government funded health services and determine the scope of these services independently of the secretary of state for health. They may delegate this decision to commercial companies. The bill also provides for health services to be arranged by local authorities, with provision for new charging powers for services currently provided free through the NHS (clauses 1, 12, 13, 17, and 49), and it will give the secretary of state an extraordinary power to exclude people from the health service. Taken together the measures would facilitate the transition from tax financed healthcare to the mixed financing model of the United States. We provide an analysis of the key legal reforms that will govern policy development and implementation if the bill is enacted.”

The NHS reforms that are currently going through will require that private, for profit companies manage and administer one of the largest pots of public money. The services they commission will increasingly be provided by private, for profit companies. These providers will be able to discriminate on the services they deliver, with current NHS hospitals able to take 49% of their revenue from privately funded healthcare. This leads to a reduced range of services available on the NHS, deprioritisation of NHS patients, and much greater reliance on insurance policies or personal wealth. We are entering an age of two tier healthcare based on ability to pay.

This means that people will suffer and people will die unnecessarily, because they are poor. I have three questions – two sensible, and one guttural. What can we do to stop this, how can we prevent it getting this close to happening again, and who do we blame?

Who is to blame? There are a number of culpable parties here. Firstly, the Conservative party. They are evil cunts of the highest order – I don’t care that they may improve access to healthcare data, refocus the school ICT curriculum onto something useful, scrap the ID card scheme and allow gay marriage. These are all good things, which should have been done, but they do not come close to making up for the damage this bill will cause, without even considering the damage already done to those on benefits, and especially the disabled.

But this is what they do. They are ideologically commited to privatisation, free markets, leaving those in need to suffer and reducing tax for the wealthiest. Perhaps they justify their actions internally by appeal to ‘trickle-down-economics’, in which case they are idiots rather than cunts. Perhaps they feel that taxes are an unjustified imposition when they are not direct beneficiaries, given their personal wealth, comfortable incomes and expense structures, and lucrative careers post-politics, in which case they are merely self centred idiots. Perhaps they honestly believe that the poor, the disabled and the sick deserve to suffer, as they brought it on themselves somehow, which shows a horrifying lack of understanding of the real world and the situations that people are in through no fault of their own. Whatever, any system that promotes suffering to create profit is abhorent to me, but intrinsicly Conservative.

The Liberal Democrats are also culpable, and have taken quite a lot of the wrath assosciated with the Health and Social Care Bill. This is because people honestly expected better of them. They presented themselves as a left-of-centre, liberal, rationalist party. I would have happily voted for them at the last election had I lived in a Lib Dem / Tory marginal. Since the election, the party leadership have openly admitted that they were lying toward the end of the election campaign, gone back on publicly signed pledges, and generally enabled the most Tory government in living memory – including Thatcher. I suspect they will suffer the after effects of this for a long time to come.

It is worth thinking about what the Liberal Democrats have achieved in return for this, as I could happily accept that some poor policies could be balanced out against strides made in other areas. Having a quick think about it, I suggest they have achieved fuck all that is good and of any significance.

They were in a hard place at the election, and I understand that – join a coalition or let a minority Tory government rule until they held another election and got a Tory majority. There was no winning, and I can see why they felt they should join the coalition. However, they didn’t need to kill the NHS on the way – the privileges of being in governement must be sufficiently good that all the leadership no longer care about the principles they once said they had.

I am also angry at you and me. The student fees caused sustained mass protests, and I’m not even sure that the new system is particularly worse than the old system, even if it should all be paid out of general taxation. The new healthcare system will lead directly and inexorably to people suffering and dying, and there has hardly been a peep. I know that there was some protest, which was woefully under-reported in the mainstream media, but nothing like the scale it should have been. I wrote to my MP, I signed a couple of petitions, and I tweeted Lib Dem MPs and peers. I was probably one of the more active members of the public around.

But how can that be enough? How can I justify my actions? When our grandchildren first hear of the magical time when the people who could afford it all contributed to look after each other and everyone else, and ask why it stopped, what can I say? ‘Well sweetie, I wrote to one of the people who was sort of in charge, but he was more interested in preserving his job and getting richer.’ That hardly cuts it for me, and I can’t believe it does for you. We need to do something in a last ditch attempt to save the NHS.

What I can do that will have an effect I don’t know. I will write again to each of the local parliamentary candidates (your local MP can be found here), I will ask the Labour party leadership to pledge to undo at least the privatisation aspects of the bill and preferably the marketisation of the previous Labour government, I will let the Liberal Democrat leadership know that this has cost them any chance of having my vote at least until the party kicks them out and repeals the more Tory parts of their policies, I will go to any protests I can.

That’s still not enough though – everyone else needs to get involved too. Possibly, hopefully, we can still create enough pressure and noise that the process breaks down, or at least a future government will undo the damage that the Tories and Lib Dems are visiting on us.

Our long term innoculation against this sort of damage has to be that enough people who give a shit about social justice get really involved in politics, to the extent that they can change it. I need to have a proper think about how I do that.

Health reporting and regulation – the case for change

This post is a recreation of a post at Demsoc.org. They are working on a project to explore media regulation in light of the Leveson inquiry and the Carnegie Plan for Better Journalism. I was asked to write something to highlight the relationship between regulation and healthcare reporting. Here is my first draft. 

 

I am going to write about the representation of healthcare and the science that underpins it in the media, the potentially dangerous effects this can have, and highlight some of the key discussion points around regulation. There are a number of passionate journalists who are very quick to pick up on particular misleading health stories – with amateur and professional ‘skeptics’ leading the way – much better than I could, so I will stick to the systemic issues, borrowing illustrative examples. What I hope to do is demonstrate that there is a case for change to the regulation of health reporting.

As I see it, health reporting suffers from a number of key issues. Stories tend to be simplified and sensationalised, use advertorials unchallenged and are vulnerable to political agenda. At the heart of healthcare reporting there are a set of crucial, perhaps irresolvable, central conflicts which I will try to draw out.

Mainstream media outlets have minimal direct motivation to report healthcare science stories well. The primary motivation for a media organisation is to drive revenue, and healthcare reporting is a tool by which to do that. Whatever the chosen market, this tends toward creating an internal culture that values output over quality and accuracy, often to a particular template. This actively prevents even the best intentioned journalists being more thorough than the minimum required to meet the standard for their organisation.

The reality of the science that informs and underpins healthcare, and the sort of story that best sells papers, drives clicks or otherwise gets the public attention, are wildly different.

On one hand, medical science progresses by small steps, with each new result acting as just another data point in an array that should be considered as a whole. Single facts, experiments or case studies that radically alter the way we view healthcare are rare at best. The key advances in any science are complex, and there is a necessary technical language built around any given area.

On the other hand, magazines write stories weekly, newspapers create new headlines every day, and websites can’t stand still for an hour. This leads to a tendency to inflate the claims of healthcare stories in the search for something new to grab attention, to distinguish the information in this particular story from the general background understanding. Additionaly, the language and concepts must be simplified to fit the audience.

However, we often see the essence of a story damaged in this simplification process. Nuance is lost around the causality of relationships, the confidence in conclusions and the distinction between relative and absolute risks. One example of both oversimplification and sensationalism, explained by Ben Goldacre, is the use of red wine to prevent breast cancer. Red wine contains resveratrol, a chemical that could indirectly reduce damage to DNA, and therefore cancers. But this is an isolated reaction between two chemicals in a lab, ignoring the complexities of the human body and the wine. The other ingredients in red wine, particularly alcohol, cause cancer. The evidence Ben cites suggest that red wine is known to cause cancer, yet because of oversimplification, people are encouraged to drink it as a cancer preventative. It is worth noting that while Ben was writing in 2008, a quick search shows equivalent ‘red wine prevents cancer’ stories still run regularly, and I am not aware of a dramatic change in the evidence base.

Due largely to the sort of output pressures described above, there is also a tendency for journalists and media sources to accept stories at face value. A well written press release by an organisation with an interest in promoting a particular idea will very quickly do the rounds at all the major news outlets, not just unchallenged, but largely unchanged. This process of converting a press release into a story without challenge relieves the pressure on a journalist, as they have effectively outsourced their job. It also means that the public is subjected to advertorial masquerading as editorial, no journalistic investigation applied to the representation the company would like you to see.

Particularly in the special case of publicly funded media, although not exclusively, there is the additional problem of false balance, whereby all views are given equal time and space to be expressed. This is done in the name of fairness, although it presents a false picture, as if the homeopath and the GP view on treatment of particular conditions are of equal value. It feels to me like this is changing, following the recent ‘BBC Trust – Review of impartiality and accuracy of the BBCs coverage of science‘ recommendations, although I would need to see a further study to see how well this has been enacted.

Finally, there is the potential for an agenda to intrude. Here there is a risk that editorial positions can be imposed on ostensibly science reporting in such a way as to mislead. A moral position can lead to particular views on, for example, birth control, and so affect the reporting of sexual health stories. A prior view on the effectiveness and appropriateness of the free market, for example, can lead to misrepresentation of healthcare outcomes under different healthcare delivery systems.

These factors, and more, mean that the healthcare reporting we see in mainstream media is regularly inaccurate. We hope that the inaccuracies are trivial and understandable, in that a process is simplified without loss of meaning. More commonly, there is exaggeration and sensationalism such that the media representation is potentially dangerous. Much has been written on the persistent misleading reporting in the Wakefield and MMR case, largely uncovered by Brian Deer, and there have been outbreaks of measles in recent years, likely as a result. There is also an ongoing controversy around the clinic of Dr. Burzynski in the USA, where unevidenced claims were supported in the national press, prompting charitable donations for children to be sent at great expense to America for treatment that has not been shown to work.

It is important to note that these sorts of reporting problems are found in all mainstream media channels I am acquainted with. There is a tendency to mock the onoing ‘ontological oncological’ project of the Daily Mail, to divide every item into something that causes cancer, cures cancer, or both. The Daily Mail is indeed a regular for poor health science reporting, but is by no means alone – above Ben Goldacre is talking about an article in The Telegraph, and The Observer was involved in the Burzynski controversy. Basically every media outlet was guilty of dangerous misinformation during the MMR crisis. Every mainstream media outlet suffers these problems to a degree.

We have identified some of the main concerns in health reporting, and it is clear that each of these can lead to harm to the public. However, little has been done to rectify these innacurate stories, and those those dangerous reports go largely unchecked. The PCC as it has been is an inappropriate body to take on this role for a number of reasons that become clear when we think of what a regulator should look like.

The key discussion should be around which of these interests we should expect a regulatory system to serve, and how we would expect those to be served. The interests of the public are in having media coverage that is accurate, accessible, complete and relevant. It is through this sort of coverage that people decide to make the best evidence based lifestyle and healthcare decisions.

Given these aims I think a few of the key considerations for the formation of a regulatory body should be:

  • Degree of empowerment to impose sanctions that decrease likelihood of inappropriate activity, including financial penalties
  • Degree of empowerment to impose sanctions that rectify damage – corrections and clarifications in at least as obvious a manner as the original misguiding information
  • Independance from the media sector to reduce conflict of interests
  • Transparency in and public accountability for decision making
  • Magnitude and impact of misrepresentation required for action
  • Simplicity of and mechanism for reporting (perhaps a browser plugin that reports abuses like Fishbarrel does to the ASA)

I don’t pretend to have the answers to the above, but with due consideration, I think a body could be designed that is considerably more effective at protecting the public from harm and promoting quality healthcare science reporting than the current PCC. If this isn’t done, people will continue to be harmed by poor health reporting.

In praise of the Liberal Democrat (party) and the BMA

As it stands, the White Paper for health and social care, ‘Equity and Excellence: Liberating the NHS‘ threatens the principles of universal social healthcare. Healthcare would be designed, bought and delivered by private companies, with huge competition for services that could be profitable, and no providers willing to take a financial loss to deliver required services. The health of patients and the public would be secondary to the profit motive, meaning less investment in non-invasive preventative measures and more focus on high tariff operations.

Perhaps worse is that to get these measures through will cost huge amounts of money in very difficult times, this was not in either parties manifesto and the Health Secretary keeps lying about there being evidence that health outcomes will improve when changes like this have not been attempted elsewhere in the world. It also appears he has been suppressing good news in the form of record patient satisfaction with the NHS, no mean feat given the hard time it feels it has been getting in the press.

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