Must remain aware that this is at heart an ETHICAL investigation, not social science, science or media studies.

 So – will need to include chapter(s) on ethical theories. Following Karen Sanders (Ethics and Journalism, Sage Publications, 2003), the broad divisions are:

1. Deontological
Kant, based on duty – think categorical imperatives, thou-shalt-not-kill, the Golden Rule

2. Consequentialist/utilitarian 
Bentham, Mill, Locke; based on consequences for human happiness

3. “Virtue ethics”
Aristotelian – seems to be broadly deontological but centred around an idea of meeting each scenario with a question of “what would the virtuous person do?”. This appeals to various virtues – courage, prudence, justice etc; at first glance seems to be in danger of circular reasoning: “what is a moral act?” – “moral acts are those which a virtuous person would perform” – “who is a virtuous person?” – “a person who acts morally” etc, but this will need more looking into.

4. Rights-based ethics: I am free to act as I wish as long as I don’t interfere with other people’s rights (how defined is the question).

Having done so a discussion of which approach (or more likely which combination of approaches – utilitarianism in purest form flawed by “scapegoating”, deontological by somewhat unfeeling disregard for human consequences) is best suited for application to journalism. What particular moral touchstones are there for journalists? This is obviously going to be a major theme, but I’ll jot down ideas here as I go.

My original proposal

October 11, 2006

Research Proposal
The Ethical Responsibility of the Media in Reporting Medical Stories

I propose to research the nature of journalists’ duties in reporting medical stories. In brief, my proposal shall take the following form:1.First, an examination of the ethical duties of journalists. First, it seems clear that they have a duty not to publish stories that will harm individuals or the public in general. Second, they have a duty to seek out and publish stories in the public interest. What should they do when these duties contradict each other? 2. In this context, I intend to look at the difficulties specific to reporting on medical stories – first, the difficulty of establishing scientific “truth”, especially on contested topics; second, the specialist knowledge required to interpret evidence in medicine, which will make it hard if not impossible for journalists to determine for themselves what is in the public interest for themselves; third, the risks to public health of causing health scares. Having done this, I hope to establish what duties journalists have in terms of avoiding or mitigating these difficulties.

3.Second, having – hopefully – established a moral standard for journalists in reporting medical stories, I shall propose discussing several of those stories in turn and how they were covered by various news outlets, to see whether the moral standard is achieved. As an example, I shall briefly outline what strikes me as a clear-cut moral failure by sections of the British media – the undercover stings by various tabloids into MRSA infestation in hospitals.

The philosophical disciplines involved in this project will include ethical philosophy, particularly media and medical ethics, as well as the philosophy of science and epistemology. It will also involve a great deal of study of newspaper archives and television news transcripts. 

It seems uncontroversial to say that journalists have a responsibility to the public. Just as there are limits to free speech in everyday life – the usual example is shouting “fire” in a crowded cinema – so there are limits to what can be printed or broadcast. These limits may involve harm to individuals or their reputations – slander and libel, for example, or the invasion of privacy – or risks to the public in general, perhaps through spreading panic or inciting violence. However, journalists are also supposed to find hidden truths and bring them into the open. Presumably they have a responsibility to uncover those stories that are in the public interest. Ethical journalism, then, presumably involves finding a balance between these two, often contradictory, demands. What is the ideal? It could be argued that journalists must aim for “fairness” or “responsibility” in reporting, but this either begs the question (“you have a responsibility to avoid irresponsibility”) or merely shifts the question back a yard – if fairness is the goal, what is fairness? I hope to answer these questions in the first part of my research.

Having – hopefully – established a working model for journalistic ethics in general, I intend to look at the problems specific to medical stories. First, the idea of “uncovering hidden truths” is problematic. Whatever public opinion may hold, science is not about certainty and the phrases “scientific fact” and “scientifically proven” are less rock-solid than is widely believed. Popper’s famous “black swan” shows that, however many positive examples one can produce, it is impossible to once-and-for-all prove a universal statement, such as “all swans are white”[1], as a single negative counter-example can always disprove it. There are many scientific theories that are now taken to be proven; but even the most hallowed, like the Second Law of Thermodynamics, would be overturned by one replicable experiment that undeniably contradicted them; in the case of the Second Law, by showing heat flowing from a warmer body to a cooler one.

Of course, it is arguable that this is a problem for all journalism and indeed all of human knowledge – Descartes’ “evil daemon[2]” thought experiment shows how difficult a concept certainty is. However, the problem is exacerbated in medical stories, as the knowledge required to evaluate the evidence is likely to be highly specialist and, as a rule, journalists will be unlikely to possess that knowledge.

This leads to a problem – if the journalists themselves aren’t adequate judges of the evidence, how should they go about determining whether to run a story or not? Dr Ben Goldacre, who writes the campaigning “Bad Science” articles in The Guardian, has the following suggestion:

“…if you don’t get it then you have only two choices: you can either learn to interpret data yourself and come to your own informed conclusions; or you decide who to trust[3]

The difficulty, of course, is making that decision. It simply isn’t going to be practical for journalists to re-educate themselves in every specialist topic they write about. But who should they trust to make the interpretations for them? Sometimes the scientific community will be divided over an issue that is of great public interest; what should a responsible journalist do? After all, consensus is almost as rare a thing in science as certainty: 

“As long as there is some uncertainty, a few dissenting voices will persist. These contradictions, although they are wrong most of the time, are valuable because they force a continual re-examination of scientific methods and results. On a few rare occasions, they are even right

What weight should journalists give to minority voices in medical stories? Herein lies another problem that is particularly evident in medical stories: the risk of causing public panic. If – as in, for example, the MMR vaccine/autism controversy – there is a small but highly vocal minority of health professionals declaring something unsafe while the large majority disagree, is it right to provide publicity to the dissenters? After all, as Goldacre rightly points out, “Health scares are like toothpaste: they’re easy to squeeze out, but very difficult to get back in the tube.[5]” And in the example of MMR, the health scare – almost universally discredited, it seems, by reputable medical professionals – has led to a drop in British vaccination levels from a 1995/96 high of 92% to a mere 80% in 2003/04[6] – and indeed falling as low as 62% in south-east London. This has created a very serious risk of a measles epidemic. Was it really ethically responsible of, for example, The Daily Mail’s Melanie Phillips to be stating in a national newspaper that “the idea that MMR was always safe is demonstrable nonsense[7]” in 2005? This was, after all, nearly five years after a report by the American Academy of Pediatrics concluded:

  • available evidence does not support the hypothesis that MMR vaccine causes autism or associated disorders, nor does it cause IBD [inflammatory bowel disease];
  • separate administration of components of the vaccine would provide no benefit and would result in delayed or missed immunisation. [8]

    The final and, I anticipate, largest section of the research would involve examining a variety of medical stories in the national media and determining which, if any, outlets failed to meet the standards of responsibility that we will have established.

    Stories would include the abovementioned MMR vaccine scare, recent concerns over the so-called “superbug” MRSA being found in British hospitals, avian influenza and its apparent confusion in the British media with the anticipated flu epidemic in the winter of 2005/06 which led to flu vaccine shortages, the “3rd-generation” oral contraceptive pill and its links with an increased risk of embolic thrombocytaemia, and others. I envisage each story having a chapter devoted to it, subdivided into tabloid, broadsheet and broadcast media.

    Each of these stories will require a large amount of research, and so it is impractical to go into each one in much detail here. I will, instead, focus on what seems to me to be a fairly clear-cut example of ethical failure on the part of several media outlets as a taster. In August 2004, the Sunday Mirror ran a story called “The Mop of Death”, declaring that “One mop we tested was infested with 300 TIMES the safe limit of the superbug MRSA”. All the other major tabloids ran with similar stories, each revealing dangerous levels of methicillin-resistant Staphylococcus aureus – to give it its full name – in one hospital or another.

    These were truly alarming results, and understandably there were considerable column inches given over to the topic. However, all was not as it seemed. It turns out that all the positive results used in the above stories came from a single laboratory. I hand over to Dr Goldacre once again:

    “…a small unaccredited laboratory in Northants called Chemsol, run by a man with a non-accredited correspondence-course PhD and no formal microbiology training, and he seems to find MRSA in hospitals where other accredited labs, in universities and the like, cannot. And, weirdly, almost every undercover tabloid journalist who gets an “MRSA hospital scandal” scoop involving positive swabs seems to have used this Chemsol operation. I include the Evening Standard, the Mail, the Sun, and of course the Mirror, for their fantastic “Mop Of Death” story[10].”

    He continues to say that after some years of trying – including questions being asked in Parliament – UCL microbiologists were sent eight of the samples from which Chemsol got positive MRSA results. Six were found to be negative – both for live bacteria and the PCR “DNA fingerprinting” which would allow the testers to find dead ones – and the other two contained a strain of MRSA which had never been seen before outside Australia. Chemsol, incidentally, also performed tests for Australian media outlets, so the probability of cross-contamination was high. More than this, Chemsol’s main source of income was the sale of “Compact Antimicrobial Hospital Packs” for people worried about MRSA in hospital, and the methods used in the lab were unable to distinguish “Staph. aureus” – including, but not limited to, MRSA – “from the mostly harmless and completely different Staph. epidermidis[11]

    When Goldacre was writing – November last year, fully fifteen months after the Mirror’s “Mop” story – not one newspaper had retracted its story. I intend to investigate this and the other stories in far more detail, but I hope to have shown that there is at least room for research in the area of media ethics in reporting of medical stories. 

    ·   


    [1] Karl Popper, The Logic of Scientific Discovery, Routledge; New Ed edition, March 29 2002, p27[2] René Descartes, Meditations on First Philosophy, Cambridge University Press 1986 edition, 1st Meditation

    [3] “The MMR sceptic who just doesn’t understand science”, Ben Goldacre, The Guardian, Wednesday November 2, 2005

    [4] S George Philander, Is the Temperature Rising? The Uncertain Science of Global Warming, Princeton University Press,
    Princeton NJ, 1998; p9

    [5] “The MMR sceptic who just doesn’t understand science”, Ben Goldacre, The Guardian, Wednesday November 2, 2005

    [6] “MMR crisis could spark measles epidemic”, The Daily Telegraph, 23rd September 2004

    [7] “MMR: the unanswered questions”, Melanie Phillips, The Daily Mail, 31 October 2005

    [8] “Measles-Mumps-Rubella Vaccine and Autistic Spectrum Disorder: Report

    from the New Challenges in Childhood Immunizations Conference Convened in
    Oak Brook, Illinois, June 12-13, 2000”. Halsey NA, Hyman SL (2001). Pediatrics 107: E84 (full text
    www.pediatrics.org/cgi/content/full/107/5/e84): quoted on www.healthwatch.co.uk,7th March 2002.

    [9] “The Mop of Death”, The Sunday Mirror, 29 August 2004

    [10] “The man behind the Mop of Death”,  Ben Goldacre, The Guardian, October 22nd, 2005

    [11] “After feeding the scare he’ll sell you the solution”, Ben Goldacre, The Guardian, October 29th, 2005

  •   What resources will I need?

    1. Archives from, say, three newspapers (perhaps – Guardian, Daily Mail, Sun? Another point for debate) on MRSA, MMR and Herceptin stories
    2. The relevant scientific papers. This will include (but probably not be limited to) the original Wakefield report suggesting a link between MMR and autism, as well as the Cochrane meta-study critiquing the various trials that followed; the reports following the “mop of death” stories on MRSA on the undercover samples taken; and the NICE reports on the clinical (and cost-) effectiveness of Herceptin. I may need outside help determining which papers are relevant.
    3. The Press Complaints Commission’s code of practice (already have it off their website) and (perhaps) an equivalent for broadcast journalism
    4. DoH policy stuff – ask Mum about this; particularly worth looking at www.mmrthefacts.nhs.uk in the meantime, though.

    Who will I need to speak to and why? 

    Medics:

    1. To compare scientific literature with press reporting.
    2. To  gain front-line information on how reporting affects public opinion and how easy it is to do their jobs; how much harder did the Wakefield/MMR scare make it for GPs to convince parents to vaccinate? Did MRSA scare stories lead to problems either in convincing patients to go to hospital or treating them once they were there – and (despite the apparent malpractice of the press in the undercover-swab stories) were these scare stories justified? Do oncologists feel pressured into prescribing Herceptin in cases where it is not cost- or clinically effective?
    3. To establish what, if any, responsibilities medics believe they have in communicating effectively with journalists.  Clearly they have a duty to report their research etc fairly, but should they treat distortion as a “natural hazard” of dealing with the media?

    Journalists:

    1. To discover the extent of their specialist knowledge on the topics they are writing about – specifically science and health
    2. To discover their degree of training and/or understanding regarding their ethical responsibilities and the extent to which they feel obliged to honour them
    3. To discover the pressures to sensationalise stories beyond what the literature supports

    What skills will I need? 

    1. Most important, I will need to be able to make sense of scientific papers for myself. Hopefully I will be able to find a pet medic or scientist to do the real in-depth stuff but I’ll still need to form opinions of my own.
    2. Interviewing techniques (obviously – see above)
    3. Teaching skills (worth getting even if I don’t start teaching ‘til after the PhD is completed)
    4. Library training
    5. Archive training

    Questions so far

    October 4, 2006

    1.  What requirements should be placed on medical/scientific journalists to be educated in their field? Compare British to US scientific journalism.

    2. How should these – and other – requirements be put in place; voluntary regulation, legislation?

    3. Should ethical training be required for journalists?

    4. Should regulation be increased in other areas – i.e. declaration of interests, objectivity/fairness, separation of news and comment? Again, should regulation be self-imposed or legislated? What evidence is there of the effectiveness or otherwise of self-imposed (PCC) regulation, and what are the risks of legislation – might it draw the teeth of the media?

    5. What medical/scientific knowledge and understanding is it reasonable for a journalist to assume of his/her readership? Where is the line between helpful exposition and condescension? How much should it change between publications? Is it true that The Sun is deliberately written for a reading age of nine, and if so should it assume a similar level of expertise in its readers?

    6. Do journalists have a duty to their employers to sell papers? To what extent could sensationalism be justified by that? Or, rather – since it sounds tautological to say that “sensationalism” is a bad thing – when does justifiable volubility become sensationalism? Presumably if there is such a thing as a duty to their employers, then it will require “upselling” stories somewhat or the duty becomes meaningless.

    7. Perhaps the chief question: what is the line between reporting in the public interest and scaremongering?

    8. When should the scientific consensus view be taken at face value, and when should it be questioned? Scientifically untrained journalists should be wary of seeking out controversial views for “balance”, but I believe there are cases when the “establishment” view has turned out to be dangerously wrong – BSE? Asbestos? Were these views supported by the scientific community? A decent-sized section on Popperian scientific philosophy – what is certainty? Can it be achieved? Falsifiability, inductive reasoning, etc – would be interesting and informative.

     9. What responsibilities do scientists and doctors have in reporting their research to the media? Ben Goldacre, the Newton’s Apple Thinktank launch essays, badscience.net, 16th Oct 2006:

    Scientists and doctors, for example, can take care to be clear about the status and significance of their work when talking to journalists. Are the results preliminary? Have they been replicated? Have they been published? Do they differ from previous studies? Can you generalise, say, from your sample population to the general population, or from your animal model to humans? Are there other valid interpretations of your results? Have you been clear on what the data actually show, as opposed to your own speculation and interpretation? And so on.

    It is naive to imagine that such basic guidelines will be heeded by the irresponsible characters on the fringes who produce so much media coverage. However, they do represent best practice, and so they are always worth reiterating: they deserve to be incorporated into codes of practice from professional bodies and research funding bodies.

    “Scientists and doctors would also be well advised to take some even simpler steps: to think through the possible implications of their work, inform interested parties before publication, and seek advice from colleagues and press officers. This advice and more is all covered in the Royal Society’s excellent Guidelines on Science and Health Communication, published in 2001 [3].

    Journals, too, can take a lead, since they often produce the promotional material for research. Risk communication is a key area here, and although it is tempting to present risk increases, and indeed benefits, using the largest single number available (the “relative risk increase”) it is also useful to give the “natural frequency”. This figure has context built-in and is more intuitively understandable: it is the difference between ibuprofen causing “a 24 per cent increase in heart attacks” (the relative risk increase) and “one extra heart attack in every 1,005 people taking it”.

    10. Does freely available, peer-reviewed scientific literature – which should in theory remove concerns about conflicts of interest on the part of the writers – confuse journalists more used to hunting out hidden agendas? A common theme appears to be “this researcher has in the past received funding from Drug Company A; therefore we should distrust his research purporting to show the efficacy of Drug Company A’s new product”. Is this unfair or is there reason to doubt it? Goldacre: http://www.badscience.net/?p=251 “…over the past few years there have been numerous systematic reviews showing that studies funded by the pharmaceutical industry are several times more likely to show favourable results than studies funded by independent sources”. Sinister?

    11. Further to the drug company thing – how widespread is the practice of using charities and friendly media outlets to sidestep advertising standards rules? Who has what responsibility where in that scenario?

    12. How should I decide which articles to use? Presumably won’t be able to use all of them. Is there a way of randomly selecting them? Should I deliberately choose the most distorted pieces or am I then guilty of distortion myself? Anyway. Will need to establish a selection process. Could simply be “the ones that interest me”, I suppose – they don’t have to be representative of a paper’s editorial stance, since the existence of an unsound piece is A Bad Thing all on its own. Hmm. Seek advice.

    13. From Dad: [There are things like] glue sniffing which by consensus just don’t get a mention in the press in an attempt to prevent young people giving it a try. This made us wonder if you should have a chapter on examples of formal and informal agreements like this and their effectiveness.

    P-value/Error bar – let’s face it will need overall scientific skills refresher

     Interviewing techniques

    Archive stuff – particularly news archives (Lexis Nexis? Someone who knows what that is would be handy to know)

    “Although the nature of the distinction between withholding and withdrawing seems clear enough initially, cases that obscure it abound… Many therapies in medicine require repeated applications of an intervention. Does failing to continue to reapply count as “stopping” (the series of treatments) or “not starting” (the next element in the series)? Even when a clear distinction can be made between withdrawing and withholding, insofar as the distinction is merely an instance of the acting-omitting distinction it lacks moral significance.” Source Book in Bioethics (ed. Albert R Jonsen, Robert M Veatch, LeRoy Walters)Georgetown University Press 1998 p173

    The New Elites – George Walden (2000)

    Autonomy and Trust in Bioethics – Onora O’Neill (errr, really should have got date) – particularly chapter 8, Bioethics and the Media

     MMR and Autism – Michael Fitzpatrick (see also 2003 article on Spiked.com)

     Christians, 1995

    Starck, 2001

    Kieran, 1997

    Frost, 2001

    Keeble, 2001

    Tobjorn Tannsjo, Understanding Ethics: An Introduction to Moral Theory, Edinburgh University Press 2002

    ‘As Dan Klein wisely points out, “That there is twilight does not destroy the distinction between night and day. Conditions might be ambiguous at 6:30 in the evening, but at 12 noon it unambiguously is day and at 12 midnight unambiguously night.”‘ Daniel B Klein, Mere Libertarianism: Blending Hayek and Rothbard, Reason Papers: A Journal of Interdisciplinary Normative Studies March 2001, p12

    ONLINE REFERENCES

    http://www.mmrthefacts.nhs.uk/
    http://pediatrics.aappublications.org/cgi/content/full/118/4/1664
    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15877763&query_hl=3&itool=pubmed_docsum
    http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004407/frame.html
    http://bmj.bmjjournals.com/cgi/content/full/331/7525/1148
    http://www.royalsoc.ac.uk/document.asp?tip=0&id=1412

    And a PubMed search for MMR – autism articles in the Lancet, BMJ, Journal of the American Medical Association, and New England Journal of Medicine: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=Display&DB=pubmed

    MORE ONLINE REFERENCES KINDLY PROVIDED BY THE GOOD FOLKS AT BADSCIENCE.NET

    http://badscience.net/forum/viewtopic.php?t=1082

    On climate change: http://environment.newscientist.com/channel/earth/dn11462

    Right. This is the Inaugural Entry of Tom’s PhD diary – which will probably be not so much a diary as a series of unconnected ramblings, interesting references, links and bookmarks, occasional notes-to-self and aides memoire (memoires? Whatever) and wild digressions on what happens to be on my mind at the time. So it’ll probably be of very little interest to anyone but myself – indeed, it will certainly be of no interest for the next few months until I work out the vague shape of what I’m going to be doing. I just thought I’d warn anyone who’s stumbled across this by accident. If you actually want to read something I’ve written, then go to http://blog.myspace.com/tommychivers and may God have mercy upon your soul.