Viewpoint

Medical Science, the Media and the Public

We live in an age of accelerating change. Individual people, societal institutions and communities have limited capacities to react appropriately to these changes.

As society becomes more crowded, as technology accelerates in terms of its capacity to alter the environment around us, and as the mass of knowledge increases, it becomes increasingly difficult for individuals, no matter how intelligent or hardworking, to maintain a balanced perspective over the range of available knowledge. Nevertheless, society has to decide what pieces of knowledge are valid, which are important, which require action, which should lead to further investment of resources, or deviation thereof.

Over recent decades there has been development and exploitation of the doctrine that the media fulfill a major function by promoting confrontation between individuals, organisations and so forth. Unfortunately, the activities of the Fourth Estate itself are generated by people, with all their prejudices and vested interests. As financial control of the media internationally becomes concentrated in relatively few hands, the possibility of providing unbiased information from a wide series of perspectives becomes increasingly unlikely.

When we consider the practical application of scientific knowledge, some further issues become apparent. Scientists are also human, and those who produce a particular piece of know-ledge generally believe in the basic truth of that knowledge. Moreover, they often feel a moral or ethical compulsion to contribute the results of that knowledge to humanity in general.

No scientist possesses an overall perspective whereby a particular piece of new knowledge can easily be placed into the overall context. Thus there is a universal tendency to overstate cases. This is not in any way dishonest. It is equally common for complex issues to be simplified for presentation to the public or other interested but non-expert groups; that also is not dishonest.

Extrapolations, however, are often made inappropriately. The process of simplification can lead to suppression of awkward or untidy facts which provide the clues which could lead to the next major advance. Problems of funding, and career structures, have produced an increasing tendency for groups of scientists to combine into teams. This process at times intensifies vested interest in particular projects and their continuation. Sometimes these pressures, which include better access to the media by larger groups, can distort the presentation of data in terms of its ultimate public value.

Regardless of these problems, communities, politicians and industry expect scientists to provide practical answers to key questions. The medical scientific community has increasingly used consensus conferences and meta-analysis. The former gathers together a group of eminent experts, preferably with one or two people from outside the field, who survey the apparent state of knowledge and make a series of simplified statements which are then held to be a valid summary of contemporary truth. There is a tendency for voices of dissent to be discounted. The media welcome consensus statements for obvious reasons. Equally, however, the media have a vested interest in exploiting the unorthodox, the premature announcement and the unproven theory. The nett effect of all these processes is confusion in the mind of the public, the scientists and the health practitioners.

Meta-analysis has been introduced because of the sheer economic impossibility of obtaining some items of knowledge concerning efficacy or otherwise of some therapeutic procedures. This technique pools information by combining the results of a series of independently conducted studies. Once again there is a potential risk of supressing dissent and eliminating awkward results. Biological variability is a nuisance which confounds social planners, economists and medical scientists.

Thus, communities have problems in acquiring sound new knowledge which they can then apply unto themselves, while trying to respect the rights of the individual versus the collective responsibility for all citizens.

Communities do make decisions -- for instance to make seat-belts compulsory -- even although the real impact on morbidity and mortality applies to a relatively small section of the population. The seat-belt analogy can be applied to the forced introduction of many public health measures. Few argue about regulations and practices relating to pure water or sewage disposal. There are plenty of medical scientists who preach simplistic messages concerning dietary modification. Cigarette smoking is a relatively easy issue to review in these terms, whereas the problems surrounding alcohol are much more complex.

To what extent is society prepared to modify its manner of living, its industrial production and distribution, to change, overtly or covertly, particular patterns of lifestyle, for the benefits of some and the possible disadvantage of others? Confusion will reign for some time to come. The media will have plenty of opportunity to fill their coffers, and the politicians will not be provided with easy answers.

Can we make any sense of this? We can, provided we stick to the ever-valid principles of moderation and preservation of variety in approaches to all aspects of our daily living. The explosion of knowledge will continue. Society does need to grapple with the issue of how scientific knowledge can be imparted to the community such that the politicians can be prevailed upon to make decisions which have as their basis informed public opinion.

The doctrine of informed consent, and its consequences for ethical medical practice, have been made very plain to the medical and nursing professions in New Zealand. Ironically, however, a series of massive social experiments based upon ephemeral monetaristic economic theories are being imposed upon the population in an absence of adequate debate, or informed decisions. Neither the state nor private enterprise, when initiating major changes, has any statutory obligation to inform the public that they are the subjects of experiments, and that the outcome of those experiments may not be predictable, or even monitored. This point appears to have escaped the media.

If the citizens of New Zealand expect to lead healthier lives for longer, they, and those who determine the resource allocation of this country, need to undertake some of the self-examination which has been forced upon the medical profession over the last few years.

Sir John Scott is professor of medicine at Middlemore Hospital.