Matters of Life and Death. André Picard
they are current, though when I first discussed this idea with the publisher, I said, only half-jokingly, “The good news is that in Canadian health care, nothing ever changes, so even old columns are still current.” Of course, the bad news is that in Canadian health care, nothing ever changes.
But to be fair, that isn’t really true. Health care is immeasurably better today than when I started writing about it three decades ago. But our expectations are much higher. And the system is not adapting nearly quickly enough to profound changes in demographics, technology and medicine. It’s a constant game of catch-up where we fall a little bit further behind every day. It’s like that in journalism, too, an industry and a profession that has undergone cataclysmic change in recent years. Today, the good health reporting is better than it’s ever been, but the bad health reporting is worse than it’s ever been. If nothing else, at least the good health journalists have become more introspective and self-critical.
A few years back, Gary Schwitzer, a former medical correspondent at CNN and the founder of Health News Review, a health-news watchdog newsletter, penned a list of ten troublesome trends in health news. Most people today get their health information from the media and from television in particular. This places a heavy responsibility on journalists. But in Schwitzer’s estimation, health reporting has many shortcomings, which he summarized like this:
1 Too brief to matter. The brevity of stories—they rarely exceed one minute on TV or five hundred words in print—means they lack context and significant details.
2 No full-time health journalists. Networks such as the CBC and CTV and newspapers such as The Globe and Mail have full-time beat reporters, but they are the exceptions. Most media outlets operate on the wrong-headed assumption that any reporter can jump effortlessly from covering city hall to the intricacies of cyclo-oxygenase-2 inhibitors.
3 No data to back up sensational claims. Far too many unproven—and at times frankly ridiculous—claims are aired or printed without even the most cursory examination of data.
4 Hyperbole. Each day reports of miracle drugs and treatments appear that in fact are, at best, incremental improvements.
5 Commercialism. At times, health “news” is thinly veiled promotional material.
6 Single sources. Health stories with just a single source are commonplace. They lack balance.
7 Baseless predictions from basic science. Far too many studies conducted in test tubes or on mice are touted as potential treatments in people. If only it were so simple.
8 FDA approval treated as an accomplished fact. Consumers are often left with the impression that experimental treatments and drugs in early phases of research will be on the market imminently, as if testing and regulatory approval are mere formalities.
9 Little coverage of health policy. Trivialities like cosmetic medicine (Botox and the like) get more coverage than critical issues like access to care and defining what is in the medicare “basket of services.”
10 No time for enterprise. Much health reporting is little more than regurgitation of news releases, medical journal studies and press conferences. There is little investment in in-depth or investigative journalism.
Mr. Schwitzer’s list is a good one, but it is incomplete. Here are ten more troublesome trends:
1 Story selection. Cute trumps meaningful. Quirky or pathos-laden stories, such as the separation of conjoined twins, tend to get more extensive coverage than those with broad policy implications, such as research questioning the value of breast cancer screening.
2 Black and white. Health stories tend to be black or white. Vioxx bad; Aspirin good. Trans fats bad; omega-3s good. But in science and health research a lot of greys exist; there are rarely absolutes.
3 Jingoism. The media give disproportionate attention to homegrown research, regardless of the importance or relevance of findings.
4 Short-sightedness. There is virtually no coverage of the greatest threats to health on the planet: poverty, disenfranchisement and lack of access to clean water, adequate nutrition and basic sanitation.
5 Too little training. Much research published in medical journals is of dizzying complexity and its jargon is quasi-impenetrable. Journalists need to understand statistics and technical language to decipher it, but media outlets are reluctant to invest in training.
6 Obsession with technology. A widespread assumption exists in health stories that newer is better, and that the solution to many problems is found in newer drugs and fancier equipment. Again, the reality is that addressing basic determinants of health—income, housing and the like—carries far more impact.
7 Is it really a cure? The word cure is bandied about irresponsibly. We have many ways of treating and managing disease, but virtually no cures. And “curing” a rat of cancer is a far cry from curing it in a human.
8 A sense of proportion. SARS killed forty-four people in Canada. Influenza and pneumonia kill close to five thousand annually. Health issues that affect the economy and the lives of well-to-do Westerners are blown out of proportion compared with issues that affect broad swaths of the population.
9 Lack of skepticism. One of the most important traits for journalists is a well-honed sense of doubt—about everything. When skepticism makes way for cheerleading, the result is poor health reporting.
10 Kowtowing. A lot of uncritical reporting occurs of the views of those in positions of power—physicians, professors, medical associations and pharmaceutical company executives—without questioning their self-interest. This pandering does a great disservice to health consumers.
Good health reporting should provide a straightforward, comprehensible summary of health issues. It has to be more than regurgitation. It needs to be balanced and provide context to information-hungry consumers. It has to take complex issues and make them digestible and relevant. Good health reporting should rarely be sensational, but always be skeptical. We can’t forget that the issues we write about are important to patients, their families, policy-makers, politicians, clinicians and scientists. Often, seemingly banal issues turn out to be matters of life and death.
Chapter 1
Medicare
Dragging medicare into the twenty-first century
Nothing matters more, individually or collectively, than our health. Regardless of political allegiance, Canadians are nearly unanimous that a universal health system is a good thing—for reasons of economics and social justice. That’s why every Western country save one has a universal system. When it comes to health care, only the United States is morally bankrupt and economically inept.
Canadians take pride in besting the United States on the health front, but it is a hollow victory. In reality, every other developed country has universal health care that is better, fairer and cheaper than ours. We are big on grand pronouncements such as, “Medicare is what defines us as Canadians.” But we are laggards on the practical side.
Canadians want care that is appropriate, timely, accessible, safe and affordable, from birth until death. Yet our system is failing on virtually all those measures. Why? For starters, we lack vision and goals. Canadian health care is a $228-billion-a-year enterprise with no clear goals and a dearth of leadership. We talk endlessly about the sustainability of medicare but have no idea what we want to sustain. Our medicare model is a relic, frozen in time. Tommy Douglas’s role in shaping publicly funded health insurance for hospital and physician care is celebrated, mythologized even. But we conveniently ignore that medicare was designed to meet the needs of 1950s Canada.
In 1957—when the program became nominally national—the average age of Canadians was twenty-seven. Health care consisted of acute, episodic care: going to the doctor for treatment of an infectious disease, or to the hospital to give birth, have surgery or die. Today, the average age of Canadians is forty-seven. The