eMJA: Chapman, Media milking of sacred cows: a heart-stopping tale

Medicine and the media

Media milking of sacred cows: a heart-stopping tale

Were there alternative frames that could have attracted journalistic interest in this trial?

MJA 2001; 175: 629-630

In 1897, William Osler advised doctors not to "toy with the Delilah of the press".¹ Despite researchers being generally delighted with journalists' translations of their work into news² (few would disagree with Mae West that it's better to be looked over than overlooked), Osler's counsel sadly retains widespread support in the health professions. For too many, journalists spell trouble.

Some who have been bruised by what they consider trite, sensationalised or misleading news reports of their research assume that journalists are mere ciphers for doctors and scientists, providing a sort of popular scientific abstracting service which is falling down in its duty. While the news media may be an arm of the health service in some countries, they play an entirely different role in open societies like Australia. Here, facts frequently serve as pretexts to publish richly subtextual moral tales intended to resonate with readers, retain their loyalty and, in expanding readership, attract greater advertising revenue. Journalists' routines are governed by ambitions to get on the front page and break "exclusive" news that will ripple for days through their rival's news media. When this ambition dovetails with public health and the wider public interest, most are happy to applaud the media as a highly influential force for good. But, when popular news frames are invoked to negatively frame potential advances in patient care or public health, the media can be a powerfully conservative force that can damn progress.


	Almost by definition, people in the midst of life-threatening medical emergencies, who may be unconscious, in shock, in extreme pain or delirious, surrender their normal sentient ability to consent.

Health and medicine are rich with news value.³ Doctors are cast by the news media in many roles:⁴ for example, as medical miracle workers;⁵ as sages interpreting issues of contemporary morality; as intrepid, no-stone-unturned disease detectives;⁶ or as entrepreneurs. Rasmussen and colleagues, who describe their experience with the media in this issue of the Journal,⁷ perceived their role as just trying to save the lives of patients with acute myocardial infarction (AMI). They aimed to compare the outcomes of transporting patients with AMI to a large centre with facilities for angioplasty and stenting with the conventional wisdom of rushing them to the nearest hospital for standard treatment. These researchers were following the long tradition of those who have sought to improve survival rates through a randomised controlled trial. But reporter Gerald Ryle and his editors at the Sydney Morning Herald judged other news frames to be more compelling. They chose to see the story as one of doctors who, "believing their own omnipotence", "press-ganged" vulnerable people into some dangerous and radical "experiment".^8,9

Ryle's reports,^8,10 the Herald's editorial,⁹ and their sequelae voiced by radio commentators, framed the trial as an example of arrogant doctors dicing with patients' lives. The main ingredients of the "story" were the notions that two inviolable conventions were being trampled underfoot. Blind Freddy — or the Herald's editorial writer — knows that transporting a person having an infarct to the nearest hospital without delay, and obtaining patient consent to treatment, are sacrosanct.

The transportation issue taps into the same ordinary person's outrage when a local hospital is closed, and politicians explain that patients are better served by travelling the extra distance to a larger hospital. In criticisms of this aspect of the trial, the important question of whether patients might actually benefit by travelling the extra distance was lost.

Both the righteous indignation of the accusations that patient consent to involvement in the trial would not be obtained, and the restrained dissection by Rasmussen et al of the folly of that indignation, will cause many heads to shake in disbelief. Almost by definition, people in the midst of life-threatening medical emergencies, who may be unconscious, in shock, in extreme pain or delirious, surrender their normal sentient ability to consent. To describe this as being "press-ganged" was sure to produce popular outrage.

Were there alternative frames that could have just as easily attracted journalistic interest in this trial? Opposition had often been voiced in local newspapers, because of implications for local hospitals of the trial's possible success. If it showed important patient benefit, local coronary care facilities may have been downgraded, with all the downstream implications. "Doctors seek to stop life saving heart trial", with an investigation of the motives and interests of local opposition to the trial, might have been another headline that defined the same events with rather different outcomes.

Alan Otten, with the Wall Street Journal for 44 years, notes that "Well done investigative reporting produces public outrage . . . Ten-thousand-watt klieg lights turned on a situation focuses the minds of policy makers very fast."¹¹ Ryle's front-page arc lights precipitated ministerial intervention, stopping a trial that may have led to many lives being saved. The sacred cow of the shortest possible ambulance ride remains intact, as presumably does the despair of those hoping to use research to find ways of improving survival rates after AMI.

The history of medicine is full of tumultuous episodes where accepted procedures were challenged by innovators and where the orthodoxy stood to lose from the change.¹² This episode adds to that litany, but hopefully will not jaundice what is so often a mutually productive relationship between medicine and the media.

Simon Chapman
Professor, Department of Public Health and Community Medicine
University of Sydney, Sydney, NSW

Competing interests: None declared.

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Rasmussen HH, Hansen PS, Koyama Y, et al. Trial of a trial by media. Med J Aust 2001; 175: 625-628.
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Medicine on trial [editorial]. Sydney Morning Herald 2001; 2 April: 12.
Ryle G. A trial of the heart. Sydney Morning Herald 2001; 29 March: 11.
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