LESSONS LEARNED #5

DEFINING ETHICAL HEALTHCARE COMMUNICATIONS

By James E. Lukaszewski, APR, Fellow PRSA

As Published in PBI Media LLC's PR News, August 7, 2000

Copyright © 2000, James E. Lukaszewski. All rights reserved.

Healthcare communication is becoming medical and ethical mush. No matter tops the headlines, the evening news, or the talking heads circuit, there's little question that medical matters will always be a dominant theme. The public has an enormous appetite for health-related information. Unfortunately, this insatiable demand is spurring an increase in the number of relentless, amoral, market-driven organizations shaping today's healthcare content. Factor in the competitive instinct of journalism plus the impact of PR, and the result is a bland stew of daily information, which, when analyzed, more often than not, provides little information of true significance to consumers.

Healthcare communication is driven by a variety of agendas. Among the key drivers are institutions, medical professionals, PR counselors, health journalists, government regulators, and watchdog groups. Looking at this rough-and-tumble environment, one might assume its chemistry would eventually reveal the truth. But, in fact, the "truth" is often the main subject of debate. Some examples: there are at least five battling sectors:

• A new advance in cardiac diagnosis makes big news. It's based on a study of only 17 patients.
• A poll indicates that pregnant women prefer one pain reliever to another. The poll is created, paid for, marketed, and promoted by the manufacturers of key pain relieving ingredients.
• An M.D. publishes a book on the Green Bean Diet, describing it as "the ultimate weight loss technique." There's almost no genuine scientific evidence to support the book's largely anecdotal conclusions. It starts out at #1 on The New York Times non-fiction best-seller list.
• A medical research firm creates a very interesting vector for gene therapy and "by the way," is about to do an IPO. No patient success has yet been verified.
• A national study released last week relates a strong relationship between large daily coffee consumption and increased incidents of erectile dysfunction.
• A multi-nation large-scale study by national coffee producers also released last week indicates that low but constant consumption of coffee can actually help enhance male erectile function.

Who knows what any of this means? Is any of it important or useful?

Academic publications used to be the nucleus for medical innovation in healthcare. They provided enormously advantageous visibility for the sponsoring organizations, collaborating physicians and healthcare professionals, and pharmaceutical companies. We now see the rise of contract research organizations and other approaches that are changing dramatically what the New England Journal of Medicine calls the "drug-trial landscape."

An editorial in Journal's May 18 issue states:

"The ties between clinical researchers and industry include not only grant support, but also a host of other financial arrangements. Researchers serve as consultants to companies whose products they are studying, join advisories boards and speakers bureaus, enter into patent and royalty arrangements, agree to be the listed authors of articles ghostwritten by interested companies, promote drugs and devices at company-sponsored symposiums, and allow themselves to be plied with expensive gifts and trips to luxurious settings. Many also have equity interest in the companies."

What's going through the doctor's mind when he or she is writing prescriptions? Is the prescription being written for a drug manufactured by a company in which the physician owns stock? Or for a product in which that same physician holds a patent? Are we witnessing the complete incremental degradation of medical credibility?

"Medical journalism is big time news," blares a headline in the January/February 2000 Columbia Journalism Review. Yes - and two kinds of medical news are emerging: the news of the hero, the savior, the heart-warming breakthrough; and the victim, the destroyed, the devastated, the disturbing reality of death. What's real? Medical journalism seems as market-driven as medicine itself has become.

Feeding this medical information beast should cause ethical dilemmas from a public relations perspective. The push for publication, the necessity to punch messages through, even the honest hope of helping people leads to four crucial problems:

• Oversimplifying
• Over-glamorizing
• Jumping to unsupported conclusions
• Minimizing risks and potential negative impacts of innovative products and therapies

Granted, the physician and the reporter can each look toward their codes of conduct or ethical reference points about their actions. In the doctor's case it's to "Do no harm," from the Hippocratic Oath. From the journalist's code of conduct it is the same, "To do no harm." For the PR practitioner, however, the credo is a bit more complicated - but certainly manageable. Medical communication requires asking searching questions designed to resolve inherent dilemmas and move toward more solid ethical ground:

• Is there proper disclosure of the various interests in play?
• How credible is the supporting evidence and data?
• Has there been effective peer review by independent medical investigators?

There are undoubtedly other questions. Sorting out these dilemmas in the increasingly complex healthcare field is critical to an ethical practice. More importantly, ethical communications is essential to maintaining the confidence of the public we serve and whose lives our professional work affects.

Sidebar:

Driving Forces

In health care communication, there are at least six battling sectors:

1. Healthcare institutions striving to get their message out. They are competing daily with peers, entrepreneurs, and government regulators.
2. Healthcare professionals who carry the motivating energy to help, save, and better lives - but at the same time operate according to mantras such "publish or perish," "produce or perish," and "sell or be replaced."
3. Public Relations practitioners, alternately looked upon as saviors, slaves, spin artists, and superfluous.
4. Medical journalists, whose goal is to help people while revealing the latest, often untested information. Like all journalists, they're also contenders in the race to break the big news story that some way, somehow, somewhere, something is going to be cured.
5. Government watchdogs and their NGO counterparts. They are working to review, criticize, and perhaps improve the entire process.
6. New healthcare enterprises, created solely to commercialize medical discoveries, usually by obtaining funding in the public markets.

James E. Lukaszewski APR, Fellow PRSA, is recognized as one of America's top authorities on litigation visibility management. Although not an attorney, nearly half of his practice involves civil, criminal, or class action litigation. He'll be conducting a pre-seminar workshop, "Managing PR and Legal Concerns During a Crisis" on Monday, June 19, 2000, 8:30 a.m. to 12:00 noon at the Advanced Crisis Management Seminar sponsored by PR News, the PRSA, and others. Check out his Web site at www.e911.com for even more fascinating information about litigation visibility management. Lukaszewski is a regular columnist for PR News on a wide variety of crisis communication and management communication topics.