Brian Williams isn’t NBC’s only ethical problem; check medical news coverage issues

So Brian Williams, it’s now reported, will be suspended without pay for 6 months by NBC News after his false claims about an experience during the Iraq war.

A few months ago, NBC’s Chief Medical Correspondent, Dr. Nancy Snyderman was taken off the air after “a breach of her Ebola quarantine.” 

Almost immediately, NBC brought on Dr. Natalie Azar as medical contributor – presumably to at least temporarily replace Snyderman.

Last night, Williams’ replacement anchorman, Lester Holt, introduced Azar at the end of a video package on “What Doctors Want You to Know About Chronic Fatigue Syndrome,” saying:

“Our medical contributor Dr. Natalie Azar joins us now. She’s a rheumatologist and treats chronic fatigue disease….” Azar went on to say what a big day this was on many counts, including “education for physicians so they can refer patients to physicians who can manage this.”

Hmmm….meaning physicians like her, who was just introduced on network TV as one who “treats chronic fatigue disease”?

We may be struggling with what to call chronic fatigue disease, but we shouldn’t struggle with calling this appearance what it is:  a conflict of interest.

Dr. Azar didn’t appear as an interviewee. She appeared as an NBC News Medical Contributor.   Should we next expect – and look the other way – if a person who sells drones appears as an NBC News Contributor about the wonders of drones?  Or a Boston snow-plow company owner appearing as an NBC News Contributor about what a great job of snow removal he has done and can continue to do?

(The embed code provided by NBC doesn’t work, but you can click on the image below to get to the link with the on-air video.)

 

 

The networks either don’t get it or they don’t give a damn.  Put a bright young MD face on the air (younger, we might point out, than Nancy Snyderman) and to hell with any critics who point out conflict of interest.

Fox News thumbs its nose at blatant conflicts of interest with contributions from  Dr. David Samadi and, more recently, from Dr. Jennifer Landa.

A recent Columbia Journalism Review piece, “Database may uncover conflicts of interest for TV doctors,”  raised questions about COI at other networks, as I have in the past.

Maybe when no one with a pulse is left watching, they’ll get the message.

 

Addendum:  On February 16, I added a new post, “A new MD-journalist asks, ‘Is there a role for the physician-journalist?’ ”  It’s a long (2,000 words, sorry!) response to a series of smart questions raised by a recent Harvard Med School grad and aspiring journalist.

———————-

Follow us on Twitter:

https://twitter.com/garyschwitzer

https://twitter.com/healthnewsrevu

and on Facebook.

You might also like

Comments (16)

We Welcome Comments. But please note: We will delete comments left by anyone who doesn’t leave an actual first and last name and an actual email address.

We will delete comments that include personal attacks, unfounded allegations, unverified facts, product pitches, or profanity. We will also end any thread of repetitive comments. Comments should primarily discuss the quality (or lack thereof) in journalism or other media messages about health and medicine. This is not intended to be a forum for definitive discussions about medicine or science. Nor is it a forum to share your personal story about a disease or treatment -- your comment must relate to media messages about health care. If your comment doesn't adhere to these policies, we won't post it. Questions? Please see more on our comments policy.

Keith Taylor

February 11, 2015 at 11:20 am

So, are you trying to say that on-air TV doctors, like Dr. Sanjay Gupta of CNN for instance, should not do neurological stories and tell viewers to see a neurologist or neurosurgeon when experiencing certain symptoms… because he’s a still-practicing experienced neurosurgeon and expert in that field?

Gary Schwitzer

February 11, 2015 at 11:47 am

Keith,

Thanks for your note.

I’m saying – and I’ve provided links to several other examples – that there are many ethical concerns in the way MD-journalists-contributors are “packaged” and delivered within news segments. A more wide-ranging sampling of issues that I’ve written about in the past can be seen on this search results page: https://www.healthnewsreview.org/?s=network+tv+ethics&x=0&y=0&post_type=post.

In this case, introducing an MD-contributor as someone who treats the same condition that has just been discussed is a conflict of interest. We’d be in an uproar if we had a US Senator appear as a journalist-contributor and then ask him/her to discuss the bill that he/she sponsors. The networks just seem to consistently treat health/medical/science news a different way, under a different code of ethics.

But what, exactly, is that code of ethics?

John Cella

February 11, 2015 at 12:04 pm

Dr. Azar also perpetuated falsehoods about Chronic Fatigue Syndrome (ME/CFS, and now renamed Systemic Exertion Intolerance Disease). She stated that Cognitive Behavior Therapy and exercise can help with this disease. CBT is completely ineffective, and exercise is dangerous (hence the name Systemic EXERTION INTOLERANCE Disease) to this patient population. There is no effective treatment. There is no cure. Having had this disease for 15 years, and been disabled for 4 1/2, I have tried virtually every reasonable recommendation and several unreasonable ones. I have met doctors who are truly trying to help and doctors who have struck the mother lode of a vast community of patients desperate and willing to pay to get their lives back. Dr. Azar owes an on-air correction for the gross disservice she did to the patient community, the medical community, and to Lester Holt.

Brad F

February 11, 2015 at 6:47 pm

Gary
If the individual speaking doesnt stand to gain–the patients should get to them regardless who delivers the info– Im missing the COI.

Now I completely get where this can go way over the line and precedents can be set. But on a case by case basis, if all patients with disease x should see doctors who do y, and correspondent is y–and info conveyed is factual and correct, has anything unsavory occurred?

Brad

Gary Schwitzer

February 11, 2015 at 6:53 pm

Brad,

Maybe as a physician, you’re too close to this.

The individual involved clearly stands to gain.

I’m missing how you’re missing this.

It’s a journalism ethics 101 issue.

Brad F

February 11, 2015 at 7:01 pm

Perhaps I am.

Miriam E. Tucker

February 11, 2015 at 8:36 pm

Per Mr. Cella’s comment, Dr. Azar’s statement that both cognitive behavioral therapy and graded exercise are effective treatments for SEID is hugely controversial, dating back to the 2011 publication of the “PACE” trial. I wrote about this recently for Medscape: http://www.medscape.com/viewarticle/838452

Gary Schwitzer

February 12, 2015 at 12:32 pm

Andrew,

Good reminder.

I had blogged about that episode in a brief mention on Jan. 11: https://www.healthnewsreview.org/2015/01/sunday-summary-of-other-noteworthy-health-care-news/

But these network COI issues arise so frequently, even as (especially as?) one who tracks this stuff all the time, it’s easy to lose track.

Shara Yurkiewicz

February 12, 2015 at 8:47 pm

Several of us got into a debate about this concept at MedPage Today. My background: I graduated from medical school, am doing a one-year fellowship as a medical journalism fellow at MedPage Today, and plan to start residency in a few months. I also hope to remain involved in journalism in some form as a practicing physician.

I watched the clip, and the segment itself wasn’t led by Azar. Azar weighs in at the end, giving her opinion on why the decision was a good one. Her obvious conflict is that she benefits from the increased credibility given to CFS as a “disease,” since she can get more referrals. But I also have a difficult time imagining what kind of person should be a medical contributor. It makes sense to me that a person to comment on the study should be someone with expertise and experience in the field. Should she have been replaced by a journalist who doesn’t see patients (but who may still have an agenda)? Should she have been replaced by an internal medicine doctor, who sees CFS but less often? What about a cardiologist, who has no skin in the game?

The others in the room thought that Azar should be used as a source, not a contributor (though watching this clip, it feels difficult to tell the difference). Apparently it’s “journalism 101.” For me it raises the question, can a practicing physician also be a journalist? If so, should be MD-journalist not report on stories in his/her specialty? Expertise and experience lead to bias, but I wanted to know what the alternative was.

The others said that it was insulting to journalists to assume that they have less expertise than an MD in this role. It’s what they’re trained to do. But in turn, I wondered, isn’t it insulting to the physician to assume that he or she cannot possibly present information fairly?

I report on medical education. I am also in medical education (as a past student and future resident). I’ve felt that my background gives me good context to ask relevant questions when I’m reporting a story. I acknowledge that I’m biased. But I can’t get away from the idea that expertise leads to bias, whether you’re a journalist or a physician. So… is there a role for the physician-journalist?

robyn sterling kochan

February 13, 2015 at 2:29 pm

Having Chronic Fatigue Syndrome (CFS) for the last 14 years, I was outraged by NBC’s story for two reasons:

First, the portrayal of a very active woman as having CFS was the wrong message to send, and only further confuses doctors and the public. If the point of the story was her recovery and ability to take on exhaustive tasks that would be different, but the interviewee was NOT an accurate depiction of someone with the debilitating symptoms of CFS. At the height of this illness, most are so exhausted they can barely take care of their own basic needs much less run after very young children and get them off to school, or dress handsomely the way the interviewee appeared. CFS is not just being tired as has been the misconception by too many and for too long.

The testimonial by the doctor stating that exercise can help with this illness was also grossly inaccurate. As stated earlier in their own report, and by the new criteria from the Institute of Medicine, symptoms are worse after physical exertion. More investigative reporting would have revealed that while many doctors have dismissed Chronic Fatigue patients, much relief has been found through alternative and complementary medical professionals who take the time to care for CFS patients. Why didn’t NBC interview leading CFS expert Jacob Teitelbaum, MD, or even Dr. Oz for that matter?

Having high regard for Tom Brokaw, I had been a regular viewer of NBC nightly News for many years. However, between Brian Williams outright lies and this recent disservice to CFS patients, I am tuning in elsewhere.

Gary Schwitzer

February 15, 2015 at 10:05 am

There has also been active social media discussion about this post.

On Facebook, veteran science journalist Boyce Rensberger wrote: “Her role is a pretty clear case of journalistic conflict of interest.”

On Twitter, science writer/editor Kelly Hills (@rocza) wrote: “I do think @garyschwitzer raises a very valid point about COI and medical professionals on TV that needs more discussion.”

Also on Twitter, Dr. Mona Khanna (@AskDrMona), a major market TV news medical contributor, wrote: “Where are the news managers that should be catching conflicts of interest?”

Tazia K. Stagg

February 16, 2015 at 10:51 am

It’s interesting that the fellowship curriculum doesn’t cover this.

Gary Schwitzer

February 16, 2015 at 11:04 am

Tazia,

I don’t know for a fact, but would bet that, given who runs that program, journalism ethics and, more specifically, physician-journalism ethics will be discussed quite a bit during the fellowship program.

Shara Yurkiewicz

February 16, 2015 at 12:00 pm

The fellowship is a staff position, and much of the learning is via immersion. We have discussed this issue and many others. I’m fortunate to be surrounded by a high-caliber medical news team.

Rebecca Jones MD

February 17, 2015 at 12:13 pm

This is a great thread, and I am very impressed by the integrity and tenor of the discussion. I am very pleased that this subject of COI is being broached in such a careful and scrupulous way. The bar has been pretty low, with the subject being treated with an “oh well, everyone is doing it” attitude, so it is great to see a more professional and demanding standard. There is a confusion being expressed in some of these comments and I think I can explain the source:in fact, every physician has a fundamental conflict of interest, because we profit from illness. This is something we just don’t talk about, and yet I suspect it is determining the direction of medicine toward greater and greater complexity. My point is not to take away attention from the issue of coi with medical journalism, but rather to point out that we have a big, big problem. Consider this from the British Medical Journal: “The WHO definition of health as complete wellbeing is no longer fit for purpose given the rise of chronic disease. Machteld Huber and colleagues propose changing the emphasis towards the ability to adapt and self manage in the face of social, physical, and emotional challenges.” BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d4163 (Published 26 July 2011) In other words, we may as well just accept that health is unattainable, so we might as well adapt, and turn to the medical system to manage our chronic illnesses.