Friday, 18 February 2011

Propaganda posing as journalism

My interests are very diverse. Much of what I might want to share is done by others, and probably better. Medicine and quackery are covered by -among others- Orac, Steven Novella, Science-Based Medicine, and PalMD. Scienceblogs, Scientopia for science in general. Analysis of U.S. Policies regarding the War of Terror can be found at Glenn Greenwald's blog. Information on Global Warming can be found at Skeptical Science, Open Mind, Watching the Deniers. For other suggestions look at my blogroll.

Though I try and discuss whatever has caught my attention it is impossible to ignore the absolutely inadequate, bordering on willfully ignorant, stories presented to us by the media. Regardless of the topic you will find journalists are:
  1. Insufficiently schooled to appreciate the intricacies involved, as such they fail to intervene when factually false statements are made,
  2. Insufficiently schooled to evade, or expose logical fallacies,
  3. Insufficiently aggressive to confront powerful interviewees with inconsistencies, factual inaccuracies, or logical fallacies, (just imagine their special status being revoked, thereby limiting their access to the inner circle)
  4. Frequently employed to disseminate the talking points of politicians and religious leaders, also known as propaganda, see point 3,  
  5. Trained to obey the wish of their government (an offer they can't refuse?) to conceal information negating statements made by said government,
  6. Not inclined to ask for expert advise, when confronted with the previous points, because they are abundantly unaware of the limits their knowledge has,
  7. Inherently disinclined to support anyone who forgets to adhere to the above, i.e. those who engage in actual journalism 
With that in mind I am genuinly surprised that any selfrespecting individual would dare to claim to be a Serious Reporter while adhering to those principles. That is, it is not as if they act like those amateuristic bloggers who never fact-check and lack any credentials to be considered trustworthy.

Of course, newsorganisations have to cut down their costs and inevitably the number of (qualified) journalists goes down. As a result the public feels they become untrustworthy, which in turn makes them buy less newspapers. This leads to more lay-offs, as income for newsorganisations keeps dwindling. Under these circumstances I propose a radical thought: invest in quality journalism, even the investigative kind. That is, create the environment needed to present a factual and accurate story, as opposed to ideology driven misinformation. Naive as I am I would not be surprised if this would increase their audience. Why else are people reading blogs and fora? They still want to know things. And no, not only about who does so and so with whom.

Scary thought: what if news reports go beyond hollywood scandals, petty gossip, propaganda and turn out to actually contain existential topics using real experts; i.e. global warming does exist, Intelligent Design is inherently unscientific, vaccines do not cause autism, the exaggerated threat of terrorism is used to abolish civil rights, et cetera.

One can, and should, dream.

Update: Added point 5. You will note that the linked article there is an example of combining point 4 and 5 in an attempt to shape public opinion. Also known as Psyops.

Update II: It is becoming tedious, but Glenn Greenwald again notes the principal thing journalists consider to be in their job description: never reveal actual information but actively strife to keep it hidden from the public while dutifully reporting the propaganda. Or, in his words:
That's what our establishment media outlets largely are for:  to disseminate and amplify the messages of our most powerful political, military and financial factions without any accountability.
His article also clarifies that today the widespread use of "anonymous" sources is essential to ensure nobody can be held accountable for evidently false statements, even as they drive the perception of things. Quoth Glenn:
Anonymity does have a valid purpose in journalism:  its legitimate purpose is to protect the vulnerable and powerless when they expose wrongdoing by those who wield power. But most establishment journalists have completely reversed that, so that anonymity is used to protect those with the most power: to enable them to make all sorts of public claims and launch all kinds of attacks on critics without being accountable. When anonymity is used for those purposes, it is inherently and incomparably corrupt (that, of course, is the dynamic that led to public acceptance of patently false claims justifying the Iraq War). But this perversion of anonymity from what it was supposed to be (a means of holding the powerful accountable) into a power-shielding weapon is simply a microcosm of the broader reversal by establishment journalists of the old dictate to "afflict the powerful and comfort the powerless." Most establishment journalists -- by definition -- do exactly the opposite, and their eagerness to indiscriminately grant anonymity to the nation's most powerful officials is simply one manifestation of that power-serving mindset.
Contrast that with the way anonymity of whistleblowers is respected. But hey, let's not forget not forget how hard it is to be a Real Journalist. You need to fact-check, use your elaborate journalistic skills, and above all you need to refrain from taking sides!

Update III: The claim Real Journalists are objective, as opposed to those unprofessional bloggers, is shattered by Jack Goldsmith, according to Glenn Greenwald. Apparently U.S. media feel their duty is to show allegiance to the U.S. administration:
... allowing such loyalties to determine what one reports or conceals is a very clear case of bias and subjectivity:  exactly what most reporters vehemently deny they possess.  Many establishment journalists love to tout their own objectivity -- insisting that what distinguishes them from bloggers, opinionists and others is that they simply report the facts, free of any biases or policy preferences.  But if Goldsmith is right -- and does anyone doubt that he is? -- then it means that "the American press" generally and "senior American national security journalists" in particular operate with a glaring, overwhelming bias that determines what they do and do not report:  namely, the desire to advance U.S. interests.
He then notes:
A desire to promote American policy or its "interests" will often directly conflict with core journalistic obligations.  It's often the case that disclosing the truth about the American government (a journalistic duty) will undermine the government's policy aims or subvert government "interests."  The same is true for serving as an adversarial watchdog on government officials: exposing their false statements and lies, uncovering their corruption and deceit, contradicting their propaganda; doing that can also undermine American interests.  Reporters who engage in journalism with the goal of advancing U.S. interests or promoting their nationalistic allegiance -- which Goldsmith suggests is the majority of them -- are engaged in activism and propaganda, not adversarial journalism.  That's fine, I suppose, if they acknowledge their biases, but those who are driven by these allegiances while pretending to be "objective" are engaged in a game of deceit.
Usually I write about science, but this intermezzo was meant to show this behaviour, of replicating talking points for ideological reasons while hiding inconvenient information, is not limited to science reporting: i.e. global warming, vaccination, evolution, et cetera. Whatever else is true, journalists are far from objective regarding any topic, which is the point I keep making.

Update IV: Strangely enough the NYT appears capable of "taking sides." Eventhough we have a classic example of a "he said, she said"-situation they have no problem choosing one version over the other. Would that have anything to do with the "controversy" involved?

Update V: After years of being "objective," i.e. not taking sides, the NYT has started writing about waterboarding as a form of torture. Could it be because the alleged perpetrator is not from the U.S.?

Update VI: Another newsarticle incapable of  being accurate, whether its writer is intentionally misleading his readers I leave up to you.

Update VII: To quote Pharyngula:
Science journalists, you really piss me off…at least some of you. Here are a couple of headlines about that recent paper I summarized that make me want to slap someone.

Monday, 14 February 2011

Valentine's day

Like every year today is Valentine's day. Of course, an utterly commercialised event. Despite that I hope everybody will have a great and romantic day.

Update: The insect input for romance, Shellac:
is an insect-produced product that may be part of your Valentine’s candy (and many other things). 
More is explained by bug girl for Skepchick.

Update II: For the Guardian Jason Goldman gives us:
seven tips from science that just may help you find a date on Valentine's Day. You've heard of evidence-based medicine? This is evidence-based dating.
And Pharyngula introduces some loving hedgehogs.

The House of God

When I began as a resident I was allowed to ask for any diagnostic tool. The only requirement was that I needed to show the specialist I worked for how the results would influence my decisions. Imagine ordering an X-ray of the left foot to evaluate a possible heart attack. As it is impossible to make any reasonable connection between the two (foot-heart) no radiograph would be allowed.

Before that, as an intern, I was impressed to see an orthopaedic surgeon evaluate patients in order to find reasons not to operate. Later, as a resident I found that it is a trait seldom found among those trained to use a scalpel. The reasoning was, obviously, that we as physicians do cause complications, and as such may end up hurting patients.

With that in mind I just read an article, by Harriet Hall, which underscores that point:
We are healthier, but we are increasingly being told we are sick. We are labeled with diagnoses that may not mean anything to our health. People used to go to the doctor when they were sick, and diagnoses were based on symptoms. Today diagnoses are increasingly made on the basis of detected abnormalities in people who have no symptoms and might never have developed them. Overdiagnosis constitutes one of the biggest problems in modern medicine. Welch explains why and calls for a new paradigm to correct the problem.
To me, this is not rocket science. If anything, we were already warned by Samuel Shem that medical interventions inevitably introduce risks. His "good medical care is to do as much nothing as possible" I interpret to stand for:
  1. There are so-called self-limiting conditions. This means they resolve by themselves without any treatment: i.e. common cold.
  2. Medical interventions are inherently dangerous, there is always the risk it leads to complications.
These points should make any physician question the necessity of any intervention. The following examples are meant as illustration to those points, and of how I view diagnostic and therapeutic interventions.

One day a patient did not sufficiently produce urine. The medical history showed abdominal surgery the previous day, while the current status showed an i.v. drip with NaCl 1 liter/24h, an NSAID to counter the post-operative pain, blood tests suggesting deteriorating kidney function, and diuretics to correct for the diminishing urine production. At this time I was consulted to look at the kidney function. To the trained eye there already are several clues.
  • Fluid replacement at 1 l/24 h is not much (the patient did not yet eat or drink), especially in abdominal surgery. This alone might cause dehydration. After evaluating the patient I concluded this was what happened,
  • Of course, once a patient is dehydrated using diuretics appears somewhat counter productive: you need fluid to urinate, not lose more by stimulating diuresis,
  • Then the use of NSAIDs, they are known to cause stomach, and kidney problems. In a patient that already has a compromised kidney function these drugs should be immediately discontinued, and replaced by another type of analgesic,
After concluding this was prerenal kidney failure, or dehydration, the fluid volume parenterally administered was increased to 2 l/24h, the NSAID and diuretic were stopped. Several hours later the urine production, and lab tests, returned to normal. This is not meant to embarrass any colleague but as a warning that something trivial as a painkiller may have devastating effects. In this case the patient might have ended up requiring haemodialysis.

An example of the risk diagnostic methods pose is perforating the colon, which is rare, when taking a specimen to evaluate polyps. To prevent you from falling asleep I will stop illustrating the point. You undoubtedly understand my point.

Thinking about these possibilities today my view is that we should always ask ourselves: is the possible complication from the therapy/diagnostic method I want to prescribe worth the expected benefit?

In short, is this test required for a diagnosis, and is non-treatment more dangerous than treatment? Only then should one proceed with the intended intervention. Or, "good medical care is to do as much nothing as possible."

As an aside, this maxim is applicable to other professions too.

Wednesday, 2 February 2011


Be sure to help your favourite medical blog by voting at MedGadget:
After a careful analysis and consideration, we are pleased to present the finalists of the seventh annual Medical Weblog Awards.
There are several categories:
After reading my musings you will be pleasantly surprised, or shocked, to find there are much, much, much better bloggers around. (h/t PalMD)

The red moon

A highly informative and interesting post by Ethan Siegel explains why the moon turns red during an eclipse. You should read it in full so I won't bother you with my take on it.

Update: Still wondering how the universe came into being, from nothing? That is, how could there be a Big Bang without some sort of creator? Be sure to read his new post on how something can come from nothing.