Gary Schwitzer, Production Director at the Foundation for Informed Medical Decision Making, was a medical news correspondent and producer for CNN before joining the foundation. He argued that the confusion caused by mass-mediated health messages makes new technologies for tailoring communication to the needs of individual patients both necessary and desirable.While most people have witnessed the explosion of medically oriented advertisements and news stories during the past 10 to 15 years, many are unaware of how these messages are generated. Gary Schwitzer of the Foundation of Informed Medical Decision Making provided a perspective on medicine in the media, gained from years of experience in medical journalism.
"During the years I spent at Cable News Network, the coverage of medical news changed dramatically. The 1980s were a time of great excitement and tremendous activity in medical research. It was also the era in which medicine, the media, and society had to learn together about a terrible new disease, AIDS. I look back on it as a time of great disappointment--because of the direction taken by many major news media in covering anything and everything, while failing to provide context and analysis for an information-hungry but confused audience. It brought into focus the age-old dilemma of the science/medical journalist: the conflict between getting it first and getting it right. In many cases, the pressure to get it first led to false hope, retractions, and embarrassment. For anyone keeping score on how medical news was being disseminated, the 1980s were a disaster. The credibility of both the medical and journalistic endeavors suffered.
"My biggest complaint is that medical news is treated differently in the wrong ways. In short, where it should get special treatment, it does not. This is complicated information, much of it expressed in a scientific language that most journalists are not trained to read. Even if they could read it, could they interpret it? Do they all know that an article in a medical journal is not the last word on a subject, but simply the latest word in a continuing stream of information? A journal article might not include conflicting scientific views. Do journalists know what those views might be, or where to look for them? Do they have the time to look? Special treatment is required because this is information relevant to individuals' health. Highly personal, emotionally charged decisions may be made based upon the information conveyed.
"Coverage of medicine today demands that journalists consider all of the different sources of information: clinicians, researchers, patient groups, regulators, providers, insurers, employers, drug companies, manufacturers. Each group has its own agenda. Clinical medical topics are not well served by a breakthrough mentality. Given these views, it should not be surprising that I found my calling with a group of researchers who coined the term 'watchful waiting' as a legitimate medical treatment option. I was recruited out of television news by the Foundation for Informed Medical Decision Making. Dr. Jack Wennberg, a Dartmouth Medical School epidemiologist, and Dr. Al Mulley, Chief of Internal Medicine at the Massachusetts General Hospital, built this nonprofit company as a spin-off of their pioneering outcomes research.
"In the 1970s, Wennberg began to study the rates of surgery and other forms of treatment in 193 small areas in the 6 states of New England. The rates of the three most common surgical procedures--hysterectomy, prostatectomy, and tonsillectomy--varied sixfold from high-use areas to low-use areas. The most important determining factor seemed to be that one group of well-intentioned physicians was enthusiastic about surgery while another group of equally well-intentioned physicians was more skeptical about surgery's overall benefits in light of the potential risks. It was apparent that physician preference steered many of the care decisions. Wennberg suggested that informed patients may be the most important factor in making rates of treatment reflect health needs, thus eliminating unnecessary medicine.
"The foundation was established four years ago, with the mission of collecting and providing the information needed to enable informed medical decision making. Our approach has been to develop, produce, evaluate, and disseminate interactive video programs that provide patients with tailored, unbiased information about the benefits and risks of alternative treatments. The topics all reside in the gray area of medicine, where the scientific evidence is inconclusive and quality-of-life issues are of great significance. This is the area in which we feel we can do the most good by laying out accurate, patient-specific data along with narratives from patients who have already selected various treatment options and are living with the results. Since the physician refers the patient to a viewing session, patients report that they have a greater sense of partnership--a 'care-giving' atmosphere, rather than one of 'care withholding.'
"The shared decision-making programs are presented in an interactive format via a videodisc player, minicomputer, and video monitor. Individual-specific probabilities of treatment outcomes are outlined on the basis of information input by the patient. In addition, video interviews with patients who have experienced the benefits and/or risks of treatment allow the patient to gain better understanding of treatment options in human terms. In many ways, the foundation functions like an educational publisher. It contracts with production groups in academic medical centers to develop the scientific content of each program. The development process relies heavily on patient and physician focus groups to identify key issues in the content areas. Scriptwriters and interactive video production teams generate the master video material, related software, and documentation, and the programs are tested for balance, fairness, and 'viewability.'
"There are times when I feel I am still in journalism. Our interactive videos seek the elusive 'truth'--they seek to help people by providing information they might not otherwise get. Indeed, this direct-to-the-individual process is a far more efficient delivery mechanism than sending messages out into the vast broadcast wasteland, not knowing what impact they will have. I have learned that any true health-care reform begins with improved communication between caregivers and patient. And at that level, the shared decision-making concept is finding a home wherever it is tried. Patients are becoming empowered and are reflecting their satisfaction with caregivers who treat them as partners in decisions about health and health care."