The Great Debate

The keepers of truth: Seth Mnookin on fear and the vaccine wars

Reuters Staff

Jan 18, 2011 20:52 IST

Whooping cough. Measles. These diseases, once thought almost gone, are creeping back into schools and hospitals around the country. The reason? Parents are refusing to have their children vaccinated, because they’re afraid that the shots can cause autism.

This ideas stems from a 1998 study in the medical journal The Lancet, in which British doctor Andrew Wakefield suggested the MMR (measles, mumps, and rubella) vaccine may be linked to autism.

The journal has since withdrawn the study, Wakefield lost his doctor’s license, and the British Medical Journal declared it fraud. But that hasn’t stopped celebrities such as Jenny McCarthy from declaring that there’s a link.

The problem comes from our idea of truth, says Seth Mnookin, author of the newly released The Panic Virus: A True Story of Medicine, Science and Fear. Who’s easier to believe? Scientists and doctors you don’t know, or your neighbor with the autistic son, who said his symptoms started right after a booster shot?

“When it comes to decisions around emotionally charged topics, logic often takes a back seat to what are called cognitive biases — essentially a set of unconscious mechanisms that convince us that it is our feelings about a situation and not the facts that represent the truth,” Mnookin said in a recent essay in The Atlantic.

Mnookin, a contributing editor at Vanity Fair, is the author of two previous books: Hard News: The Scandals at The New York Times and Their Meaning for American Media; and Feeding the Monster: How Money, Smarts, and Nerve Took a Team to the Top, a book about the Boston Red Sox.

For his new book, he spent more than two years investigating the alleged link between vaccines and autism. As it became clear to him there was no such link, the book became a hard look at who decides what’s true, why we believe what we do, and why fear can trump logic.

Business must change to earn back the public’s trust

Reuters Staff

Mar 17, 2010 21:08 IST

– Jeff Kindler is the chairman and CEO of Pfizer. He has agreed to reply to readers’ responses about this opinion piece. The views expressed are his own. —

While it’s encouraging that slightly more people say they trust business and government today than a year ago, surveys show more than 70 percent of Americans and Europeans fear companies and governments will return to business as usual once the recession ends. It’s easy to see why.

In just the past year, a UK accounting scandal forced out the Speaker of the House of Commons, for the first time since 1695. The Governor of Illinois was thrown out of office for influence peddling, and a Congressman was convicted of accepting bribes and storing the cash in his freezer.

Businesses haven’t done any better, from taking reckless risks with other people’s money, to Ponzi schemes, to insider trading. Many banks and automakers now owe their existence to taxpayers, who bailed them out then paid them bonuses. My own company paid a $1.8 billion fine after some of our sales people improperly promoted a medicine for uses the FDA hadn’t authorized.

Actions like these are leading people to demand more restrictions on business. People say banks should risk less, and pay their executives less. They want oil companies to drill less, and burn less. They want drug companies to charge less, but not do less R&D. Sometimes, this criticism is warranted. Sometimes, it’s not. But when people don’t trust you, they’ll find a way to force you to change.

If leaders fail to change, the shape of things to come will not be pretty, for companies or for society. And if any business or government leader thinks they’re exempt, they are wrong.

Your health plan’s Toyota complex

– Ford Vox is a medical journalist and a physician. The opinions expressed are his own.–

A trade group by the name of America’s Health Insurance Plans began the week with oddly revealing rhetoric against a key proposal under debate at the health care summit today – controlling insurance premium hikes. Obama’s proposal “would be like capping the prices auto makers can charge consumers, but letting the steel, rubber, and technology manufacturers charge the auto makers whatever they want,” said Karen Ignagni, AHIP’s president.

Ignagni’s analogy shifted blame onto doctors and hospitals — the rubber and whatnot — but her analogy is apt in one way – we’ve got to pay attention to where the rubber hits the road. Relying on face-to-face relationships and earned trust, doctors are better poised to control costs than any federal agency or insurance company. Family practice doctors, who wield the referral, are the key to reigning in the excessive outpatient specialist care that accounts of much of the waste in American medicine. But they need some skin in the game.

University of Manchester researchers followed UK private practices and chronicled the power shifts that occurred after the roll out of the 2004 National Health Service contract, which was designed to allow family doctors to reap financial rewards by proving they’re keeping their populations healthy. U.S. legislation can similarly require that whatever fund is paying the bill (private, Medicaid or Medicare) hand over more control to the doctors on the front lines by designating more administrative responsibilities, and the dollars that go with them, to physician practices.

The National Committee for Quality Assurance has already laid some foundations, getting primary care physician organizations on board with the concept of the medical home, so that primary doctors will adopt outcome measures and accepted processes that are known markers of quality and that keep costs down.

Now is the time to give this program teeth. Let’s legislate such programs and mandate that significantly more insurance dollars (government and private) go where the rubber hits the road.

Live Debate: Breast cancer screening and mammography

Reuters Staff

Nov 17, 2009 02:47 IST

Sweeping new U.S. breast cancer guidelines released on Monday recommend against routine mammograms for women in their 40s, and suggest women 50 to 74 only get a mammogram every other year.

The new guidelines by the U.S. Preventive Services Task Force, an influential panel of independent experts, would sharply curtail the number of breast mammograms done in the United States, sparing women the worry of false alarms and the cost and trouble of extra tests.

But U.S. cancer experts say the altered schedule may mean more women will die from breast cancer.

Should you and your loved ones get mammograms? What are the implications for health care reform, with members of Congress looking for ways to cut costs?

Join us for a live online on breast cancer screening and mammograms on Tuesday, Nov. 17, at 12pm ET. The event will be moderated by Reuters Health Executive Editor Ivan Oransky and joined by Reuters’ editor in charge of health and science, Maggie Fox.

Our confirmed participants:

Heidi Nelson, research professor of medical informatics and clinical epidemiology and medicine at the Oregon Health Sciences University, who has led systematic evidence reviews for the U.S. Preventive Services Task Force. Daniel B. Kopans, professor of radiology at Harvard Medical School and director of breast imaging at the Massachusetts General Hospital.

from Ask...:

Should junk food be taxed?

Increasingly vocal calls for taxes on sugary drinks and junk food are fueling a behind- the-scenes battle that public health officials say is reminiscent of America's war on cigarettes.

Fueling the debate are revenue-hungry federal, state and local governments officials who are eying a potential $50 billion windfall from taxes on over 10 years.

Take a look at the New York City Department of Health's ad discouraging people from drinking sugary sodas, and let us know whether you think a junk food tax would be good public policy, or an intrusive step too far by the nanny state.

Moore is less for healthcare reform

Peter Pitts

Aug 6, 2009 01:39 IST

Peter J. Pitts is president of the Center for Medicine in the Public Interest and a former FDA associate commissioner. The views expressed are his own.

In SiCKO, Michael Moore portrayed the British National Health Service and the Canadian health system as particular exemplars of excellence. He backed it up with a lot of statistics, but statistics, as the saying goes, are like a bathing suit. What they show you is interesting, but what they conceal is essential.

And what SiCKO concealed was that systems such as those in the United Kingdom and Canada are cost-based rather than patient-centric models. Facts, no matter how inconvenient to one’s argument, must not be ignored.

Citizens of countries with government-run health care systems experience long wait times, a lack of access to certain treatments and, in many instances, substandard medical care. For example:

• The five-year survival rate for early diagnosed breast cancer patients in England is just 78 percent, compared to 98 percent in the U.S.

• A typical Canadian seeking surgical or other therapeutic treatment had to wait 18.3 weeks in 2007, an all-time high, according to The Fraser Institute.

• The average wait time for bypass surgery in New York is 17 days compared to 72 days in the Netherlands and 59 days in Sweden.

from The Great Debate UK:

Confronting medical issues for women

- Shelley Ross is secretary general of the Medical Women's International Association, a non-governmental organisation representing women doctors from all continents. The opinions expressed are her own. -

The Medical Women's International Association was created in 1919, not long after the first International Women's Day in 1911. MWIA's founder was an American by the name of Dr. Esther Pohl Lovejoy, who served as its first president. She was an obstetrician by training but an activist and humanitarian by action. Not only did she establish MWIA but she also founded the American Women's Hospital Service during the First World War.

The motto of the Medical Women's International Association, Matris Animo Curant, comes from Latin and translates to read, "She Heals with the Spirit of a Mother."

From the time of Hygeia in ancient Greece to present day, women have had a significance influence on the practice of medicine.

To name three of its objectives, MWIA (1) works to overcome gender-related differences in health and healthcare between women and men throughout the world, (2) works to overcome gender related inequalities in the medical profession and (3) works to promote health for all through the world with particular interest in women, health and development.

International Women's Day on March 8, gives us an opportunity to reflect on how we are doing with accomplishing these objectives.

Are a CEO’s health problems a private matter?

– Dana Radcliffe is a Day Family senior lecturer of business ethics at the Johnson School at Cornell University. The views expressed are his own. —

Are a CEO’s health problems a private matter? Or does he or she have an obligation to disclose them to investors and other stakeholders?

These are questions Apple and its iconic co-founder and chief executive Steve Jobs have had to face ever since he was diagnosed with a rare form of pancreatic cancer in 2003.  Happily, the disease proved to be treatable with surgery, which Jobs underwent in 2004.  But shareholders didn’t learn that Apple’s chief had been ill until he sent out an email to employees, announcing that he had had cancer but was now “cured.”

The issue of what, if anything, the company should disclose about its CEO’s health concerns resurfaced last summer, when Jobs spoke at Apple’s annual developers conference.  There he appeared, as the New York Times put it, “unusually thin and haggard.”  Reacting to the inevitable rumors that Jobs was ill again, the firm’s public relations department reported that he was suffering from “a common bug.”

A PRIVATE MATTER

However, according to the Times’ John Markoff, Jobs told some associates that he was experiencing “nutritional problems.”  Moreover, people close to Jobs told Markoff that in early 2008 he had a surgical procedure to treat a problem related to his weight loss.  Yet, in July, in a conference call after the release of Apple’s quarterly earnings statement, a senior officer deflected an analyst’s question about Jobs’s health, calling it “a private matter.”

Not surprisingly, investor uncertainty about whether Jobs would be able to continue as CEO was reflected in sharp fluctuations in the price of Apple’s stock.  In December, the worries intensified when the company said that Jobs would not give his much-anticipated annual keynote address at Apple’s Macworld conference.  At first, the reason offered by a spokesman was that the firm would not take part in the event after 2009.  That “explanation” only fueled the rumors.