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A. Jay Block, MD, Master FCCP
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Affiliations: Gainesville, FL
 ,  Dr. Block is Editor-in-Chief, CHEST, and Professor Emeritus of Medicine, University of Florida.

Correspondence to: A. Jay Block, M, Master FCCP, Seagle Building, Suite 408, 408 West University Ave, Gainesville, FL 32601

Chest. 2001;120(3):693-694. doi:10.1378/chest.120.3.693
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Published online

The hair on the back of my neck stands up and I get an acid stomach when I watch the new ads on television for pharmaceutical products. There are three phrases that make me crazy. The first is,“ Nothing is better than (insert drug).” What does this really mean? It could also mean that nothing is worse, but it usually means that all the drugs in this category are of the same potency, often even the same chemical compound. A bombastic statement of this kind influences public opinion and buying habits but really has little meaning.

The second phrase that bothers me is, “It has been clinically proven.” Never are there any data provided to back up this claim, but the phrase sounds very good. I propose that this phrase never be used in an advertisement without attribution to the clinical proof in a refereed medical journal or other scientific forum.

The third irksome phrase is, “There has been a medical breakthrough.” This phrase usually means one of two things. Often physicians have been aware of the facts reported for years, but the real breakthrough occurred when the media finally discovered the facts. Alternatively, the “breakthrough” has been made only in animals and no human testing has yet to be done. Never does the press retract the contention that there was a breakthrough when, years later, the drug or procedure doesn’t work in people. Often, the media do not even remember the initial report.

At least recently, the television advertisements have told the public which conditions to ask their doctor about. Initially, when prescription drug advertisements appeared on television, you were instructed to ask your doctor about (insert drug) but not informed of the indications for its use. Many patients called their doctors, asked about the drug, but did not have the disease for which the drug was used. This was a tremendous waste of physicians’ time.

Medical journals are not immune from these influences. Many journals follow the lead of the New England Journal of Medicine and the Journal of the American Medical Association and either provide press releases explaining what will be published in each issue or forward the issue to the press electronically or by fax. CHEST also provides press releases for two articles in each issue. I have had mixed feelings about this practice, although press coverage of the cough supplement and the whimsical chicken soup publication were accurate and beneficial to the journal.

On the other hand, there has been some problem with “spin.” Without identifying the publication or the press involved, let me try to identify the problem. I have believed for years that the press and public have no clue about the practice of intensive care medicine. Specifically, the issues of rapid invasive treatment, do-not-resuscitate orders, cardiopulmonary resuscitation, euthanasia, etc, can be inflammatory without the proper background and experience on the part of the reporter or the lay public. I have not selected such articles for press releases for that reason.

Recently, one study from a respected institution was included in our press releases. Autopsy results from a selected group of ICU patients were compared to clinical diagnoses made before death. From my own experience as a medical ICU attending, I know that in the year 2001, autopsies are sought in cases where the diagnosis was not obvious, ie, the difficult cases. When the diagnosis is already proven, there is little need to do an autopsy. The cases in this report were therefore highly selected.

As I did the math, the autopsy results would have changed the treatment in only 8.8% of the autopsies that were reported. In addition, only 22.7% of the total of medical ICU patients who died underwent autopsy. While one doesn’t wish to miss any diagnoses, this small number was reported to help in future diagnoses and reflects excellent care.

The spin in the press was otherwise. “How could diagnoses be missed in such a prestigious clinic?” was the gist of the report. Lord knows, only malpractice lawyers are perfect because they have years to analyze the events that take place in seconds in the ICU. I thought that the press treated this report and this institution poorly and wished to bring this issue before the readers. I now review all press releases personally and will not allow an ICU-related press release from CHEST. While we cannot send all reporters to medical school, we can demand that they have some modicum of knowledge about and responsibility for the facts that they write or read on television.




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