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Trust in Health Care
May 13, 2019

Why Bolstering Trust in Journalism Could Help Strengthen Trust in Medicine

Author Affiliations
  • 1Department of Medicine, University of Chicago Medicine, Chicago, Illinois
  • 2The Henry J. Kaiser Family Foundation and Kaiser Health News, San Francisco
  • 3HealthNewsReview.org, Minneapolis, Minnesota
  • 4University of Minnesota School of Public Health, Minneapolis
JAMA. 2019;321(22):2159-2160. doi:10.1001/jama.2019.0636

Declines in public trust in US institutions has been widespread and well documented.1 Neither journalism nor medicine is immune from this trend, although the combination has the potential to adversely affect both population and individual health. Individuals are inundated with health information from news media, with news stories ranging from the latest trends in health and wellness to breaking news about new treatments or technologies that have the potential to revolutionize health care.

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    3 Comments for this article
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    Do Our National Medical Journals Need to Do a Better Job as Well?
    Edward Volpintesta, MD | Bethel Medical Group
    Yes it is important that journalists in the mainstream media strive to make their reports more accurate so that patients get a true picture of what the latest advances can do and not get their expectations disappointingly high.
    But our medical journals need to do a better job in their editorials, their perspective pieces, and in their commentaries on describing the changes that physicians are dealing with; because articles that appear in the mainstream media often reference commentary that appears in some of the high-profile medical journals.
    Too often these commentaries fail to convey the true feelings of physicians. They
    are not written in simple language; and more often than not they are written not by practicing physicians but by academic experts with medical school affiliations who do not fully understand the realities of private practice.

    The intrusions of insurers, exploitation by the medical liability system, the distractions of electronic health records—these need to be described in our national journals in commentaries written by private physicians. But I doubt that editors would accept this. It is more likely that our state medical journals will take on this role.
    CONFLICT OF INTEREST: None Reported
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    The Problem of Human Enterprises
    David Pogge, Ph.D. | Hospital
    Is a loss of trust a problem to be corrected, or is it the cure to the problem? In my opinion the loss of trust has evolved naturally from the experience of seeing one discovery after another reversed or refuted (e.g., eggs are bad for you, eggs are good for you), one declaration after another shown to be inaccurate (e.g., depression is caused by a chemical imbalance), hearing one physician after another weigh in on political or moral issues about which they have no valid claim to expertise (e.g., pediatricians should ask parents if they own firearms), and finding one conflict of interest after another exposed (e.g., physicians who receive more gifts from pharma prescribe their medications more often).

    As the world has become more informed, the general public has gradually learned that all human enterprises - including science, medicine, and journalism - are rife with inherent human flaws. Among these are greed, narcissism, ideological commitments, narrowness of mind, ignorance, and error. We have all learned that these are inevitably at work in how news - including news about medicine - is reported and we have also learned that they are at work in the practice of medicine and in the enterprise of generating knowledge. For those of us who practice, we have seen fads come and go, each time introduced with certainty and enthusiasm, and seen them eventually fall short of their promises and unexpectedly cause harm. For those of us who do research, we have seen fads, political correctness, orthodoxy, and the agendas of editors and the grantors of funds shape the studies that are allowed, the results that see the light of day, and the shape of that the message takes.

    The more we know, the more we doubt. Free speech - which is unfortunately becoming less free all the time, particularly in the halls of academe - is the only corrective. Trust should not be the goal. In fact, trust is an impediment to the goal of knowledge. Only if the free flow of information is allowed, and competing ideas can be viewed skeptically and challenged directly, can some fragment of real knowledge ever be obtained. The cry of those who seek truth should not be "trust me", but rather "hear me out, so you can decide." As the public becomes increasingly educated it is becoming increasingly skeptical. However, instead of lamenting a "loss of trust", journalists, scientists, and clinicians should be asking themselves why the arguments they are making are not convincing. Perhaps it is the benighted ignorance of the audience, but perhaps it is because it is simply less convincing, less coherent, or less well supported than they would like to believe.

    If competing points of view are presented in their fullest and best light, and the argument can occur for all to see, truth may be the eventual result. But those who would rather be trusted and taken at their word, I would ask: If you are right, why do we need to trust you? If journalists were doing their jobs, they would be working to present the full story, with all of its caveats and limitations, and alternate points of view and contrary evidence. If they are not willing to do that then they are just marketers for the investigator with the catchiest way of packaging their study. If that is the case, then no trust is warranted or deserved.
    CONFLICT OF INTEREST: None Reported
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    Improving trust with Professional Reportage
    D Venes, MSJ, MD |
    More accurate and nuanced reporting may result when medical journalists are professionally trained in both fields, i.e., when reporters are required to have degrees in both Journalism and Medicine.
    CONFLICT OF INTEREST: None Reported
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