21st October 2002
In a recent MBRI poll for the Irish Times the press is described as trusted by 33% of those surveyed and distrusted by 61%. This is a little worse than the Government which is trusted by 34% and distrusted by 58%. (I.T. 18/10/02). The European Union fares much better, being trusted by 53% of voters and distrusted by 25%, hence, I presume, the "Yes" to Nice this time.
A few weeks ago I had the good fortune to attend a lecture in Trinity by Onora O'Neill, Professor of Philosophy and Principal of Newnham College, Cambridge. The topic she spoke on was "Trust". Was there, as the press said, a crisis of trust or was it an increase in suspicion, she suggested. She quoted MORI polls in the U.K. which consistently showed nurses are considered to be the most trustworthy of people followed by general practitioners and, a little behind, hospital consultants. But at the end, below even politicians and estate agents, were print journalists. This, she said and I would agree with her, is very serious because if they are held in such low esteem when they write the truth it will be looked on with as much scepticism as when their work is inaccurate.
Every day we, medical and scientific professionals, are all called to account for our standards and performance. I must say that the professionals in medicine and science that I know have a huge professional pride in their work and its integrity. Of course, poor performance should be detected and those involved penalised but really life has been made very hard for the many by the misdeeds of very few. Professionals have to work to more and more exacting standards to meet relentless demands to record and report and to be subject to ranking and re-structuring. It is little appreciated how much time this takes people away from clinical work.
League tables seem to be trusted more than professional judgement. Yet you and I know that someone who can show he or she has carried out one hundred cholecystectomies with no complications may not be the person to operate on someone with stones in the common bile duct. We may know that this surgeon always refers on such cases. It is all too simplistic to judge people, universities or hospitals on league tables. Performance has to be monitored in some sort of intelligent manner. People need to be able to use their judgement or ask the judgement of a professional on the information before them.
This is the information age, but in what information can we put our trust? Who has endorsed the information? Have they an interest, financial or other, in putting forward information in a certain way? Authors in the most reputable journals must declare any financial interest in drug trials they are reporting but once in the public press there is no compunction on other people to declare interests in some drug or treatment they could be seen as promoting.
Recently a friend with little or no knowledge of medicine phoned me early one morning to tell me he had cancer of the pancreas. I said I was very upset and surprised to hear this having seen him a few days before and I told him I thought he looked very well. No, he said, he was sure he had cancer of the pancreas. He had a pain and some other problems after dinner the night before and he had looked up the internet and the diagnosis was cancer of the pancreas! Reading information on a subject he knew nothing about on the internet was enough to convince him of the diagnosis. By the way, as you have guessed, he was perfectly healthy.
Well publicised claims can become credible if they are said frequently enough. If the credentials of the person presenting a popular radio or T.V. show are trusted by the public, debates take on a life of their own. It can be hard for professionals in the relevant field to bring all the facts forward so that a balanced discussion takes place.
People say they want transparency but sensitive information has to remain secret. No one wants their personal details open for scrutiny. Recently I heard it suggested that taking a family history from a patient had potential problems because the other members of the family had not given permission for their medical problems to be disclosed. Computers allow for large scale searches of data very easily and access to information can be essential for research. The need for disease surveillance was well made by Chris Verity and Angus Nicoll of the British Paediatric Surveillance Unit recently. "Effective protection of public health requires direction from the information provided by disease surveillance - for example, in the case of AIDs and variant CJD surveillance data led to action that protected health". Doctors and other health professionals have to report accurately and promptly on the occurrence of infectious diseases for example, to protect the health of others. The public need more information as to the value of such reporting. Requiring consent before such reporting would lead to the skewing of statistics as the "refusers" data would be excluded. The screening of anonymous left over, throw away samples of blood, urine or other samples can be of great value, too.
The parents of children whose organs were retained without their consent have withdrawn from the Dunne investigation. I doubt if any of those involved in retaining organs were trying to deceive these people but we certainly do not seem to have got through to them or the public at large how valuable pathological specimens are to research and to the better treatment of other children in the future. It is hard to keep people's trust. We need to put some work into this area.
Senator Mary Henry, MD
