Tuesday, August 25, 2009

Separating Fact from Fiction

Today's blog is my first since returning from a family vacation in London, U.K., during which I was able to follow the U.S. health care debate via the internet. I found it interesting that British politicians were drawn into the U.S. debate, with the leader of the conservative Tory party repudiating remarks from members of his own party that were critical of the U.K.'s National Health Service. (Their remarks had been cited by U.S. critics of health care reform, even thought Obama hasn't promised anything even remotely akin to the NHS.)

During the weeks while I was gone, the debate in the U.S. took a serious turn away from consensus. Instead of moving toward common ground, we have seen warring ideological camps go into attack mode. Instead of all sides listening to each other, we have seen town hall meetings devolve into shouting matches and invective. Instead of arguing on the basis of a common understanding of the facts and evidence - and from there, debating our legitimate policy differences - we have seen misinformation designed to stop health care reform spread like wildfire.

Howard Kurtz writes in the Washington Post that an effort by the mainstream media to debunk even the most inaccurate and outrageous claims - such as that the House bill will create "death panels" to cut off care to the elderly - are not believed by much of the public:

"The crackling, often angry debate over health-care reform has severely tested the media's ability to untangle a story of immense complexity. In many ways, news organizations have risen to the occasion; in others they have become agents of distortion. But even when they report the facts, they have had trouble influencing public opinion."

(Kurtz's online discussion about his column makes for interesting reading.)

Now, I believe that critics of how health care reform, as it is being pursued by President Obama and Congress, have a right and responsibility to make their best case for a different approach and to cite the facts and evidence to support their views, just as proponents must do the same. But I also believe that the public is not well-served when people cross the line from making a principled argument to spreading outright untruths to score political points. Nor is a free and open debate served when people shout down those who disagree with them. Two independent and well-respected fact-checking websites (Politifact and FactCheck) have shown that both sides are guilty of stretching the truth, but some of the biggest whoppers are coming from critics of health care reform.

I also believe that physicians have a special responsibility to get the facts about health care reform. Doctors are trained to analyze evidence to reach the best possible treatment decisions for their patients. No patient would trust a physician who ignores the facts of their case or falsifies the presenting information to make it fit a diagnosis. The public should have the same expectation that physicians will strive for accuracy in weighing conflicting information about the implications of proposed health reforms. As an evidence-based scientific organization, ACP has made resources available to ACP members to help them make their own informed judgments, based on the facts and evidence.

To be sure, "facts" about public policy aren't always clear cut, may be contradicted by other facts, can be cited or ignored selectively to make a point, or may be viewed differently depending on one's own views. As Mark Twain famously wrote, "there are three kinds of lies: lies, damned lies and statistics." By the same token, though, some things about health care reform are either true or false. Saying, for instance, that the House health care reform bill would allow the government to set up "death panels" simply is untrue, while arguing that the government should stay out of discussions of living wills is a legitimate point of view, and worthy of debate.

Today's questions: Do you agree that the health care reform debate is being poisoned by mischaracterizations and untruths? What responsibility do physicians have to get the facts straight?


bruce said...

Yes, it is being effectively poisoned, yes physicians, especially internists, should stick to facts about health reform, and no, it won't make any difference anyway, because the religious right has effectively mobilized the elderly to tell their congresspeople to keep 'their goddamned government hands off my medicare!' It would all be hilarious if it weren't so sad. I don't know who to be more upset with, the lying Republicans like John Boerner, or the fractious, crazy liberal democrats. The six Senators on the Finance Committee meeting 'in secret' for the first months of the summer have/had a chance to pull together something noble for America ala Webster, Calhoun, and Clay in the 1840's, but it looks increasingly like Enzi and Grassner are too interested in reelection to vote their better judgement. Can we get an increment of insurance reform and move clinical choices, effiacacy decisions, and payment systems out of the congress when the consequence of their discussing all this is billions shoved in their pockets? It doesn't seem likely. Things are going to have to get worse...

Jay Larson MD said...

Absolutely the health care reform debate is being "poisoned by mischaracterizations and untruths". Death squads? Give me a break. Max Baucus, AARP, and state newspapers have put out good information to debunk the myths. This information has been shared with my patients. When President Obama was in Bozeman, MT for a town hall meeting, he also commented on the untruths. The White House also has a useful web site (www.healthreform.gov) that helps people understand health care reform.

On an entertainment note. Extreme left and extreme right in the octagon would be much more entertaining than a UFC fight.

Arvind said...

My simple contention is - if all what the Democrats are proposing is so great, then why are they exempting themselves from participating in such a plan. It seems to me that the blog master here is completely biased, hence making this a very one-sided post. Very big disservice to all dues-paying ACP members that disagree.

BDoherty said...

Arvind raises two important points. I agree with him that it would be good politics and policy for congress to include itself in the program it is designing. Congress has a long standing practice though of exempting itself from laws that are administered by the executive branch on separation of powers grounds, a practice followed by Democratics and Republicans alike. My bias is to accurately reflect ACP policies informed by my own perspectives formed over 30 years advocating for internists, first with ASIM and then ACP. I also have a bias that disagreements on policy should be based on principled arguments as supported by facts and evidence to the degree possible and that factual misrepresentations to score a point are a disservice to all points of view. I also try to be provocative in this blog to stimulate a broad discussion of the issues and I expect and hope that internists who disagree will continue to avail themselves of the opportunity present in this blog to be heard by thousands of your colleagues and other interested readers. I thank Arvind for sharing his views even though critical of this blogger.

jfddoc said...

Howard Dean explains why tort reform isn't in HR 3200...from the town hall meeting with Jim Moran..not a big confidence builder for me:

"This is the answer from a doctor and a politician. Here's why tort reform is not in the bill. When you go to pass a really enormous bill like that, the more stuff you put in it, the more enemies you make, right? And the reason that tort reform is not in the bill is because the people who wrote it did not want to take on the trial lawyers in addition to everyone else they were taking on. And that is the plain and simple truth."

Arvind said...

Thanks for the opportunity to disagree, Bob. It would be advisable that you as our spokesman have an even-handed approach to "reform".

As far as "factual misrepresentations to score a point" are concerned, there is fault on both sides. For example, did the ACP ever question President Obama about his outrageous comment that doctors frequently look at the fee schedule before deciding whether to treat a sore throat with antibiotics versus a tonsillectomy? Did the ACP pick up on Dr. Dean's remarks that tort reform is off the table because the administration is too timid to take on the trial lawyers?

If you really want to know how angry my patients here in Bucks COunty, PA (only 15 miles from the ACP headquarters) are, you welcome to question some of them. I have yet to hear a single comment in favor of any of the proposals from my patients, and we are in an area populated by moderate-minded voters. So we should take a closer look before we accuse these folks of being orchestrated. This is what happens when decisions are made in the ivory towers without involvement of the grass roots.