Talking Points

So, I've been mulling over CodeBlueBlog's coverage of Bill Clinton's decortication. Like with the Yuschenko / dioxin poisoning and other CSI: Medblogs cases before it, I'm slowly being won over to his line of thinking. What can I say? I'm still reluctant to question attending physicians, even when I have all the records of a case. Their experience and familiarity with particular patients dwarfs my own. I tend to give them the benefit of the doubt.

But it's even more difficult to second-guess media reports on medical cases. We never have all the facts of a case, or even a tenth of the details in a patient's chart. We're going on vague answers from press conferences, and photos shot from the crowd.

For those trying to piece together the truth, it's especially frustrating to dig for more data amongst the 1,277 nearly-identical stories on Google News. When you consider the basic questions that are consistently unasked, while reading the same parroted talking points over and over... it can either lull you into complacency or make you give up altogether.

CBB doesn't do either. He takes what the doctors have disclosed, throws in some observations, checks against the literature and his own experience, and draws up a list of possibilities as to what's really going on. Often, his differential includes malpractice, addictions, sexually transmitted diseases, and feeble attempts to cover them up.

CBB's motivation behind his CSI Medblogs posts is explained well on his site and in comments to this blog (more below). He'd invoke holding reporters accountable for viewer conclusions, raising the bar of journalism... Sometimes I think even more is at stake. The blogging activity around Clinton's surgery is not the best example -- I think the sad death of Red Sox fan Victoria Snelgrove is more appropriate. Her death by a police officer's pepperball gun has never been adequately explained, and has clear implications for the future of crowd control in America.

The family is entitled to privacy, but the public is entitled to safe demonstrations. We need to know what happened. And you'd learn a lot more relevant details from reading the CBB and blogborygmi discussion of this case than you'd learn in the 1000+ mainstream media reports that were filed.

But we don't have the access that these reporters do. And we've got, well, day jobs. The best we can do is try to steer the reporting in the appropriate direction. As CBB said in a prior comment, responding to my contention that medical blogs haven't produced a Rathergate:

These same reporters and editorialists will pontificate thousands of words on why the entire health care system should be overhauled YET THEY DON'T KNOW A VENTRICLE FROM A FEZ. They are INCAPABLE of reporting a story that follows a medical case in a way that makes sense so I AM ALMOST ALWAYS ABLE TO REMAKE THEIR REPORTING to come to ANOTHER conclusion!

See the issue?? If they say poison, I can say alcoholism. If they say pepperball I can say malpractice. But they can't do the same to me, because I'm reporting the same thing that they are (using their data) but putting it together in the proper order and sequence so that one is left NOT with answers but a DIFFERENTIAL DIAGNOSIS, from which we have to draw the MOST LIKELY diagnoses.

If I can win THIS point and THIS idea gets across, THAT will be my Rathergate.

I'm starting to think that, if this were to occur, it wouldn't be a Rathergate (a blogger-spurred correction in mainstream reporting) but instead, a sea change in medical journalism.

Let's say a reported read CBB's posts and cornered Clinton's doctors: "How could you have let him go five months with this easily anticipated post-CABG effusion? Or is this a new effusion unrelated to his bypass, but possibly related to his new gaunt appearance? Maybe it's cancer? AIDS lymphoma?"

The doctors would have to either admit they goofed in waiting (which would sink them), or admit they're hiding something (which would sink them, their patient, and generate a hundredfold increase in questions), or open up the chart and explain each decision, piece by piece (which could still leave the doctors and Clinton vulnerable to more questions, and would require responsible reporting to avoid headlines like, "Clinton docs were worried about AIDS!" -- and, I should add, this would require a responsible audience).

In short, I wonder if doctors, patients, reporters, or the general public are ready for this level of inquiry and access.

CodeBlueBlog argues (again, from an earlier comment):

I really don't think I am pushing a conspiracy at all. Just like with Teddy Bruschi (who is more likely to have had a stroke from snorting cocaine as anything else)the PATIENTS are HURT by incompetent reporting because it leaves open the types of deductions I have made in thewse cases.

Yushcheko an alcoholic?
Bruschi a cocaine freak?
Clinton with AIDS?

All these items are open without adequate, intelligent, comprehensive reporting.

My sense is, these issues would be more "open", "in play", "fair game" or whatever the parlance is, if they passed from the caregiver's lips. It might be better, from the high-profile patient and physician perspective, to ignore certain diagnostic evaluations, for fear of what the lay audience would conclude.

Trial lawyers and police PR have learned to manage the press in high-profile cases. Same with the NTSB after a plane crash. They control the amount and rate of information disclosure, they give some food for thought each day, they steer the conversation while they go about their investigations. CBB and I have more or less assumed that doctors were not playing this game -- that if someone were asking the right questions we'd have a story that made sense.

But maybe the docs are managing the press with the savvy of a PR agent. In the case of Clinton, they're not going to spend one second talking about the chance of HIV or malignancy, even if it's on their differential, even if they're testing for it. From their perspective, it's simply not worth bringing up other options at this point. Better to stay on message and not encourage more questions.

So is this a failure of good reporting? Or have the doctors and patients decided in advance just how much they're going to reveal to journalists? And would more aggressive, educated reporting actually give us more information in these high-profile cases, or would it turn the sources against the media and bloggers alike?