The commodification of prevention

In the 1980s Australian television viewers were stuffed with a diet of big-budget, government-sponsored health-promotion campaigns. Most of these have now been pared to the bone, partly because of government austerity but also because of a growing recognition that huge media coverage can be obtained without cost via “infotainment” programs, help with soap-opera scripting, and the media’s appetite for health as news.

A recent study of a full year of the Sydney Morning Herald’s front page found that 38 percent of editions contained at least one health story. After politics, health and medical topics consistently rank highest of all news categories, and for virtually any health issue the public will nominate the news media as their main source of information.

So for health promoters the media present enormous opportunities. But, as one Australian group found out recently, the road to health promotion is also paved with banana skins. A recent study in the Medical Journal of Australia reported a significantly reduced risk of asthma among 8- to 11-year-old children who regularly ate fresh, oily fish. After controlling for most of the relevant confounders and discussing the biological plausibility of their findings, the authors concluded that consumption of oily fish “may protect against asthma in childhood”.

An accompanying editorial was less sanguine, cautioning that the estimated mean intake of eicosapentaenoic acid in the subjects’ diets was much less than that which would plausibly predict anti-inflammatory effects on leucocyte mediator and cytokine generation. It suggested that the oily fish was likely a proxy for some undiscovered wider dietary or social factor in fish-eating families.

About 20 percent of Australian children experience wheezing, so the story leapt to the top of every news bulletin, featuring interviews at Sydney’s fish market with the first author. A “miracle food”, “Grandma was right” subtext swept the critical “may protect” caveat from all but one bulletin. Whatever cautious note the author may have uttered wound up on cutting-room floors.

The next week Media Watch, ABC TV’s scathing weekly review of journalistic standards, denounced the reportage as irresponsible in ignoring the editorial caveat while trumpeting the “discovery”. While the study acknowledged the financial support of the fishing industry, only one bulletin mentioned this. The incident exemplified the problems central to the popular communication of research and to the question of when health promoters should be able to translate epidemiology into take-home messages about more of this, less of that. Other studies contradict the results of this one, so aficionados of evidence-based medicine would probably judge that this fish story should go back into the water for now.

But is it reasonable to expect journalists to adopt the same standards of evidence and to take a meta-analytic perspective on every report published in journals? As governments privatise more and more of their responsibilities, we may well see much of health promotion being “commodified” into messages about goods and services that have health as their main selling point. The private sector has many health-promotion selling angles – for foods and drinks, drugs, sunscreens, safety innovations for cars and houses, and exercise equipment – that leave those of government campaigns in the shade. But the price of these advantages seems bound to lie in the abandonment of the cautious language of benefit and risk. Try as they might to avoid this, scientists taking research money from industry will find themselves regularly exposed to such dilemmas thanks to the media’s lack of interest in what it would probably regard as scientific onanism.