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Health in the Headlines: The Stories Behind the Stories.

Stephen Klaidman. Oxford, $24.95. Maybe you've noticed revisionism running rampant through the environmental-hazards community of late. Take asbestos. Turns out society might prefer to leave it in our kids' schools--Bobby's risk of being harmed by it is miniscule, says the new dogma, but woe to the construction worker who pulls it out. Then there's "Deadly Dioxin," the Agent Orange stepchild that was once candidate for the Most Pernicious Carcinogen Award. Now, some researchers say, dioxin may be dangerous only after high levels of exposure.

For scientists, reappraising the evidence is as essential as the original research itself. It's often these second or third looks that truly zero in on an issue. But for the layman, reappraisal leads to confusion. Is cholesterol good this week, or bad?

Whose judgment should we accept when scientists disagree or change their views? How can we hedge our bets so that we avoid massive overreactions that cost us far more in the long run than putting up with the perceived dangers? And how can we protect our lives in the process? Is more data necessarily better? And how can we tell when the media is hyping a story? If these kinds of questions bother you, Klaidman offers some answers.

A journalist who spent 23 years with The New York Times, The Washington Post, and The International Herald Tribune, Klaidman earnestly recounts the histories of seven of society's most difficult environmental and public health dilemmas. This is not fireside reading. Chapter by 20-page chapter, Klaidman sketches chronologies of the public policy debates that have raged over AIDS, nuclear power, pesticides, the greenhouse effect, smoking, radon, and cholesterol. Examining how the authorities behaved as each worry surfaced, how the press reported each story, and how the public reacted, Klaidman issues his frustrating verdict:

Reporters and editors must grapple with uncertain scientific results that resist interpretation, fundamental assumptions that are hidden and untested, undisclosed values that underlie important regulatory decisions, and the clandestine substitution of illegitimate economic or political goals for the public interest. As a result, even the most thoughtfully reported and composed stories . . . rarely, if ever, are able to provide the definitive answers the public is seeking.

In other words, when it comes to plumbing the legitimacy of this week's health crisis, your guess is as good as mine. But Klaidman isn't out to depress us. Hidden in the sea of health reports, he contends, are "generizable patterns" that can help the reader evaluate the significance of the reports. What was the size of the research study, and were the subjects animals or humans? What is the likelihood that a particular scientist or public official may be tilting news coverage in a direction not warranted by the data? And has a health or environmental risk been openly weighed against other risks?

Klaidman's moral is simple: "There is room for improvement in coverage of health risks, even by America's best news organizations. But there may be even more room for improvement in the way Americans interpret and understand news."

Preachy? Indubitably. But also warranted. The problem is that Klaidman's argument should have been taken further. Klaidman's measure of his own success would be the degree to which his reader becomes a more skeptical observer of scientific reports. But that's only a half step to full citizenry. True enlightenment consists of knowing what to do in the absence of good data--and doing it. An example: Last December you may ahve read in your favorite newspaper about a scientific study published in The New England Journal of Medicine, which reported that women who carry a particular rare gene may be predisposed to breast cancer. (Ataxiatelangiectasia is the gene's excruciating moniker, but it is popularly referred to as the AT gene.) Moreover, the researchers found evidence that those AT-carriers who had undergone routine diagnostic x-rays during their lives were substantially more likely to have suffered breast cancer than those who had not.

The first-day media coverage of this report, even in The New York Times, left the impression that if x-rays could endanger women with this rare gene, they might imperil other women as well. The study specifically warned women carrying the AT gene not to undergo mammography; thus one could easily make the connection that women with predisposition to breast or other forms of cancer whose triggering genes had yet to be identified would be better off avoiding all diagnostic x-rays.

But the reports were overblown. Follow-up stories explained that only a tiny percentage of the population carries the gene. Moreover, because doctors cannot yet test for the presence of the AT gene, women cannot even determine if they have reason to worry. Moreover, researchers warned that skipping mammograms and other diagnostic x-rays poses a greater peril than the possibility of triggering the AT gene.

Sure, Klaidman's Rules for Readers provide, on the surface, all the ammunition needed to retain a correctly skeptical posture on the AT study. But he falls short by leaving us bereft of advice where we most need it: How do we arrive at a conclusion--perhaps only a temporary one--in the midst of such confusion? Suppose, for example, that your family pediatrician recommends that your 9-year-old daughter get a routine chest x-ray because her lungs have been congested ever since pneumonia was diagnosed among friends at school. Regardless of your level of skepticism, are you still comfortable about having her take the routine x-ray?

In essence this is just the difficulty facing the government in countless public health arenas. In establishing a national policy on global warming or AIDS or radon, it can be as skeptical as it likes about the data, but it still ought to be doing something, even if only hedging its bets. Data is always going to be imperfect, and conclusions subject to change. What we really need from Klaidman, or some equally politically uninflected author, is not more evidence that scientists routinely change their minds. Rather, we need a "how to" book to guide us through in the meantime: how to make hard choices on public health issues in the absence of good data and scientific consensus; how to go beyond skepticism; how to take action amid ignorance. We can call it Health in Tomorrow's Headlines: How to Gamble on Your Future.
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Author:Rubinstein, Ellis
Publication:Washington Monthly
Article Type:Book Review
Date:Apr 1, 1992
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