It’s not just diseases, media reports on the recent Bihar deaths are also a type of dangerous ‘outbreak’. The cacophony in the media is the sign of a larger disease and reflects the confusion among healthcare workers, locally and nationally.
Lack of evidence-based disease diagnosis and lack of purpose, focus and clarity in media descriptions shows the ills of both medicine and media.
For instance, as a result of the ‘media outbreak’, some states are now reportedly worrying
about litchi sales, especially about litchi from Bihar. The media seems to have conveyed the message that a toxin in litchi has killed the children in Muzaffarpur.
Medicine and media have one primary duty – primum non nocere – first, do no harm. Both have violated that duty.
The role of the doctor is first and foremost, to make the correct diagnosis for every sick child – in this situation the sick and unconscious child. The appropriateness of treatment depends on the correctness of diagnosis. Once the diagnosis is made and verified, the treatment is as recommended by experts and accepted by peers. What exactly was that disease in Muzaffarpur?
The role of the media is to investigate and inform. Disease diagnosis is not a game of who says what, but a discipline of disease classification based on specific criteria and their application to every sick child, one by one. If anyone in healthcare pronounces a diagnosis, the one who reports it must clarify if case definition criteria has been fulfilled. Ask the doctor – it is a legitimate question. If case definition was not applied, the process of diagnosis itself is faulty. If the reporter asked and was unconvinced about the diagnosis, then he/she should have reported that as well.
Was the outbreak disease acute encephalitis? Or, was it acute meningitis? Or, was it acute encephalopathy? All three have clear case definitions. The term used by most media as diagnosis is acute encephalitis syndrome or AES, but that is an umbrella term inclusive of all three diseases named above. The treatment is entirely different for the three.
If the disease is diagnosed as AES, the media must inquire about the treatment that was given – that would have clarified what the treating doctor had in mind, encephalitis, meningitis or encephalopathy. If the outbreak disease was none of the three, then there has to be a new disease previously not described – is Bihar seeing a new disease emerge?
If the doctors were diagnosing the outbreak disease as AES, then the media reporter should have highlighted the fact that the cases were so confusing to the doctors that they were unable to distinguish between the three diseases. In that case, doctors needed urgent and immediate help from outside experts. Was that provided by the health department? If not, it was legitimate news about a system that failed to rise to the tragic occasion.
Media should utilise reporters familiar with health and disease. The blind cannot lead the blind. Those who report on diseases and outbreaks should familiarise themselves with the basics of reporting on medicine – including the correct names of diseases.
In democratic nations, the state has clear responsibilities regarding people’s health. The numbers and specifics of an outbreak are formally and authoritatively put out by the state for the public. But not in India. Those interested in distribution and determinants of disease depend on an alert media for reasonably reliable information. So, the media has the responsibility to be objective in observations and erudite in interpretations. But for media reports, the large numbers of children dying in Gorakhpur and Muzaffarpur would not have come to people’s attention.
Recall the Nipah virus outbreak in north Kerala just a few months ago? Healthcare professionals and health ministry officials were consistent and the media played its role superbly. While the media must reflect on the lack of clarity/consensus among medical professionals and ministry officials in Muzaffarpur, reports must be credible, even if critical. The media must not magnify, but simply reflect facts and what they signify.
Muzaffarpur shows the problems of healthcare in just one district among the 725 in India. The media must represent people and do reality checks on our health management system as a whole, and report both its pluses and minuses.
For the media, it is easy, and tempting, to sensationalise the Bihar tragedy like some TV broadcasts did and feel good about itself. That is not mature. Did our health management system just deteriorate in Gorakhpur in 2016-17 or in Muzaffarpur in 2019? The litchi fruit may only be the ‘last straw that broke the camel’s back’. Do you blame the heavy load or the one straw?
There is something rotten in the state of… India’s health management system. But it is not as if something went wrong recently, something was wrong for a long time.
The system design is not need-based or result-oriented. Don’t expect the medical profession and its organisations to fix it because they are a part of the system, not its designer.
Media being outside that system, can see it objectively, investigate the defects and suggest remedies. The purposeless and sensationalised reports that have flooded the media, especially social media, can’t fill the vacuum of authentic reports. Investigative reports would have helped the system, prevented the outbreak and saved lives. Remember, these outbreaks have been an annual occurrence in Muzaffarpur since 1995.
The author is a retired professor of virology from CMC Vellore. Views are personal.