I hate to take off on the press. I do it every once in a while, but not often. The slow and agonizing demise of the main stream press has major consequences for keeping the public informed about issues both big and small. It’s also a personal tragedy for many dedicated professional journalists. Still, while newspapers-as-we-knew-them aren’t dead yet, they are at least moribund, and like the famous definition of a statesman as a successful politician who is dead, there is more than a bit of a tendency to endow the working press with some virtues it doesn’t have now and in general never did. There is quite a lot of truly dreadful reporting every day and it isn’t new. Consider the tragic case of the GP in the UK who died after contracting swine flu:
Natural causes claimed swine flu GP
Swine flu sufferer Dr Michael Day died from natural causes with the major factor being a blood clot to the lungs, it has emerged.
No inquest will be held into the 64-year-old GP, who died on Saturday in the Luton and Dunstable Hospital, said a spokeswoman for Bedfordshire Police.
Tests carried out following his death showed he was suffering from the swine flu virus but a post mortem examination established he died from natural causes.
Sources said Dr Day died primarily from a blood clot to the lungs. He also suffered from heart disease and high blood pressure, and had viral pneumonia. (The Guardian, UK)
This is a news feed from a UK wire service, The Press Association. It was carried in many news outlets in the UK. Alas, it is not an outlier.
What’s wrong with it? Two things. First, it’s just taking dictation from a police spokesperson. It’s reporting, all right, in the most literal sense. The Press Association “reported” what the police spokesperson said. And that’s all they did. A tape recorder could do that (and maybe did). Second, there is a complete failure to examine the meaning of what was reported. Meaning in the most literal sense. What does it mean when someone who has swine flu dies of “natural causes”? This doctor had heart disease, high blood pressure and . . . viral pneumonia!. On the one hand we’re told that a major risk factor for dying from swine flu is having an underlying medical condition. Like what? Heart disease and high blood pressure? And what does infection with the influenza virus cause in someone’s lungs? How about viral pneumonia. How a police spokesperson could say, with a straight face, that the doctor didn’t die of swine flu but “natural causes,” and then that a reporter could copy it down and transmit it to readers as some kind of fact beggars belief. But it’s quite common and barely raises surprise or comment.
The egregiously bad reporting aside, there are some interesting scientific questions in this personal tragedy (this is the first health care worker I am aware of to die in the acute phase of a swine flu infection). A CDC MMWR Dispatch widely reported last week reported in 10 cases from a Michigan tertiary care facility that treated Acute Respiratory Distress Syndrome (ARDS) in 10 swine flu cases. There were two unusual features in this case series (which is not obviously representative of all severely ill swine flu victims but still of interest). One was the high proportion of very obese patients. In CDC lingo, Body Mass Index (BMI) from 25 to 30 is considered “overweight.” Obesity is a BMI over 30. If someone has a BMI over 40, they are considered “morbidly obese” (if you want to know what your BMI is you can go to one of many online calculators, for example, here; you’ll need to enter your height and weight). Nine of 10 were obese by these standards (BMI over 30), and 6 of the 10 were morbidly obese (BMI over 40), 4 of the 6 with BMIs over 50. I’m a person of average height (5’10”). To have a BMI of 50 I would need to weigh 350 pounds. The relationship of marked obesity has not been previously noted.
I don’t know the weight of the doctor who died (his photo is head shot but he doesn’t appear morbidly obese), so there is no indication that obesity is an additional risk factor here. So why am I bringing up this report? Because there was another unusual feature in these 10 intensive care patients. Half of them had pulmonary emboli (blood clots in the lung):
Pulmonary emboli are not known to be a common complication of ARDS or of sepsis syndrome, but both ARDS and sepsis represent hypercoagulable states. Pulmonary emboli were not noted in patients hospitalized with novel influenza A (H1N1) virus infection in Mexico. One clinical study did not identify any increased risk for pulmonary embolism with seasonal influenza virus infection. However, a report of two patients with rapidly progressive hypoxemia associated with influenza A (H3N2) virus infection noted that they received a diagnosis of acute pulmonary embolism. Clinicians providing care to patients with novel influenza A (H1N1) virus infection should be aware of the potential for patients with ARDS to develop a hypercoagulable state and for pulmonary emboli to cause severe complications, including fatal outcomes. (Morbidity and Mortality Weekly Reports, CDC [cites omitted])
The unfortunate doctor in this case probably died of his pulmonary emboli, so he becomes yet another data point associated swine flu associated ARDS. Whether pulmonary emboli went along with obesity in his case is thus of interest. I understand that these scientific issues are probably beyond the ken of most non specialist reporters, but one would think that the death of the first GP at a time when the role of GPs in treating swine flu is a matter of discussion and controversy in the UK would have merited more than perfunctory treatment. And to call it perfunctory is perhaps being generous.
I regret beating up on a press already reeling from the catastrophic economics of their industry. If this case were unusual, now or in the past, I’d probably let it go. But it isn’t unusual. When we acknowledge and mourn what we are losing with the demise of newspapers — important things we got regularly — we should remember other things we also got: regularly.