The current UK measles outbreak reminds us that, as far as healthcare communication is concerned, the voice of the people is not necessarily the voice of God, writes Reflector.
The localized outbreak of measles in the UK is alarming in more ways than one. There can only be sympathy for the victims of this sudden return of a disease that had almost slipped from the perception of an entire generation. In addition to the discomfort — and on occasions serious complications — of the disease itself, there is now a sense of something approaching panic in the region where the incidence is highest. Anguish over the risks is evident in the faces of the parents and young children jostling with adolescents in long queues outside special vaccination centres that have been set up.
But there is a more general reason for concern. The background to this sudden recrudescence is well known. Urban myths about the risks of the MMR vaccine were given prominence more than a decade ago in a campaign by a local newspaper in the area where the most cases have been registered. The result was wide refusal of the MMR vaccination across the region. The subsequent clear rebuttal of the myth never received equivalent publicity — such is often the nature of the media. “Titanic sinks!” is a story. “Titanic doesn’t sink” isn’t.
Consequently, the ill-founded conclusions from the pseudo-research that lay behind the perception of risk remained as the accepted wisdom among a large swathe of the population over many years. Bolstered by the apparent absence of measles, there was even a small sense of triumph: “We were right to avoid the risks of vaccination — because the vaccination is anyway unnecessary. There is no measles,” ran the logic…
Emergency clinics and modern treatment techniques will probably manage to bring the outbreak under control over the coming weeks and months. But it is a wake-up call, not just to parents hesitant about the merits of immunization programmes, but to everyone involved in healthcare planning and healthcare provision. Because the circumstances in which urban myths can flourish have gone through a revolution since that local paper spread ignorant pseudo-science in the valleys of South Wales.
The entire communication game is changing. It has always been changing — but most of the time slowly. More recently, it’s been changing faster. And now it’s changing very fast, out of all recognition. That’s an earthquake for everyone involved in every aspect of healthcare communication.
There was a time, thousands of years ago, when most information came from the person with the loudest voice. But gradually technology took over. And in the last couple of centuries these technologies tended to concentrate the power of communication into very few hands – consolidating a system in which a few people at the top told everyone at the bottom what the people at the top wanted them to know.
Over the same period, the healthcare business moved on, leaving behind the vestiges of witchdoctors and barbers. The new healthcare establishment tended to dominate communication too — leading to a culture in which the doctor told the patient what the doctor chose to tell the patient, and prescribed the treatment he or she chose — perhaps influenced by the drug industry, and perhaps even by research … but most patients never saw much of that.
More recently, after years of patient docility, another trend started to emerge, principally among patients, who wondered if they were getting the best deal from being at the bottom of this top-down approach. The effect was a small rise over the last 50 years in activism — and even skepticism and distrust.
Then technology took another step forward — a giant leap for mankind. The internet. Communication — all types of communication — moved into a different dimension. The monopoly of authority over communication started to crumble.
Now, no single powerful voice can dictate unchallenged to everyone else. Everyone else can, if they wish, communicate among themselves, changing the balance, dethroning the former authorities.
From the perspective of democracy, this is unquestionably a good thing. From the perspective of healthcare communication, it raises as many questions as it answers. Of course researchers, regulators, drug firms and doctors can make use of the new technology in their own work — and are doing so in many cases with transformational consequences. But their voices are only some of the voices among so many others. There is much to be said for patients, consumers, customers, even the public, acquiring a new status in healthcare information and discussion. Patients, consumers, customers, the public, can no longer be taken for granted. The paternalistic top-down approach has been more or less neutralised by the rise in technology and the rise of — for want of a better expression — people power.
It would be foolish to suggest that everyone who has traditionally been at the top until now — doctors, researchers, drug firms — is necessarily wrong. Importantly, it would be equally foolish to suggest that everyone else is always right. It is flying in the face of common sense to contend that all healthcare issues are best solved by a form of popular democracy. This can go right, or it can go wrong. In some instances, a majority can come up with an answer that looks right, but isn’t. Vox populi is not necessarily vox dei — as the UK measles outbreak demonstrates. If patients or the public have the right to question the traditional sources of information, they also have a duty to maintain a similar degree of healthy skepticism about all sources of information — including from other patients or consumers or customers or the public. The web 2.0 and the smart phone are not the weapons of a coup d’état. They are merely the tools to permit a better debate.