As it turns out, medical news is a lot like a medicine: Too much can be as serious a problem as too little -- and the wrong sort can be downright harmful.
That’s the persuasive case made by Caltech President David Baltimore, the Nobel Prize-winning virologist, who this week took the U.S. media to task for what he sees as its alarmist coverage of the international effort to contain severe acute respiratory syndrome, or SARS.
“Restaurants sit empty in Chinatowns. Parents keep children home from school in Toronto. Asian hotels and airlines reel at dramatic drops in bookings,” he wrote in Monday’s Wall Street Journal. “Just as the media recently gave us a new and particularly intimate experience of war, we’re now getting a new and particularly fearsome experience of a public health crisis with SARS -- in which a media-transmitted epidemic of concern for personal safety outpaces the risk to public health from the actual virus.”
Baltimore, who in 1975 at age 37 shared the Nobel Prize in medicine for work that dramatically expanded scientists’ understanding of retroviruses such as HIV, is regarded as one of his generation’s most influential biologists. In the 1970s, for example, his was one of the cooler and more constructive heads to take a leading role in the great debate over the dawn of recombinant DNA research.
His observations on the SARS coverage carry a special weight, therefore, particularly because he discerns a sequence of media-induced hysterias. The empty Chinese restaurants across the San Gabriel Valley and in New York’s Chinatown strike him as a telling example of the problem’s destructive consequences.
“The de facto boycott of Chinese restaurants across America is the most alarming overreaction, since there’s absolutely no reason to think SARS can be transmitted through food, or by people who happen to be Chinese,” he wrote. “Your chances of being killed by SARS are remote compared to the chance you’ll be killed in your car on the way to a Chinese restaurant. But media viruses are immune to rational inoculation. The anthrax scare of late 2001 was the preview. With Tom Brokaw and the Senate involved, it was no time before well-to-do mothers added stocks of Cipro and gas masks to the inventory of the compleat parent. That this anthrax episode claimed five lives -- when each year 40,000 Americans die in highway crashes, 400,000 from tobacco-related illnesses ... doesn’t seem to allay fears.”
In an interview Monday, Baltimore argued that responsible reporting of the SARS problem begins with the recognition that the level of concern depends on the country: “In China, they have a very serious problem. It is enough out of control to say you still don’t know where the danger is coming from. In Canada, there is a serious problem, now largely under control. In the United States, there is so little problem that it simply is not reasonable for people to be worried about it.”
Thus, said Baltimore, “for people here to avoid Chinese restaurants is totally out of proportion to the real nature of the threat. Here, we’re talking literally about a minor occurrence compared to the toll taken every year by AIDS or the flu or -- to cite a number that hit me in the paper recently -- the number of homicides in the L.A. Basin. Now, those are serious problems. A global death toll of 321 [where the SARS total stood Monday] just is not catastrophic in the way so many news reports suggest.”
In fact, since SARS first was identified late last year, slightly more than 5,000 cases have been reported worldwide. During an average winter, 36,000 Americans die of influenza and 114,000 are hospitalized. Roughly 1 in 5 Americans contract the flu annually. In 2002, 653 Los Angeles residents were victims of homicide and 148 more have been killed so far this year.
So far, Los Angeles County health officials have reported five confirmed and four probable cases of SARS. New York -- the U.S. city with the highest reported incidence of suspected and probable cases -- has 20. Of those patients, according to city Health Commissioner Dr. Thomas R. Frieden, 18 already are well and the other two are recovering. All the cases, Frieden said, involved people who had traveled abroad. “We don’t have local transmission in New York City,” he said. He too is concerned about people avoiding Chinatown. “I had dim sum there yesterday and it was delicious,” he told the New York Times on Monday.
Even while making the point that the SARS threat has been exaggerated in the U.S., Baltimore is equally insistent on what needs to be done in China, where it continues to spread. “SARS’ 5% level of lethality there is far higher than anything we allow to exist,” he said. “It’s really serious and we don’t want this virus to be a part of our population. I don’t even want to think about what it might do if it were passed among kids, which hasn’t happened yet. We have to be serious about this and put our attention and resources to work intelligently. We don’t want this thing to get out of the box,” as HIV did.
Preventing that, however, means confronting the tension Baltimore sees between modern public health and contemporary media. “The chief means of avoiding an HIV-style scenario are strong and open public health measures. Openness, however, breeds fear and overreaction,” he wrote. “This risk has to be managed by careful reporting and characterization -- a challenge for the media that may be as thorny as that facing health officials.
“Indeed, it’s arguable that new media technologies are accelerating public anxiety about viruses faster than new health technologies have enhanced our ability to cope with them. Then Internet, e-mail and satellite-enabled saturation media coverage have put public fear on steroids.”
Truthful public health information reported in a measured and intelligent way, Baltimore said, is critical: “Credibility is the key to bringing things like this under control. You need people’s confidence and cooperation if you’re going to ask them to do things like stay in quarantine, so that SARS can be brought under control, as it has been in Vietnam. We can get that cooperation if we are open and honest and intelligent, so that people believe what they’re being told makes sense. I don’t believe that, even in China, this is so far into the population that it can’t be contained.”
According to Baltimore, “Given what’s happened thus far, the appropriate response is to pursue targeted and aggressive public health measures, while the 99.9% of us not conceivably at risk go on with our lives.”
Why, then, the overreaction in the American press?
“The media believe -- and I can’t say they’re wrong -- that people just enjoy being scared,” Baltimore said. “And because their readers and viewers enjoy it, the media play to it.”