Robin Fox, 54, the editor since 1989 of the premier international medical journal, Lancet, was in New Delhi recently for the Lancet Grand Round on Leprosy held at the All India Institute of Medical Sciences (aiims) and a seminar on "Medicine and Media" organised by the National Medical Journal of India. A specialist in internal medicine, Fox had been associated with Lancet for over 2 decades before taking over its reins. In the years since, medical research has undergone tremendous changes, with an increasing number of research programmes being sponsored by corporate houses. Consequently, media coverage on medicine and research have also begun to reflect these changes with newspapers bringing out health supplements and research journals going on-line. Fox talks to MAX MARTIN about the changing trends in medical research and its reporting.
Would you agree that in recent years researchers have become more communicative?
You're quite right. In the past 10 years, the scene has changed. Scientific institutions have been teaching scientists the techniques of public relations, publishing and writing for science journals and holding press conferences. These days, we even have an M Sc programme in science communication.
Have hospitals also adapted themselves to this open door policy?
I would have said no 10 years ago. This was especially true of hospitals that were under the patronage of the National Health Scheme. We could not even think of competition between hospitals then. But we can certainly do so now. It is part of the new ethos to report, in your journal, on a new technique that is available in a hospital. It promotes people's interest, enquiries and, in turn, commercial prosperity.
What kind of a role do you envisage for the media?
The Press needs science and science needs the Press. The funding bodies, like the Medical Research Council, have quite rightly talked about informing the public -- the taxpayers -- about how their money is being spent. These bodies now have sophisticated public relations machinery. But there are other public relations organisations who steal the show. Besides, there are journals. Although people think of journals as dry, they have tremendous scope. Many journals now produce press releases of their own, so that people can read about their articles in newspapers.
What changes do you find in mainstream reporting of medical research?
In the coverage of medical research by the mainstream media in the uk, politics was of primary importance 10 years ago. Then came sports. But it is no longer so. A recent survey by Oxford University has showed that politics is certainly not the top priority. Medical discoveries top the list, followed by inventions and new technologies, scientific discoveries, sports, films and then politics. Serious papers now have a weekly page for medicine.
With medical reporting going into the hands of laypersons, doesn't it leave the field open for scientists and medical researchers to misuse the media?
You're right. Media hype can be counterproductive. Mediapersons and researchers have to be alert. The Guardian once carried a report headlined "Drug hope for lung cancer", about a new drug being tested. The claim was exaggerated. Later The Independent carried a story on the same drug, which quoted experts to show that the claim was premature. The paper's medical reporter cut through the hype, making the story more genuine.
Would you recommend a doctor on the editorial board of newspapers, as many eminent doctors and editors of medical journals suggested during the recent seminar on "Medicine and Media"?
I don't subscribe to the idea. Having a medical qualification is no passport to heaven. Whether or not to have a doctor on the board is not the question. You should cross check your information and take advice from the best person available. That is what good journalists have always been doing.
What are the effects of privatisation in the field of medicine?
With more private hospitals coming up, the competition between them will improve the techniques. But privatisation can be a major threat to research. It affects research patterns as pharmaceutical concerns that sponsor research programmes may do so to suit their own ends. For instance, you may not get funds for a research programme to find out if internal bleeding in the legs can be treated without drugs but by, say, positioning the legs on a higher plane. They expect reasonable returns. Also, tertiary hospitals now find it difficult to get patients, as secondary hospitals are less willing to refer patients for tertiary care. With the decreasing number of serious and complicated cases coming in, the tertiary hospitals are finding it difficult to carry out long-term research.
And yet it is true that private firms are playing an increasingly important role in medical research?
It is true that more and more research is being done by private firms. In the uk, for example, the largest sponsor of medical research is the Wellcom Trust. There are other large conglomerates as well. At the National Institutes of Health, however, the Americans have had problems related to private research by conglomerates. The scientific community's concern is whether the pharmaceutical industry would take more of an interest in the research on vaccines rather than on expensive therapeutic agents. The success of the industry depends on concentrated action at hospitals where they make their profits. Does the pharmaceutical industry try to influence the contents of your journal?
Certainly! You would expect that from commercial organisations.
How do you deal with that?
In a journal or newspaper that depends entirely on advertising income, it is not easy to do publish something that may upset the advertisers. That is the hazard. Some of the advertising may be disguised as reports, which actually carry detailed information about a client's product or research programme. A balance has to be struck between editorial content and advertising. But an editor has to be able to do as he or she wants. At times, what you say may hurt the subscribers. At other times, it may hurt the advertisers. The trick is not to hurt them both at the same time.
From which areas of research does Lancet get the maximum number of papers?
I'd say cardiology and infectious diseases.
What about aids?
In the early stages, when aids first made news, we had published some papers. But now the activities have more or less stabilised.
Out of your journal's circulation of 50,000, how many copies go to developing countries?
Africa, Latin America and the developing countries of Central Asia and South Asia account for 15,000 copies. We publish many articles from the developing world, especially on developmental issues. One reason for this is that among the subscribers in these countries there are many who can influence policy decisions.
Have you had to deal with fraudulent data?
Several times. Quite often only a small part of the article would have data that is questionable. When the writer puts his name to the paper, he is certifying not only his own work but also the work of colleagues from whom he might have collected the data. Some papers that were suspect have later been published with corrections. We have a rule at the Lancet: the more surprising the finding, the less likely it is to be true.
At a time when journals are going on-line, what has been the Lancet experience?
Lancet had a close link-up with On-line Journal of Current Clinical Trial, published by the American Association of Advancement of Science (aaas). The idea was to satisfy persons who wanted detailed information. We carried 4 stories simultaneously. They did longer, detailed papers, while we carried them in a shorter form. We published one story recently on coronary bypass surgery -- 4 pages in the Lancet and 70 pages in the aaas On-line.
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