Wednesday 24 October 2012

Media reporting of youth suicide: What has happened to responsible reporting?

Once again the issue of media reporting of youth suicide has raised its head. Upsetting reports of a B.C. teenager’s suicide have flourished throughout the media. Details regarding the persons actions, method of suicide and other intense details have been revealed and given this teen a prolific profile in the media. The death has certainly taken the country by storm and opened public’s eyes to bullying and teenage suicide. But, some worry that these reports and continuous updates will affect youth in similar situations and could result in copy-cats.
Over the past week, I had the opportunity to touch on this subject where I discussed ways the media can report these tragedies responsibly and provide the public with useful information. Click here to view an article from the Chronicle Herald.

These sensational reports of youth suicide seem to be increasing throughout Canadian media. Evidence shows that this type of reporting is linked to increased rates of suicide, especially in young people. Some research data shows that there is a “dose response curve” with suicide rates increasing proportionally to the amount of media exposure. On the opposite side of the spectrum, data shows responsible reporting of suicide is associated with decreased rates of suicide in young people.  So why are vulnerable young people being exposed to sensational media stories about suicide? 

A study conducted in the USA found that many reporters were not aware of the degree of negative impact that sensationalized reporting of suicide had on young people.  However, it also showed that many of those did know or did not believe that to be the case.  Personal bias (or maybe some other factors) trumped the data.  I frankly, do not know which is worse, not knowing or knowing and not caring.

Responsible reporting includes, but is not limited to:
 Do not explain suicide stories, undue prominence and avoiding sensational headlines
• Do not provide details of the method
• Give a balanced description of the victim (do not create a model for those considering the same act)
• Do not publish photos of the deceased
• Do not romanticize or provide simplistic explanations (such as bullying being the causation of suicide)
• Provide information about depression and substance abuse - as important factors in youth suicide
• Provide information on where to get help and examples of positive outcomes for young people in similar circumstances 

Is following these guidelines too much to ask?

Teens are known to be substantially impacted by media. Youth who are struggling with suicide intent may be particularly vulnerable. Most young people who are planning to take their own life are not certain that they want to go through with the act.  So, what can tip the balance towards choosing life or death? There are many causes of suicide. Media influences are one of the tipping points, which could push the young person in one way or another.

I am not saying that the media should never report on suicide, just that the reporting needs to be done responsibly.  Most suicides never get reported, meaning there is a choice the media is exercising regarding on what suicides they will report and how they will report them. 

Can they not exercise this choice in a way that does not cause harm to vulnerable people?  The media does not have to compromise their right to let the public know about important issues and events, but they need to know that the matter, in which they choose, can be part of the solution or part of the problem.

I have heard some argue that the public’s right to know, trumps all.  This may or may not be the case all the time. Frankly, I wonder if those who make this argument have other factors at play. I have noticed how commonly people can wrap themselves in the cloak of public interest to cover up their self-interest. It is important to have this conversation, but can we not have it in a positive and constructive manner? When it comes to reporting on suicide, the media has the power to provide useful information and hope, instead of a recipe for death.

-Stan

Below are some resources and associations who have worked to underscore scientific evidence on the negative impact of sensational reporting of suicide to urge the media to report on these issues responsibly.

 Canadian Psychiatric Association
 World Head Organization
 National Institute of Mental Health
 Media Contagion and Suicide Among Young People 

• Media contagion and Suicide Among the Youth, American Behavioral Scientist, May 2003, vol. 46, no. 9, 1269-1284
• American Association to Suicidology
• American Foundation for Suicide Prevention
• Annenberg Public Policy Center
• Office of Surgeon General of the USA
• Centers for Disease Control
• Substance Abuse and Mental Health Services Administration

Tuesday 2 October 2012

ADHD Medications: Real concern or media hysteria?

Recently, sensationalized reports of health problems associated with the use of some medications used to treat ADHD have appeared in the media.  Check out some of the stories here:




It can be frightening to read about incidents of severe adverse effects to medication, but it's important to keep a critical perspective when reading about these sensational stories.
Do medical treatments have risks?  Absolutely!  Every treatment does.  What must happen when a treatment is prescribed is that the patient, parent and health provider must agree that the benefit is likely to be greater than the risk.  For some treatments, risks can range from mild to severe, or either common or uncommon.  For example, the risk of a heart attack may be 1/10,000 as a side effect of that medication, while the risk of a stomach ache may be 1/100 or a headache 1/10.  Compare that to the risk of dying by being struck by lightning (1/79,700), dying in a bicycle accident (1/5,000) or dying in a car accident (1/84).Check out the annual risk of death during one's lifetime.

Determining whether the benefit is greater than the risk is the key issue to almost everything we do.  Indeed, this is part of the government’s assessment of regulated treatments, such as medications (through institutions such as Health Canada), whether they be deemed safe and therefore available as self-selection products (such as over-the-counter medications and natural health products) or deemed to require the opinion of a “learned intermediary” (such as a licensed prescriber) to support their necessary and judicious use. It’s the latter group of prescription medications that carry more risk, but are still considered potentially helpful when used by the right person.  

In order for the patient and parent to be properly informed, they need good and valid information to be able to make a decision about accepting the treatment recommendation or not. Many of the adverse effects reported recently in the media may not be caused by ADHD medication. That’s the difference between correlation and proven cause and the only evidence that’s able to tell us if the medication is causing the adverse effect is solid scientific research. This can be a problem. Sometimes the right information is hard to find. The information can be confusing or even contradictory. There tend to be a lot of misinformation or even disinformation out there. Sometimes the health provider does not give you the information needed.  So what is the patient or parent to do?

It’s essential that all legitimate health providers use the best evidence available to suggest treatments to patients. Patients however need to have a high degree of comfort that what is being suggested is driven by credible evidence, not anecdote, conjecture or simple association. And, they need transparent, clear information.  It can be difficult getting that information and it can be hard ensuring that your health provider is giving you what’s needed. You may require additional help in getting all the information you need.

This is why I suggest young people and parents use guides and health related tools to help them in interacting with health providers.  It’s important to know what questions to ask to help ensure that they get the best possible care.  We have created a number of useful aids for youth and parents. They fall under the rather boring heading of “Evidence Based Medicine”. Boring name, but crucial stuff to countering sensational and uncritical assertions and inferences. It may be a good idea to use them in order to ensure that you get the information needed to make better judgments about the potential risks and potential benefits of any treatment! Click here to view an outline on what you should ask health care providers. 

Another good resource is a mental health medications guide and treatment tracking booklet, called Med-Ed. It was specifically developed to support patients, parents and health providers do a better job in choosing and monitoring medication treatments – checking on their risks and benefits carefully and consistently. The tool promotes something very important - open, clear communications about the benefits and risks of medication treatment between the patient and their prescriber. 
Oh yes – one other thing.  The media stories suggest that regulatory agencies are not doing a good enough job to monitor possible adverse outcomes of regulated treatments. I, for one, would agree, and so do many others who’ve examined Canada’s systems and regulations for assuring that only acceptably safe medications are available to Canadians.  I think that we need to have a properly functioning national adverse events surveillance system and we need to have a solid feedback loop to the regulatory mechanism to make sure we have the ability to better determine risks and benefits of treatments in the long term.

The reports in media may not turn out to be scientifically valid in the long term, but perhaps they will generate some positive benefits if patients begin to ask their health provider some hard questions – not just about their ADHD medications, but about all the treatments that they’re getting. This would be in the best interest for the health of all Canadians.

-Stan