Broadcaster Beware: Can there be harm from the message

The Sunday Edition featured a 30-minute interview with science journalist Robert Whitaker, who has written a book questioning the use of psychiatric drugs. He says there is evidence they often don’t work, they may even make some conditions worse and the whole notion that mental illness is caused by a chemical imbalance in the brain is just a theory. The complainant, Marvin Ross, was concerned that Mr. Whitaker went unchallenged and that his message would cause people who desperately need them to stop taking their medications. CBC policy calls for balance and fairness over time, and it is legitimate to explore one set of ideas. The caveat when vulnerable people might be affected, especially when dealing with health and medical stories, is an important one though.

COMPLAINT

You were concerned about an interview Sunday Edition host Michael Enright conducted with science journalist Robert Whitaker. Mr. Whitaker is the author of a controversial book entitled Anatomy of an Epidemic: Magic bullets, psychiatric drugs and the Astonishing rise of Mental Illness in America. Mr. Whitaker argues that psychiatric drugs, particularly a category of drugs known as Selective Serotonin Reuptake Inhibitors (SSRIs) are not always the most effective way to treat people with mental illnesses, and that their long-term use may worsen the condition.

You thought it was wrong to interview a journalist as if he was an expert because the consequences of his position are potentially so dangerous:

“… he is a journalist and not a scientist or medical practitioner and his critique of psychiatry unchallenged can have serious consequences.”

Your concern is that people listening to the interview would be encouraged to go off their medications, with potentially dire consequences. You pointed out that this would violate CBC’s Journalistic policy on health reporting which states:

In matters of human health we will take particular care to avoid arousing unfounded hopes or fears in persons living with or close to those living with serious illnesses. We will also avoid suggesting unproven benefits or risks to health related to changes in habits of consumption of food or pharmaceutical products.

You thought the interview also violated CBC journalistic policy because it did not provide a diversity of views. You quoted part of the policy that states single point of view content should be labelled as such. You also thought the segment, through Mr. Whitaker’s statements, misrepresented other points of view. As an example you mentioned that a psychiatrist quoted by the author left a comment on The Sunday Edition’s web page that he had been misquoted.

MANAGEMENT RESPONSE

The executive producer of The Sunday Edition, Susan Mahoney, responded to your concerns. She pointed out that a diversity of perspectives does not have to be in one broadcast. She noted two interviews done in the past season that had a different view about the value and efficacy of psychiatric drugs. She added that Mr. Enright quoted one of them in the course of the conversation with Mr. Whitaker. He mentioned that Andrew Solomon, author of The Noonday Demon, said he could not “exist without drugs.” She told you that the program also featured a lengthy interview with Scott Stossel, who suffers from anxiety, about his reliance on a range of pharmaceuticals to cope with it. And she added that in this interview Mr. Enright mentioned the work of a psychiatrist who is an advocate for medication.

She also felt that it was clear that this was a single point of view by the very nature of the way Mr. Whitaker was introduced as someone who believes that many people prescribed SSRIs get no benefit from them, and in fact might be harmed.

She did not agree with your concern that a journalist was interviewed when it would be more appropriate to have this discussion with scientists:

“Mr. Whitaker was referring to and summarizing currents of research about the efficacy of psychiatric drugs. It does seem appropriate that as a journalist, his job is to present those findings to a general, lay audience. That is the role of journalists; to disseminate ideas, to initiate and participate in conversations that are in the public interest.”

She rejected your statement that Mr. Whitaker’s conclusions are unfounded statements of opinion, saying they were backed by citations from various scientific studies, or by conversations with individual psychiatrists. She pointed out that the interview did not advocate that people go off their medications, but rather examined Mr. Whitaker’s analysis that psychiatric drugs may not be the best long-term treatment for some conditions. She believed the message was that there should be more care in prescribing them.

She addressed the issue of the psychiatrist, Dr. Ronald Pies, who said he was misquoted. She said that he was accurately quoted as saying that the “chemical imbalance notion” of mental illness was a kind of “urban legend.” She explained that his actual concern was that listeners would think he endorsed people suspending their medication. She cited as an example of fairness and balance that a statement from Dr. Pies was read on the next edition of the program.

REVIEW

One of the issues you raise is that of balance and fairness, core CBC Journalistic values. The policy on balance states:

We contribute to informed debate on issues that matter to Canadians by reflecting a diversity of opinion. Our content on all platforms presents a wide range of subject matter and views.

On issues of controversy, we ensure that divergent views are reflected respectfully, taking into account their relevance to the debate and how widely held these views are. We also ensure that they are represented over a reasonable period of time.

While you are right that there is essentially only a single point of view in this interview, it does not automatically mean that it has violated the policy. You dismiss Ms. Mahoney’s explanation that over the course of the season there were at least two other interviews that talked about the value of medication in treating various mental disorders. Note that the policy says over “a reasonable period of time.” That is left to the discretion of programmers. Generally it is understood that the more controversial the topic, the shorter the time frame should be, but there is no formula. There is nothing that prevents a program from examining one point of view in a single episode.

The policy on opinion requires that a single point of view be labelled as such. In this case, while it was not explicitly labelled, the introduction makes it clear that this will be an examination of one man’s point of view. Mr. Enright begins by saying, in part:

“My next guest has argued for years that millions of people who have prescribed those drugs derive no benefit from them. And in fact the drugs may make their illness worse…”

Free expression means the examination of ideas, no matter how unpopular they may be. In this case, there is a very polarized debate around treatment and models of mental illness. This discussion was somewhat more nuanced than some of the extreme positions taken by both sides. While for the most part the interview was an exploration of Whitaker’s thesis, the program host cited other contrary perspectives. Mr. Enright asked Whitaker about people who say they are helped by the medication. He asked why people get worse when they come off the medication. And when Mr. Enright overstated what Mr. Whitaker has been saying – “that psychiatric drugs are not only ineffective, but that they can actually damage the brain,” he does not agree. He replied that “I do believe they work for some people, including some people long term. The message is that there is a need for a more selective and judicious use of these medications.”

The program appropriately showed a commitment to fairness and accuracy when it clarified what Dr. Ronald Pies, a psychiatrist quoted by Mr. Whitaker in the interview, said. Dr. Pies had left a comment on the Sunday Edition website which said:

Dear Mr. Enright,

Since I am quoted, somewhat out of context, in this posting, I would like to clarify my position re: the "chemical imbalance" metaphor. The article asks:

"...what if mental illnesses like depression aren’t really caused by chemical imbalances, and that millions of the people who are prescribed those drugs derive no benefit from them? And what if those drugs could actually make their mental illness worse and more intractable over the long term?"

There is a big difference between saying that the "chemical imbalance" idea is simplistic--a statement I would support-- and claiming that people derive "no benefit" from antidepressant-- a claim I do not endorse and is in fact wrong. There is no question that for moderate-to-severe major depression, people do get significant benefits from these medications, though their exact mechanism of action is not clear, and is undoubtedly more complicated than correcting a "chemical imbalance." The claim that antidepressants or antipsychotic agents make mental illness worse in the long term has never been substantiated in carefully controlled studies.

It is extremely difficult to prove that medication, as opposed to the patient's natural course of illness, caused any "worsening" that might be seen, and it is premature and speculative to blame medications.

A version of this statement was read on air in the next broadcast.

One of your concerns is the science and studies that Whitaker cites, without challenge. The literature is full of debate and questioning of studies, even some based on meta-analyses, that come to very different conclusions. Dr. Pies actually published a paper in the journal, Innovations in Clinical Neuroscience, entitled “Are Anti-depressants effective in the Acute and Long term Treatment of depression? Sic et non,” assessing the two sides on some critical questions about the efficacy of psychiatric medications. He begins by saying, “The efficacy of anti-depressant treatment of major depression remains a matter of controversy.” And while he would not agree with Mr. Whitaker, he does “advocate a conservative approach to antidepressant treatment, as well as a substantially extended “tapering” period when antidepressants are discontinued.”

If there is controversy, then it is a valid journalistic pursuit and in the public interest to explore ideas about it. As for having this discussion with a journalist, and not a scientist or health care practitioner, there is no policy violation. His credentials were not misrepresented and it is certainly common practice to interview journalists who have expertise and have researched a particular area.

You raise a valid concern that programmers should be mindful of the kind of impact interviews like this might have on vulnerable people. As you noted in your complaint, CBC has journalistic policy to cover that very situation in covering health and medical news. It states:

We take care to understand properly and reflect the true implications of medical or scientific study results that we obtain, especially those involving statistical data.

We will exercise caution with regard to results disclosed at a conference but not yet published in a peer-reviewed scientific journal.

In matters of human health we will take particular care to avoid arousing unfounded hopes or fears in persons living with or close to those living with serious illnesses. We will also avoid suggesting unproven benefits or risks to health related to changes in habits of consumption of food or pharmaceutical products.

At no point does the interview advocate that people throw away their medications. More than once Mr. Whitaker makes the point that it is important to gradually withdraw, if one chooses to do so. He also acknowledges that medication helps some people in both the short and long term. Ethics in journalism calls for the balancing of competing values. There is the value of free expression and exploration of ideas that are in the public good against the potential harm, in this case that airing the discussion might prompt someone who needs medication to go off it. That is a serious consideration, but it is not the deciding one. There was no violation of CBC’s journalistic policy.

Your complaint though reminds programmers of the importance of considering unintended consequences when it comes to discussions like these. You mentioned that in some of your own writing, you have been asked to ensure that there is always an independent and opposite voice when you are presenting a particular point of view. It is a reasonable suggestion in situations like this. Since this issue is an ongoing one, I hope the programmers will consider revisiting it. Judging by the comments from their audience members, there would certainly be an appetite for it.

Esther Enkin
CBC Ombudsman