Fairness, Balance and Methadone

The complainant, Sean Enani, felt an article about some controversial methadone clinics in Thunder Bay was out of line when it noted the clinics were “private” and recently purchased by an American company. After all, many family doctors are private businesses, too. Or, in this case, is there evidence that a drive for profit is affecting patient care?

COMPLAINT

You were troubled by an article posted October 9, 2018 on the CBC Thunder Bay website headlined: Doctor questions 'disgraceful' care provided by private, high-volume methadone clinics amid opioid crisis. The story was one of several published in recent months examining issues raised by the use of opioids, and in particular the number of overdose deaths related to opioids. In this case, the specific focus was on methadone clinics. These clinics dispense methadone (or sometimes suboxone) - which are themselves opioids - to help people wean off more dangerous drugs such as fentanyl. The clinics are considered helpful and a valid part of treating the problem.

However, according to the article, there are concerns that the care provided by some high-volume clinics is less than optimal - and that that they are more focused on maximizing profit than they are on offering a full range of appropriate treatments. Dr. Meldon Kahan, the former co-chair of a methadone treatment advisory commission for the Ontario government, was especially critical of these high-volume clinics. He described the system as “disgraceful”.

You found the article to be misleading for emphasizing in both the headline and the body of the story that these clinics are privately owned:

Doctors providing methadone care work under OHIP, and get paid like all other 40,000 Ontario physicians. Their offices are as "private" and "for profit" as your family doctor's office.

You thought it was especially unfair for the article to dwell on the fact an American company had recently purchased a group of these clinics around Thunder Bay, and you argued that publishing these accusations and framing it in this way was irresponsible:

It's one thing showing evidence that practice model A works better than practice model B. But to just call others "disgraceful" using ambiguous words like "private" and "for profit" is really childish.

MANAGEMENT RESPONSE

The Executive Producer for CBC Thunder Bay, Michael Dick, explained that there were reasons to focus on this issue. The opioid death rate in his city, he wrote, is twice the provincial average. He noted that the reporter, Nicole Ireland, had spoken to dozens of medical professionals and many of them had flagged the type of care provided in privately-owned, high-volume methadone clinics as a concern.

He disputed that the story was framed unfairly. He said it was made clear that OHIP (the provincial health care plan) covers the costs of the treatments provided at these clinics. He also pointed to the inclusion in the article of Dr. David Marsh from the Canadian Addiction Treatment Centres, who defended the practices of his clinics:

Dr. David Marsh, chief medical director for CATC and a professor at the Northern Ontario School of Medicine, says that the fact his company is for-profit doesn’t compromise patient care. It’s “not any type of drive for profit”, Dr. Marsh explains, “Our goal is to offer the best quality of care we can. It's about making sure that we bill enough in order to cover the costs of running the clinics."

Mr. Dick said the overall package was fair and balanced:

It is our obligation to present those differing views fairly and accurately affording Canadians the opportunity and the information they need to make up their own minds about the nature or quality of the views expressed. And I believe we did that in this story.

REVIEW

There is more than ample reason for producers to consider the role and actions of these clinics as a subject worthy of scrutiny. I listened to a CBC Thunder Bay radio interview done the morning this article was published and learned that in the Thunder Bay district, the most common opioid found in the body of people who died from an overdose is methadone - whereas in the rest of Ontario it’s fentanyl. Clearly there is something here that deserves to be explored.

When a reporter begins asking questions, we should expect that they do so with an open mind - that they don’t presuppose the answers and then look for evidence to support their theory. Ms. Ireland appears to have gone about this phase of gathering information appropriately. She spoke to a wide array of sources in the community to hear as many perspectives as possible. Among them were many different members of the medical profession, including people who have worked in treatment centres such as the methadone clinics at the heart of this story.

Gathering the information is just the start of the process; the rest is deciding how to present the information. At CBC, the obligation of the journalist is to demonstrate fairness, balance, and impartiality. This is how those values are described in CBC’s Journalistic Standards and Practices:

  • Fairness

In our information gathering and reporting, we treat individuals and organizations with openness and respect. We are mindful of their rights. We treat them even‑handedly.

  • Balance

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.

  • Impartiality

We provide professional judgment based on facts and expertise. We do not promote any particular point of view on matters of public debate.

I find Mr. Dick’s explanation satisfactory here. The article gives Dr. Marsh ample opportunity to present the point of view of the CATC, and he offers a response to all the key criticisms made by Dr. Kahan. The reader is entitled to judge the merits of each side. There is also some exploration of what other options there might be for patients who might look for methadone or suboxone as treatment for their opioid addictions. The article doesn’t answer every question one might have about the subject - but it doesn’t pretend to.

I was further pleased to hear in the radio interview, the inclusion of remarks from the city’s associate medical officer which make it clear there’s no consensus yet on why methadone turns up more prevalently in the bodies of people who die from opioid overdoses in the region. That gave me additional comfort that CBC Thunder Bay is giving its audience information that is proportionate and nuanced, rather than jumping to a conclusion about who or what is at fault.

Your point about the emphasis on the word “private” when referring to these clinics is one that CBC would be wise to keep in mind when doing future coverage. After all, you are correct that most family doctors are “private”, and so are pharmacies and other businesses that make up large chunks of our healthcare system. At the same time, Ms. Ireland was reasonable in trying to highlight one of the most important questions raised by critics: are these high volume clinics doing less than they should for patients, and if so is it because their priority is generating profit? To downplay those core questions would be counterproductive, and I disagree that the coverage is misleading. That does not mean there is no room for improvement in the journalism. The trick going forward will be finding language that is more precise to describe what makes these high-volume methadone clinics different from other services available to people seeking treatment.

Similarly, it is reasonable for journalists and others to wonder if having a big new corporate owner will have any effect on the way these clinics provide care to patients. That is an appropriate course of enquiry, so long as reporting does not get ahead of known fact.

There was no violation of policy here.

Sincerely,

Jack Nagler
CBC Ombudsperson