Media's Medicines

August 12, 2008, 8:10 a.m.

[Note: The "Sexual Assault Update," July 19-August 8, 2008, blog entry remains at its former location; however, any updates to it following August 8, 2008, will be found, along with the blog entry as of August 8, at a new Web site, Nicholas Johnson, "University of Iowa Sexual Assault Controversy -- 2007-08."]

Practicing Medicine with an FCC Broadcasting License
Are broadcasters practicing medicine -- or at least undercutting our family physicians ability to do so?

I found a report on last evening's [August 11] "ABC World News with Charles Gibson" a little troubling.

Unfortunately, I cannot now find a link to a transcript or video of what ABC's Dr. Tim Johnson said. But in some ways that helps to make my point. [I subsequently (Aug. 14 9:00 p.m.) found this ABC Audio feed interview with Dr. Tim Johnson that is comparable. He repeats that he's now added a 1000 IU dose to his former 400 IU of vitamin D; he goes on to say that there's no evidence doses in that range and higher cause any harm; and he says nothing about the adverse effects of doses of 2000 IU and above reported by the Mayo site, referenced below.]

Unless we TiVo or tape the TV news, days or even minutes later we have little but faintly recalled impressions to draw upon regarding what we learned; impressions created from moving images (more than the voice over) and however much attention we were paying at the time.

TV news may not be a very efficient, or safe, way of communicating information that matters. In fact a Pew study revealed that the more TV news viewers watched the more likely it was they would be misinformed regarding such things as whether the 9/11 terrorists had come from Iraq, and whether we'd actually found weapons of mass destruction there.

Dr. Johnson was reporting on new studies revealing that some of us, some of the time, have inadequate levels of vitamin D. The more shocking and attention-grabbing suggestion was that, as a result, we were more likely to die.

So what was he, personally, doing with this information? Although he was formerly taking a multi-vitamin with the standard 400 IU of vitamin D he was now, as a result of these studies, adding an additional 1000 IU to his daily intake.

So what's wrong with that?

What's wrong with it is an application of my late friend, Molly Ivins', insight that her fellow Texans are a people who believe "that more is better, and too much is not enough."

While that observation related to conspicuous consumption generally, especially of hard goods, it is applicable beyond the borders of Texas, automobiles, houses and jewelry.

How many Americans are today buying up vitamin D capsules, hoping that if 1400 IU will keep Dr. Tim Johnson from dying, just to be safe they're going to start taking 5000-25000 IU a day?

To the best of my recollection, during the TV news broadcast there was no effort to explain the many limitations on the studies' findings, or even more significantly the very serious harms that can come from taking excessive dosages of vitamin D.

And yet, as the Mayo Clinic's online resource points out,

"Vitamin D is an essential nutrient for your entire body. Still, it's possible to have too much of a good thing. . . . You're unlikely to get too much vitamin D from the food you eat, and prolonged sun exposure doesn't seem to cause vitamin D toxicity. Over time, however, megadoses of vitamin D supplements can cause nausea, vomiting, poor appetite, constipation, weakness and weight loss. More seriously, excessive doses of vitamin D can raise the level of calcium in your blood — which can cause confusion and changes in heart rhythm. Generally, the upper limit for vitamin D is 2,000 IU a day."

Katherine Zeratsky, "Vitamin D: How much is too much? Is it possible to take too much vitamin D? I know vitamin D is important, but I wonder if too much is dangerous?" MayoClinic.com, July 25, 2008.

It's true that sunscreen reduces your skin's ability to make vitamin D from sunlight. But sunscreen also reduces the likelihood of your getting the skin cancer called melanoma -- which, if you're interested in long life, has the possibility of shortening rather than lengthening it. Some may react to Dr. Johnson's comments by risking sunburn (not to mention skin cancer) in their rush to grab as many unscreened rays as possible before school starts -- convinced that tans are now good for you because they are a source of vitamin D.

The power of the Internet is such that it has turned all other media -- radio, television, newspapers, magazines, billboards -- into advertisements for itself, efforts to direct readers and viewers to Web sites. That's where you are sent to see the company's full catalog, T. Boone Pickens' energy plan, the continuing conversation in the ABC "This Week" green room, the online store from which you can order and pay for the advertised product.

And so it is with ABC News. And in fairness, its full-length, online report on the vitamin D studies is relatively full and balanced, complete with scientists' skepticism and warnings. Joseph Brownstein, "'Sunshine Vitamin' May Cut Death Risk; Vitamin D Appears to Cut Risk of Dying Early; Exact Mechanism Remains Unclear," ABC News Medical Unit, abcnews.com, August 12, 2008.

[T]he study's researchers and others were quick to say that the study provides absolutely no evidence for now that taking vitamin D can reduce the risk of heart disease.

"Before we tell all Americans out there that this will definitely prevent heart attack, we need some clinical trials," Michos said.

Some took it a step further and questioned whether low vitamin D levels can even be considered a risk factor at all at this point.

"A relative increase in risk of death of 26 percent is not trivial, but not huge, either," said Dr. David Katz, director of the prevention research center at Yale University School of Medicine.

"Consider that being physically active, not smoking, and eating well could reduce the risk of premature death by as much as 80 percent," said Katz. "We would not want people to get the impression that a vitamin D supplement is a panacea. The findings are by no means that significant."

Others strongly agreed.

"It can't be considered a risk factor with the strength of cholesterol and hypertension until further studies are done," said Dr. Melvyn Rubenfire, the director of preventive cardiology at the University of Michigan. . . .

Dr. James O'Keefe, a cardiologist at the Mid America Heart Institute in Kansas City, Mo., . . . noted that the latest study's findings were unclear because many of the risk factors for heart disease, like obesity, can actually cause a deficiency in vitamin D. So, it may be a marker rather than an agent.

Of course, however much harm can be done by inaccurate, or inadequate, journalistic reports of medical studies, they pale by comparison with the potential harm from the broadcast of pharmaceutical companies advertising of "illegal drugs."

Why do I call them illegal drugs? Because it is against the law for TV viewers to buy the product being advertised. They are not over-the-counter medicines. They are medicines that, by law, can only be authorized for purchase by physicians. So what it the purpose of the commercials? To encourage us to put pressure on our doctors to give us prescriptions for the advertised drugs. And the commercials work.

Moreover, to the extent the effect of this aspect of broadcasting is that we are taking medicines that may be at best unnecessary for our conditions, and at worst actually harmful, it is the result of deliberately manipulative presentations, drawing on all that is known about the psychological and emotional promotion of sales, as applied by America's most professionally skillful advertising agencies. Journalists may be simply not fully informed, or not given sufficient time (or space) to tell the full story. Pharmaceutical companies' presentations are focused on one goal only: an increase in sales. "Broadcast and print advertisements accounted for some 94 percent of the $4.2 billion spent in 2005 on direct-to-consumer drug ads, according to a recent report by the federal Government Accountability Office. It said that such ads are increasing each year by about 20 percent a year, and officials say the spots are working, increasing profits of drug companies . . .." Bill Hendrick, "Self diagnosis from TV drug ads can be dangerous," Atlanta Journal-Constitution, January 8, 2007.

As a former FCC commissioner I can assure you, whatever Congress originally authorized the Commission's broadcast licenses to permit broadcasters to do, it never intended them to be a license to practice medicine.

Taking excessive quantities of most vitamins only results in a waste of your money as you transfer most of them directly into your local sewer system.

Not so with vitamins A and D.

Before you are swept away with enthusiasm for excessive doses of vitamin D in your quest for life everlasting I'd recommend you see your doctor.

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Alcohol, Three Items and a Comment

January 22, 2008, 12:30 p.m.

Three Items and a Comment
* Senator Barack Obama has called Senator Hillary Clinton, and former President Bill Clinton, on their unethical, negative campaigning involving a number of knowing and deliberately false characterizations of Obama's positions and statements -- repeated once again by her during the South Carolina debate last night [Jan 21]. "Most recent was an interview in which Obama described former president Ronald Reagan as a transformative leader and also said that over the past 10 to 15 years, the Republicans were more a party of ideas than were the Democrats. . . . Hillary Clinton pounced on Obama on Monday night, as Bill Clinton had done over the past few days [with the distorted assertion that Senator Obama had praised and endorsed Reagan's ideas when of course he had not]. 'They were bad ideas for America,' she said. 'They were ideas like privatizing Social Security, like moving back from a balanced budget and a surplus to deficit and debt.' Obama protested . . . 'You just said that I complimented the Republican ideas. That is not true.'" He was right; she was wrong, and wrong to do it. Dan Balz, "The Other Clinton is an Absent Presence," Washington Post, January 22, 2008.

* In response to my list of what the UI could do if it really wanted to get serious and effective about reducing under age students' binge drinking, a friend emailed: "Do you really mean this? . . . What a demoralizing and hypocritical (not to mention just plain mean and vindictive) set of proposals. . . . [W]hy take it out on students who are accepting the community's invitation to drink?" And see State29, "Prohibition Always Works," January 18, 2008. [Nicholas Johnson, "Don't Get Tough, Get Effective" in "Getting Real About Alcohol," January 18, 2008.]

* Two UI Delta Upsilon members have been charged with allegedly dealing marijuana; one other, and a guest, with possession. Following their arrests, the University suspended the fraternity -- which has been on campus for 82 years, with over 1000 members during that time -- during the investigation. This morning's [Jan. 22] news is that "Delta Upsilon International Fraternity announced Monday it has closed its University of Iowa chapter . . .." Rob Daniel, "Fraternity closed after drug raid; Delta Upsilon says it hopes to return," Iowa City Press-Citizen, January 22, 2008, and see Erin Jordan, "Pot Case Spurs Closing of U of I Fraternity," Des Moines Register, January 22, 2008.

Comment
I had noted in that January 18 blog entry, linked from paragraph two above, that:

"As I wrote last Tuesday in the context of considering options and rational analysis in assessing the needs for additional police officers (and increased budgets), it may very well be that the best thing to do about underage drinking is nothing; or, more properly, to simply lower the drinking age to 18. Nicholas Johnson, "'How Many Police Officers and Fire Fighters Does It Take To . . .'" in "Rational Thought About Realistic Needs: Police & Fire," January 15, 2008.

Nor, even without that clarification, was my list, above, a wish list that I was advocating the University adopt. I was simply noting that IF the UI wanted to do something effective about binge drinking there are a number of things it could have done over the last 10 years. It's not what they say -- or what they do (or in this instance don't do) -- that bothers me so much. What I'm addressing is the inconsistency between the two: representing that this is a serious problem, that they don't want to be known as one of the intercollegiate binge drinking capitals of America, that they're doing all they can to stop it -- when in fact that does not seem to be the case.

In short, I am not advocating that the "binge drinking problem" be addressed with draconian measures, only that it is hypocritical not to consider effective regulation if one is professing to want to "do something" about the problem. (Indeed, I deliberately headed the discussion "Don't Get Tough, Get Effective.")

Let me also make very clear that I am not suggesting those criticizing my draconian list were deliberately misrepresenting my position. After all, we're not candidates competing for public office, unlike Clinton and Obama. Anyone who finds himself misunderstood bears at least as much responsibility for that misunderstanding, and probably more, than his audience. But the experience does further illustrate the underlying analysis of Wendell Johnson, "The Communication Process and General Semantic Principles," in Wilbur Schramm, Mass Communications (2d ed., Urbana: University of Illinois Press, 1975).

As a lawyer, I think it is destructive of the "rule of law" and "ordered liberty" to have any given laws that are routinely and widely flouted -- because it tends to undermine respect for all laws. So what are some alternative approaches?

(1) Enforce the 21-only law; and the most rational and administratively feasible way to do that is to follow Ames' example. If you don't want under-age students to drink you don't permit them to enter establishments the sole purpose of which is to prosper from the sale of alcohol.

(2) Work to lower the drinking age to 18, thereby eliminating "the problem" at least for those over 18.

(3) Engage in "civil disobedience": openly disobey the law, knowing that arrest will follow, and accepting jail or other punishment, as a way of protesting what is thought to be an unjust law.

(4) Come up with a compromise, such as the "21-only after 10 p.m." proposal that was voted down by a bar-owners-organized students protest. This would have forbid violations of law for 28 of the 168 hours each week (10 p.m. to 2 a.m.), while permitting under-age students in bars at all other hours.

(5) Although destructive of "rule of law" purposes, simply accept rampant violations of law -- whether eliminating any and all enforcement of law regarding all alcohol related crimes, or limiting enforcement to the consequences of excessive drinking (e.g., drunk driving, public urination, fights, sexual assaults) rather than arresting students for the illegal drinking itself.

There are presumably many other options, including draconian measures applied by the University, but these five are major ones.

It is true that I think alcoholism and alcohol abuse are associated with serious social problems. As I led that January 18 entry:

Alcoholism, alcohol abuse, binge drinking, drunk driving, under-age drinking. We should not be surprised that our nation's number one hard drug problem by any measure (e.g., economic impact, health/medical consequences, numbers of people affected, involvement in crime and violence, adverse impact on the brain, prison population, unwanted sexual activity ("accidents cause people"), impact on fetus, automobile and other death and injury) is a major problem in Iowa as well.

Which brings me to the third paragraph, above, and how it reminds me of the following story:

A man's son was involved in a drunk driving accident in which one passenger was killed and his son and two other passengers were very seriously injured. On being informed that all had been drinking he responded, "Thank God they weren't using drugs."

Alcohol is a drug; an "illegal drug" when sold and consumed in violation of law; our nation's "number one hard drug" for many reasons, including those cited above.

Marijuana is also an illegal drug. But the harm it causes -- in the categories just detailed -- are far less than the consequences of alcohol. And yet, just as the penalties for possession or sale of crack cocaine (used by the poor) far exceed those for powdered cocaine (used by the rich), the penalties for the illegal possession and sale of marijuana far exceed those for the illegal possession and sale of alcohol.

And yet we give the latter a wink and a boys-will-be-boys nod, while shutting down an 82-year-old institution on campus for the former.

Now, who will be the first to say that I have advocated the legalization of marijuana? Re-read the blog entry. I haven't -- here.

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