Health Matters

GUEST: Isadore Rosenfeld
VTR: 10/6/1983

I’m Richard Heffner, your host on THE OPEN MIND. I’d like to think that it’s not quite dirty pool to ask a guest right off what the downside is to a movement in art or politics or even science that he or she has pioneered. But that’s what I’m going to do with today’s guest, Dr. Isadore Rosenfeld, Clinical Professor of Medicine at the New York Hospital Medical Center, who’s renowned not only for his excellence as a cardiologist, but for his wonderfully empathetic ability to convey and to interpret medical information to those of us who need it so badly, a public more and more concerned with the ideal of at least a fairly sound mind and a fairly sound body. Dr. Rosenfeld’s bestselling books, “Second Opinion” and “The Complete Medical Exam”, his many lectures and articles, his regular appearances on CBS Morning News and Group W’s “Hour Magazine”, and I might add his always helpful visits to the Open Mind, make him a pioneer in public information concerning medical matters. But it’s also been charged that a continuing emphasis on medical popularization, particularly by those who can’t begin to approach Dr. Rosenfeld’s skill and wisdom but also by some who are well trained but who do not judge sufficiently their impact of their pronouncements, that talking and writing too much and too often about medical matters can prove to be bad for our health.

So, Dr. Rosenfeld, I am going to do the dirty pool business of asking you right off whether there’s any truth to that notion, too much of a good thing.

ROSENFELD: I don’t think there’s any legitimate argument about people who can communicate, who are dedicated to communicating doing too much of this thing. I don’t think anybody can know too much about his health or her health, and his or her body. I think the danger, which you appropriately talk about, arises from people who make a career out of it, who are actually removed from seeing patients, from the practice of medicine and who communicate on the basis of having read a preliminary scientific article which they don’t fully comprehend and rush to the media to interpret that as best they can for a very hungry audience. What I try to do, to what extent that I am successful is up to you and other people to judge, is using my ongoing presence in the frontline of medicine, as you might say, my eight or ten hours seeing patients every day is to use this information that is available and translate it into what I’d term responsible, legitimate, facts that people ought to know. I’m afraid that doctors are too busy treating the sick, diagnosing the sick, to sit down and explain to people what they must do, what their problems are, how to deal with them. I consider what I do as not a very big sacrifice. It’s a financial sacrifice if you would tell the audience what I get paid for appearing on programs like this. It is a sacrifice in terms of time and energy. But for me it’s a simply – at least for me, as a practicing doctor, and I would never continue to do this after I stop practicing medicine, nor would I ever stop practicing medicine in order to appear on television or write books, because the things I say and the things I write represent a distillation and a translation of my actual daily involvement in medicine. Now, if you ask me, what is the impact of people who don’t have this experience and don’t have this training, what is the impact of their conveying certain data inaccurately, I would think that that’s probably not good. To what extent it happens I’m not sure. I don’t watch the television that much.

HEFFNER: Yeah, but now wait a minute. You say to what extent you’re not sure, you would think that it’s not good; but certainly you must have come in your practice up against those people who have been, for good or for bad, ill-informed either because of their own inability to grasp from what is being told them, or because of the inability of the communicator.

ROSENFELD: Yes, that does happen. But I have found, Dick, that it happens usually when the communicator has a vested interest.

HEFFNER: What do you mean?

ROSENFELD: An economic vested interest. It may be somebody who’s pushing a machine, who’s pushing a pill, who’s pushing a product, who’d pushing a concept either for money, or for ego, or for other things. And I think that that kind of presentation by somebody who has an axe to grind in furthering some medical information, that is harmful. And I have from time to time seen adverse results from that, particularly from concepts at the periphery of medicine, mega-vitamins, the whole health food bit, the diet fads and so on, where people get on television and expound certain theories which are not generally accepted or proven or even safe in some instances. That kind of thing I deplore.

HEFFNER: But Dr. Rosenfeld, those people, the people who are most influential and pushing the big dose of vitamins or whatever it may be, generally, I think you would agree that they’re not the ones with the financial interest. We’re not talking about the advance man. We’re not talking about the huckster. We’re talking about the true convert, your person who is respectable, presumably responsible, who pushes medical information in an atmosphere that has been made respectable by your own important contributions in part.

ROSENFELD: Well, you’re very generous but I must say that I don’t follow.

HEFFNER: I have to be because I’m not paying for…

ROSENFELD: No, but I can’t accept the logic that because I do my best to convey accurate information and to dispel myths and fallacies as best I can and to report news that’s really meaningful. And every time I talk about anything medical I select the topic, I never use a teleprompter, nobody writes a script for me, I do my own research, and I make all the decisions. But I can’t believe that I am necessarily or should be identified with those who don’t have my motivation. You can’t lump everyone in one basket, you have to be discriminating, Mr. Heffner.

HEFFNER: Yes, but aside from your nasty comment about teleprompters, which I use, I still am concerned it may be unfair. And you’re suggesting that it isn’t fair, it isn’t just, it isn’t right. But it may be…

ROSENFELD: You’re comparing the poison with the antidote.

HEFFNER: But it may be, there may be a connection between the two in an atmosphere that benefits from your contribution, and I’m obviously not…

ROSENFELD: No, I understand what you’re saying. Yes, I mean, I think that the ultimate responsibility, getting down to brass tax, I think that the ultimate responsibility lies with those who control and select the kind of information that is transmitted in the newspapers, in books, on television. I’m not implying censorship. But I think that, for example, a show like yours would be very careful about inviting a guest who would proselytize some absurd or even dangerous idea. I’d suppose that you have a panel of advisors in medicine and other things who would advise you about whom you could legitimately and safely invite on your program, and that’s why I’m here.

HEFFNER: I don’t know whether the camera is on me now so that the smile on my face can be seen. No I don’t have that kind of panel and you know that perfectly well. What you’re saying I think is terribly important. What is the responsibility of a person who in the media, who is concerned with communications, when I don’t know, and most of my colleagues don’t know, what is legitimate and what is not? You want to put the burden on us. And I want, in turn, to say that, by gosh, the messenger really can’t make that kind of judgment. Perhaps we would have made a judgment, how many decades ago would it have been, that that fellow by the name of Salk had no business touting that vaccine, or Sabin, or others. Perhaps we would have made those faulty judgments on the basis of what the medical establishment would say. It’s not in our capacity to do so. It’s in yours though.

ROSENFELD: Right. Well let me tell you, for example, in the kind of communication that I do the format that I use. This morning I did a program on CBS News, just three-minute, modest program, not as leisurely and fulfilling as this one, in which I decided that it was important to tell people about intolerance to milk, which is a very common problem in maybe twenty or more percent of the American people. Now, prior to my selecting that topic I met with four or five producers at CBS, discussed the problem, showed them the references from the medical literature to which I alluded, and on a basis of a meeting of this kind we decided that this was appropriate to transmit on an important program or important network. The same thing is true at Group W Westinghouse. Both those organizations are in fact responsible, and screen very carefully the suggestions that not only I make but other people do. Now, other than that, unless you invoke censorship, you have to leave it to the good judgment of people who transmit news. I don’t know any other way to do it other than saying, well then nobody may communicate with the public, and I think that would be worse.

HEFFNER: Yes, but when you say that would be worse you’re sort of giving up the ghost, saying there’s no way to control this seemingly unending outpouring of medical information, some of it medical misinformation, some of it beating the gun on things that shouldn’t appear in print. Now you’re saying the masters of the media should be a panel in a station, or in a network, or in a magazine. What about the medical profession taking some responsibility in this area. Is that not a possibility?

ROSENFELD: It is a possibility and of course it’s done right here in New York City. The New York County Medical Society has a speakers’ bureau.

HEFFNER: Oh now wait, wait, wait a minute. I’m not talking about sending people out.

ROSENFELD: No, no, when the media say, now we want somebody to talk on diabetes or on multiple sclerosis and so on, they pick responsible people with expertise in those particular areas and make them available to the media, people with a good background, a responsible background.

HEFFNER: Alright.

ROSENFELD: I don’t know that we’re ever going to solve this problem, you and I, as long as there is freedom of the press and freedom of television. The ultimate responsibility is the same for the New York Times or any newspaper. Who decides, for example, on an editorial comment? Who decides on what news item is reliable? A correspondent calls in from Beirut, or Jerusalem, or where have you with a story: somebody’s got to make a decision. Now presumably, these people who run the newspapers, who run the television, select their correspondents and their commentators with care, and other than that I don’t know what else you could do quite frankly.

HEFFNER: Much, much easier for us to make judgments for newsmen who are tried and true in the areas of news gathering, in international affairs, in national affairs, to make those judgments. We’re now at a point where we’re talking about things that your profession, and related professions, alone can deal with. You say you don’t know what else we can do. Are you satisfied with the ethical concerns of your profession in this area?

ROSENFELD: I don’t quite know how to interpret that. How do you mean, with the ethical concerns? I know that so-called “organized medicine” is very careful about the pronouncements that its members make. There is no legal way that a medical body can discipline one of its members for saying something with which the rest of the establishment is not in agreement. There’s no legal way to do that. That’s what’s called freedom of speech. Now, there is peer pressure. So that, if somebody comes on television and says that, you know, if you die your hair you’re going to live to be a hundred because I have a lot of patients who did that and so on, he would be ostracized. And that is the only kind of pressure that can be exerted from within the profession on its spokesmen. I don’t know of any other way, but then again I’m just a doctor talking on television. I’m not a big media authority.

HEFFNER: You’re a media authority who is a doctor. You’re a media authority in the sense that you are such a continuing communicator. And you know, the trouble with asking you these downside questions is that you’re very careful, you’re very precise, you’re very concerned. But it seemed to me that increasingly there has been the feeling that there are those who are not, and I say increasingly. The New England Journal of Medicine, November, 1981: “Two developments within our society have changed or will change the traditional physician/patient relationship.” One of them they list: “the growing practice of the news media to report new research and developments in health related fields, and the public’s increasing conviction that as patients, they have a right to know all facts about their disease.” Now, take the first, “the growing practice of the news media to report new research.” Do you think that this does impact upon the physician/patient relationship?

ROSENFELD: Yes, it does. Yes it does, it does impact.

HEFFNER: For good or for bad?

ROSENFELD: I think for good. I think that there should be no secret about letting people know appropriately, in good time, intelligently, what the breakthroughs in research are. And I’ll tell you something else. I know from my own experience, I’ve had many, many personal examples of people who tell their doctor about something they read in a newspaper or heard on television of which their doctor was not aware. He may have missed that issue of the newspaper. He may not have read it in that particular journal. He may well have missed the medical meeting at which that news was developed. He would only hear it perhaps three or four months later in the course of some other meeting. And I think that it’s perfectly legitimate for a patient to say to his doctor: “Look, I read this.” “There’s a new treatment for multiple sclerosis.” “There’s a new treatment for this.” “There’s a new vaccine for that.” “What do you think about it?” Perfectly good: no harm done.

And also, as far as the second part of that equation in The New England Journal, I think that no harm can come from an informed, a well-informed patient. And the patient, I think, has a right to know.

HEFFNER: Yes, but you see the trouble is I’ve been talking about purveying or conveying medical information. You’re talking about a well-informed public. I asked the question whether you really feel that the public at large is prepared to ingest, digest, comprehend all of this information that’s being poured out. In other words, are we really making people that much better informed?

ROSENFELD: I think we are. You know, just the other day I was examining a patient. I happened to be in a hurry, got a call from the hospital and had to leave. And I said to the patient, “Well, now we’re all done.” He said, “Just a minute, you didn’t do a rectal examination on me today. I don’t consider my exam complete without that.” And that to me was absolutely the pinnacle of effective sophistication in a patient. Patients come in and ask me about the pneumonia vaccine. Should they take it? What about the flu vaccine? They read this, that, and the other thing. You know, things are changing very rapidly in medicine in terms of diagnostic techniques, in terms of what we can do for people. Not every doctor is in the forefront of medicine. And if his patient reads or hears about some important or potentially important development, I think it’s perfectly alright to confront – it may be embarrassing for the doctor, but for him to confront the doctor and say, “What do you think about this?” I think that’s very important and leads to better medicine. Now, you know, some doctors don’t like it. Some patients won’t do it. But I’m talking about the broad perspective. I think people are ready to learn. I think that the new techniques of communication are so sophisticated and you’re not dealing with a hundred years ago when many people couldn’t read or write. People are educated. They’re using computers. They’re using all kinds of things. They can deal with the important new medical information if it’s properly and honestly presented.

HEFFNER: OK. That’s the bottom line it seems to me, your conviction that the public can deal with all of the information that’s being presented to them if it’s presented well.

ROSENFELD: Yes.

HEFFNER: And you see no – look, I don’t want to make a problem where none exists, and you seem to be saying it doesn’t exist.

ROSENFELD: No, you know, I don’t say that. I think that a problem exists in politics. I think that not every legislator does it the right way or is properly motivated. Yet, I wouldn’t change government as we know it for anything. I think that there are abuses. I think that there are people who are conveying medical information improperly, or flamboyantly, or dramatically, or for effect, or for ratings. But that isn’t what I’m talking about. You’re asking me is it important that people get good information on time. And I say yes. To the extent that that’s abused, I mean I can’t do anything about that.

HEFFNER: Alright now, you say yes. To what extent do the medical schools in this country recognize the obligation of the profession to do so? To what degree is communication, a part of medical training?

ROSENFELD: Well, that’s interesting that you should ask. I think, not enough. And only the other day at Cornell I suggested that a chair be endowed and a division or a department set up on medical communication, teaching young doctors how to convey to the public whatever message they may have. I think that’s terribly important because the public demands it. And unless people who are trained and well motivated, and are willing to give the time, and have the ability to do it, fill that vacuum, then the irresponsible elements to which you allude, alluded to throughout this entire interview, will take over. And that’s precisely why I do what I do and why several other of my colleagues do what they do.

The other important point I want to make is that I think, as I said at the beginning, that this information should really for the most part be given by practicing physicians. I think the one danger lies not so much in overenthusiastic reporting or in the vested interest, but in the well-meaning individual who cannot himself interpret a news item, who reads it as a science reporter without the background to give it a meaningful interpretation to a patient. And everybody who’s watching is a patient or a potential patient. This is not amusement, this is education and medicine.

HEFFNER: That’s so interesting that you say that everyone watching is a potential patient because I was going to just ask you if you were distinguishing between communicating to the public and communicating to the private; whether you were talking about teaching doctors how to deal with their patients one by one, or teaching doctors how to communicate to the public at large. Which is it that you want your chair to do?

ROSENFELD: I think both. I think the traditional medical curriculum does teach doctors, or tries to teach doctors. Some people can’t communicate no matter how much you teach them, just like some people can’t feel. You can’t often teach people how to feel. You can’t teach, I don’t think, compassion. You can teach its importance, but you can’t really get that feeling into somebody’s heart. But I think that the medical schools try to tell doctors how to present problems with patients. I think…[unintelligible due to videotape distortion]…for a chair in communication which would teach doctors how to effectively communicate to large groups of people. But even though they are large groups of people, when one talks to them on a program like this it’s on a one-to-one basis. Anybody watching this program is watching me and listening to me talk to them. The fact that there are millions or whatever watching doesn’t alter the fact. Here are you and I talking as two people. And we’re both patients. I mean I’m a doctor, but I’m a patient too. If you’re a human being, you’re a patient.

HEFFNER: What a nice thought: if you’re a human being, you’re a patient. Do you feel that as a patient you’re being communicated with by those who know increasingly more about one field or another? Do you feel that the machinery is in place for you as a practicing doctor on the firing line to receive sufficient information? Is the medical profession geared well enough to bring you and your colleagues up to date on all the researches – it’s silly to say all the researches – the basic, the most important researches done in our times? Or is there the overload that one frequently hears?

ROSENFELD: Well there is the overload. And there’s the pressure of time, and there’s the pressure of tremendous volume of information. No one doctor can learn it all and know it all and that’s why it’s so important for patients to share in the learning process. They take some of the burden off the doctor. I think with new computer techniques it’s going to make the load easier, but it is a very important load. And I’ll tell you one very important fallout on all this communication that I do to which you refer. I think it makes me a better doctor, because it means that I’m always reading in an attempt to try to translate and communicate and bring what’s new to people who listen to the few minutes I do on television a week. I’ve got to do hours and hours of reading, in the course of which I further my postgraduate education. There’s very little that escapes my attention, and which I then apply both in my practice as well as on programs like this.

HEFFNER: I know that occasions when I’ve called your office: “Dr. Rosenfeld is in the Soviet Union.” “Dr. Rosenfeld is in Paris.” He’s here, or there. Is it your experience, in just the couple minutes remaining, that public information relating to medical matters is as widespread in other parts of the world as it is here?

ROSENFELD: Not in the Soviet Union. And I think to a much lesser extent in other European countries. There is a growing interest in England and so on, but most people have in those other countries, have the attitude, “Well, you know, you’re the doctor. You worry about it. You take care of it. Whatever you say is fine.” And you know, there is a growing tendency but the United States is unique as far as I’m concerned in that.

HEFFNER: Does that mean then that we have a much better medical care system? We are healthier? We are better off than the others?

ROSENFELD: I think that our medical care system is better. I’m not entirely satisfied with it, and perhaps on another program I could tell you some of the things that I think ought to be done in terms of delivery of medical care. But in terms of the scientific base in this country and the kind of things that medicine can do for people, I don’t think there’s any country in the world even comes close to the United States.

HEFFNER: Are there indices that indicate that we are healthier?

ROSENFELD: I’m not sure that there are. For example, in infant mortality we’re not nearly as healthy as other countries. But I don’t think that’s a function of communication. I think that’s a function of economics and not a matter of patient education.

HEFFNER: Now you’re moving out of it a little bit.

ROSENFELD: Yes, I’m moving out because you’re asking me other questions.

HEFFNER: But that’s a very difficult one, isn’t it?

ROSENFELD: It is a very difficult question. I believe that the United States has the capability and the scientific base to deliver the best medical care in the world. To the extent that we fail to do so is not due to too much or too little communication, but it is due to much deeper problems.

HEFFNER: Dr. Isadore Rosenfeld, you know we always end on an upbeat note. Thanks for joining me today on the Open Mind.

ROSENFELD: Thank you.

HEFFNER: Thanks, too, to you in the audience. I hope that you too will join us again here on the Open Mind.

Meanwhile, as an old friend used to say, “Good night, and good luck.”

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