There’s a couple of things that’ve been playing on my mind since the post about the Daily Mail‘s coverage of the Liverpool Care Pathway a couple of weeks ago.
One of them is the letter that Fiona Godlee, editor of the BMJ, sent to Paul Dacre, editor of the Mail. It points out to him what I noted – that the LCP isn’t mentioned at all in the original piece – and adds something important that I had suspected but didn’t know: that it told us nothing about the NHS because the doctor writing wasn’t even UK-based. (For those without institutional access, I’ll reproduce it in full below the fold.)
I’ve just done a search of the Mail‘s website, and it seems not to have been published, or even acknowledged, anywhere. I’m not wholly surprised by this. It might have appeared in the paper version – but that’s not enough. After all,the attacks on the LPC certainly have appeared in the online version of the paper – and continue to do so – and so it makes sense that any attempt at rectification should appear in the same place. Yet it would seem that the Mail is rather less keen to publish letters that contradict its editorial line than it is to print vexatious gibberish as a part of that line.
(As it happens, the fact that the BMJ article was used without permission isn’t necessarily all that big a problem. I think that there probably could be a public interest defence – a sort of fair use system – in relation to publishing things without permission when it’s in the public interest. But the quid pro quo here is that what’s published has to be an honest representation, rather than misleading crap. On this front, the Mail has failed.)
Anyway: an important aspect of not having published Godlee’s letter online is that it’s links to the electronic version of the paper that people would have been passing around. And that leads me to the other thing that’s been playing on my mind: the question of whether I should have provided links in my previous post.
We like to think that newspapers are primarily about news; but that’s not true. They’re about profit. This isn’t a bad thing per se: it’s just a brute fact about why people found many newspapers. News just happens to have been the vehicle by which profit was generated in one small part of the market for goods and services. Keeping this in mind helps explain the modus operandi of both the dead-tree and electronic press: if ersatz “newsiness” rather than echt news generates more profit, then newsiness will win out. Some papers’ newsiness is barely distinguishable from entertainment in its own right – I’m thinking of the redtop market here – but the preferred formula in the Mail involves a healthy dose of what I called in my earlier post “the pornography of fear”.
OK: here’s the problem. Every time a link is followed, the Mail‘s site registers a visit. There is, of course, no way of telling whether those visitors belong to the “ZOMG! Teh LCP is Evilz!” brigade, or people who’re reading the site out of a bizarre catastrophilia, or what. What matters is that the more visits a page attracts – the more traffic – the more valuable the site of which it’s a part becomes as a source of advertising revenue.
This means, in effect, that it pays newspapers to act as professional trolls (what some have called “prolls“), because they’ll get traffic from the biddable, and they’ll get it from people who just look to see what the biddable are reading. Either way: kerching! It’s all about the benjamins.
There was a twitterstorm not so long ago about an article written by Jan Moir concerning the death of Stephen Gately: but thousands of outraged liberals reading an article in a paper they’d normally ignore means thousands of extra hits, which means more income. But exactly the same, in a smaller way, applies here: when I linked to the Mail, there’s a chance that at least some people who wouldn’t otherwise have read the articles in question did so; and they’d have contributed in some small way to the success of the Mail‘s business model. It doesn’t matter whether the article behind the link is awful, or what you or I think about it. What matters is that we click through – and then post on Facebook or Twitter or blogs asking our friends if they’ve seen the terrible article behind the link that we helpfully provide. They then do the same.
In providing a links, I was complicit in the Mail‘s strategy. So I’m not sure whether I should have linked. The academic part of me thinks, “But of course one should always give appropriate citations, and a hyperlink is the accepted way of doing that on a blog”. And the denizen of the intertubes thinks, “But that’s precisely why I’m vulnerable. All Associated Newspapers (or Northern & Shell, or MGN, or whoever else: delete as applicable) has to do is to print something idiotic, and I’ll help sell it on their behalf.”
For a while, I used Istyosty – a proxy that stripped out the advertising and wouldn’t register page hits on the Mail site (and the rationale for which is explained nicely here) … but then Istyosty was closed down, apparently based on a copyright violation claim by the Mail – the same Mail that reproduced and mangled the BMJ article without permission.
Since this is only a blog, rather than a journal, I think that, on balance, the citation rules can be bent a little. In future, if I do refer to the Mail, you’re just going to have to find the stories yourself. I might provide a URL, but I won’t provide a direct link: if you want to see what’s what, you’ll have to C&P and do a bit of work for yourself. But if you don’t want to do that – and I’d support you – you’ll just have to take it on trust that I’ll be quoting accurately, or noting the fact if I have to make any modifications for the sake of syntax. I’ll try to give as accurate a representation as I can.
In other words, you’ll have to trust me that my journalistic standards are higher than those of the articles I’m citing.
Here’s the text of the letter.
Dear Mr Dacre
Your front page story (“Now sick babies go on death pathway,” 29 November) is highly misleading. It says that the events described in the BMJ article (“How it feels to withdraw feeding from newborn babies,” BMJ 2012;345:e7319), which you reproduced without our permission, are evidence of the use of the Liverpool care pathway on children in the NHS. Yet the doctor who wrote the article does not practise in the UK. Nor does the article mention the Liverpool care pathway.
The doctor was describing an extremely difficult situation—that of a baby born with severe congenital anomalies. As the article explained, these anomalies were inconsistent with a basic human experience and would have required extensive surgical and other treatment of uncertain benefit, which the parents did not want to inflict on their child. The decision to withdraw life support and allow the baby to die was made by the parents after a full discussion with the baby’s medical team.
The care of people at the end of life—whether babies, children, or adults—is a specialist area of medicine in which the UK leads the world. The practices of NHS staff are directed by national guidance that has been developed with expertise to deliver compassionate and dignified care at an extremely difficult time. To suggest that parents are pressurised by doctors to allow their baby to die in order to free up hospital beds is false, unfair on dedicated medical staff, and exceptionally insensitive to parents who have lost a baby in these circumstances.
Sadly it is fact of life that some babies die. It is a highly distressing experience for everyone involved. There is an urgent need for a proper public debate how health professionals should manage such cases. By hyping and misrepresenting this story, the Daily Mail has missed an important opportunity to advance that debate.
Dr Fiona Godlee