Gag orders in public health

The headline was kind of strange: Doctor pays for 'letting polio out of hospital'. It sounded like a hospital doctor had negligently let an infectious polio case out into the community. But in fact the doctor was the hero of the story:

A Samundri Tehsil Headquarters Hospital child specialist, who spilled the beans of polio cases before the media, has been awarded suspension from service, Dawn learnt on Tuesday.

The district administration hastened to take the decision after the doctor informed journalists about the suspected cases of polio at Samundri's villages. (Dawn [Pakistan])

This sorry story is unfolding in Faisalabad, Pakistan. Faisalbad is the third largest city in the country (2.6 million) and is divided into subdivisions, called tehsils, one of which is Samundri. It has its own hospital which has been seeing suspected cases of polio. That's bad news all the way around and not just for the polio patients. The district administration had received millions of rupees to vaccinate young children against polio but clearly the job wasn't getting done because there were reports of many cases of polio in the villages. That didn't look so good so the district managers weren't reporting them. The political situation is confused with the failure of vaccination being blamed on "Talibanisation."

Whatever the reason, the presence of polio was clearly an embarrassment and the authorities were trying to conceal it from the media:

They said the district officer for health learnt that Dr Amin was the man who gave the media the count of polio cases at Samundri. The district managers, sources said, had previously been concealing such cases from the media for fear of criticism as the growing number of polio cases brought infamy to the country's healthcare system.


Meanwhile, a World Health Organization team visited the THQ hospital to obtain information about the suspected cases of polio. EDO (Health) Dr Siddique told newsmen that it was not certain that the children had been suffering from polio. He said their stool samples had been forwarded to a laboratory in Islamabad, which would make the picture clear.

As for the child specialist's suspension, he said: "The doctor was not authorised to utter even a single word about the issue. It is the government's responsibility to inform the media about this issue."

While this sounds pretty bad, such gag orders are also standard practice in state health departments in the US. Health department employees are forbidden to talk to the media without permission and all requests for interviews must first go through the press officer. This is something that started in the 1980s and has been getting steadily worse. CDC is also a closed information shop. It used to be reporters could call up CDC scientsts and get information directly. No longer. Information is power and it is tightly controlled.

The effects of such policies are easier to see in Pakistan but the underlying principle is pretty much the same. US public health officials who gag their employees are not much different, if they are different at all, from their counterparts in Pakistan or Indonesia or China. I'm sure if queried the excuse at CDC would be something to do with national security and bioterrorism.

Call it the US variant of the Pakistan ploy.

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There are probably many instances of gag orders issued throughout the world. However, I think it is prudent for a governmental agency, or other agency, to have a coordinated message that considers all associated factors, including those most beneficial to the populace.
In my experience, it is often a very opinionated and jaded 'scientist' that does the most damage. While a more pensive message employing standard risk communication guidelines would have provided all of the necessary information without ruining the long-term efforts of the organization.
That being said, governmental agencies should always conduct their affairs in a transparent manner.

Tex: I disagree. It has been my experience, over 40 years, that the "coordinated message" explanation is really a "control the message" tactic and that direct contact with professionals rarely produces problems (for the public) while the gagging of professionals is not in the public interest. I've seen the same health department do it both ways and the information shut down is far and away the worst option.

And what of the money that was meant to go on vaccination? What did they spend it on?

Maybe ask razib the child raper what he would have done.

Revere, I agree with you completely. I work for a governmental public health agency. We are not allowed to speak to the media without permission (and it's not easy to get). The concern is that you might say something that would embarrass the government, just like in Pakistan story.

It should be considered by any dismissal/suspension tribunal whether or not an internal policy such as a universal gag order can be enforced as a contract term. Such a policy may prevent some public misinformation, but it can also be used to stifle whistle blowers and avoid well-deserved embarrassment. The truth and intention of your statements ought to override the policy of your employer.

This would send a message to administrators that they can't just make up policies that stifle the freedoms of their employees on a whim; that they can't keep a whistle blower from speaking out about a problem by making it an offense to speak out at all; that the truth trumps their policy.

It would also send a message to employees that that they're risking their job if they haven't informed themselves before speaking out publicly, or if what they're saying is a bad-faith statement of opinion.

Of course, to result in self-regulation of policy, there would have to be a court-like system set up to deal with complaints where the "infraction" does not result in dismissal - a system that doesn't require lawyers or money. Otherwise it's no better than just taking your employer to court.

By Jellybean (not verified) on 17 Aug 2008 #permalink