Dr Petra Boynton on how dramatic headlines cause problems for healthcare professionals.
Last week Director of Public Health for Teeside, Professor Peter Kelly reported his region has seen a four fold increase in syphilis cases in the past year. In a press release Professor Kelly stated “Unprotected sex, especially with casual partners, is the biggest risk for syphilis. Social networking sites are making it easier for people to meet up for casual sex. It is important that people avoid high risk sexual behaviours and practise safe sex to protect themselves from sexually transmitted infections”.
Within hours the story had gone global, with the world’s media claiming Facebook gives you syphilis.
Of course this wasn’t what Professor Kelly had said, but the mention of social networking and syphilis in a press release was always going to be enticing to the media. Aside from being able to spread a popular moral panic about technology and STIs, Rupert Murdoch’s papers also had the incentive to discredit Facebook, which is a competitor to Murdoch’s social networking site Myspace.
Despite the media hype the statement from Tees PCT does not identify how social networking was measured, what ‘using’ social networking sites involved, nor how they were directly linked to hooking up for sex. We have no idea who was engaged in this activity – their age, gender, sexuality. Nor if this was only an issue linked specifically to syphilis or to other STIs. It is also unclear whether the Trust concerned were bothered that people were using social networks to meet for sex per se, or whether they were worried unprotected sex was happening.
An appropriate course of action for professionals seeing a potential association between an activity and rising infection rates would have been to further investigate the links between these two phenomena. If it were proven to be true, then awareness with those affected about safer sex and meeting people online could have been addressed. If it turned out that there may be other factors linked to the rise in STIs those could be focused on instead.
Unfortunately, rather than taking this step, Tees PCT decided to release their speculations to the media. The result has been the media link between syphilis and social networking sites which may cause anxiety to the public and other health professionals, and misdirect our attention in the management of STIs.
As the story spread, so the inevitable backlash began with bloggers and journalists criticising Professor Kelly and the PCT and calling into question their professional judgement. Negative comments about the communities living in the North East of England, particularly women, also abounded.
At this time it may have helped if Tees PCT had addressed the problem and responded to media criticism. But they refused to share information about how they had established links with social networking sites and syphilis. Nor would they reveal the actual figures of STIs (including syphilis) within their Trust. As Ben Goldacre of the Guardian’s Bad Science column discovered when he requested this information.
Compare this with Birmingham, where the local paper also picked up on this story and tried to spin it to a local angle. The Birmingham Mail ran a story on rising rates of Syphilis and linked this to social networking sites and the Tees story. However their data was incorrect and the outreach worker from Birmingham University quoted in the story quickly pointed this out. Birmingham University also challenged the story for its accuracy and the Mail withdrew it while it investigated it further.
Sadly most organisations did not respond like Birmingham in a prompt and transparent way. The DH did not officially respond, nor did the HPA – although both were asked to get involved by health practitioners and journalists. The DH did issue this statement to me via Twitter “we expect local areas to lead a response involving GUM clinicians, other local SH providers, HPA, public health, voluntary sector”. They did not clarify if they meant responses to STIs generally, or specific responses about the current story regarding links between syphilis and social networking.
They added “we are developing a sexual health framework to provide guidance, including safer sex messages on social networking sites.” This seems helpful but only addresses half the problem. If some healthcare staff are assuming associations but not measuring any links between social networks and sexual health then presumably they also need training and advice? Particularly if the DH expects them to lead local responses on sexual health issues.
Even NHS Choices failed to engage with this story until pressured by health care staff and bloggers. Two days after the story broke they finally issued some guidance about syphilis and other STIs.
Given the huge interest in the story and the anxiety about STIs the media coverage raised it is worrying that health agencies were not quick to respond, nor seemed to spot an opportunity for public engagement and health promotion. Nor offer support to healthcare services likely to see an influx of patients made anxious by the story.
It isn’t just media mismanagement that contributes to problematic case studies like this one. My experience of working with healthcare practitioners within the area of sex and relationships health indicates often this is based on a lack of time, skills and support. Staff are presented with numerous problems to solve in practice, but do not have protected time to critically reflect on issues or apply existing research to help understand what may be going on. So when they see a story that sounds plausible about health in the media or from a colleague they may well accept it without question. Or may question it but be told they must act upon it by their superiors.
In an era where we’re all used to the phrase “evidence based practice” it is still common to see many professionals continuing to work in good faith because they think something may be the case, but without fully investigating it. This mostly happens in private and does not reach the media’s radar. But whether it is discussed in the press or not the outcome is still problematic for patients as it could result in well meaning practice being focused in completely inappropriate directions. Or our professional reputation or the reputation of the community in which we work brought into disrepute. That does not mean we should not be thinking about health messages, prevention or treatment. But that we should be certain of absolute connections before we implement any health promotion, intervention or media activity.
About Dr Boynton
Dr Petra Boynton is a Lecturer in International Health Services Research at University College London and specialises in training healthcare professionals in good practice in sex and relationships healthcare and research. For more information please email firstname.lastname@example.org or visit drpetra.co.uk