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A Very Poor Job......
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Matt Puglisi, spokesman for the American Legion and Dr. Stephen Joseph, who led the DOD's investigation of Gulf War illness, discuss the poor performance of television and the press in covering Gulf War veterans' illnesses. They cite specific examples of how the media failed to provide scientific and medical context and analyze why this happened.


Interview with Matthew Puglisi, American Legion spokesperson. During the Gulf War, Puglisi, a Marine Second Lieutenant, was an artillery officer attached to an infantry company; he controlled artillery fires in that company's area throughout the war. Interview conducted October 1997

Q: The role the media's played in this--have they helped or hindered in this story?

A: [sigh] That's a good question. Media's done both. The media has helped because of its focus on the person and that helped the American people understand what these numbers mean. When we say tens of thousands of Gulf War veterans report poor health since the Gulf War, I mean, what do tens of thousands mean? The media's been able to go in veterans' homes, talk to them and their spouses about the impact the veterans' illnesses had on the family. They've been able to talk to veterans who have had bad experiences at the Dept of Veterans Affairs and put a face behind these numbers. That's been important. The media, to its credit, took seriously the beliefs of the veterans and maybe it wasn't backed up by science, but the veterans had a strong set of beliefs and those are important things that leaders have to address and they didn't for a long time. So that's where the media's helped.

Where the media hasn't helped and through no conscious effort on it's part, but just sort of the nature of the media, its short attention span, its rush to get things out there as quickly as possible, the turnover in the media either in personnel and agencies or giving different people the story to do this week, is that they haven't remembered what's been learned and many times the media will interview so-called experts to react to a scientific study and that expert will lambast it. Maybe it was a good one, maybe it had information that's important to Gulf War veterans, but instead many national media outlets have undermined the findings, put doubt in people's minds about what we've learned and that's not doing a good thing for --

Q: Why? Because they're seeing it as a political story that requires political balance?

A: The New York Times --which has some of the best medical reporters in the nation-- hasn't been allowing them, hasn't encouraged their medical reporters to cover this issue. Why not? They've been covering it from a political angle with their Pentagon reporter. Doesn't help the nation understand what's really important about Gulf War illnesses. Helps the nation understand some of the in-fighting that's occurring in Washington, DC, but it hasn't helped us understand what are veterans concerned about, what are the medical complexities of this and how should we approach it.

Q: What about TV? 60 minutes? 20/20?

A: TV's got great images and great pictures but -- TV doesn't have the time to educate the viewer about how sophisticated and complicated this is. It's the Pentagon says this and they pick somebody to say, no, wrong. And sometimes they pick somebody who isn't even a Gulf War veteran to express the views of Gulf War veterans and again that's not really helping people understand what's occurring with Gulf War illnesses.

If they really found that average Gulf War vet, that average Gulf War vet would rail about how poor the care was at VA -- long before they would bring up the Dept of Defense. And that's not to let the Department of Defense off the hook.

Q: Are most of the veterans convinced they've been poisoned by chemical weapons?

A: I don't know. I think many are and while we haven't done any formal survey of Gulf War veterans asking them what they think the causes of their illnesses are, but I think it's safe to say that a great many are convinced that chemical weapons are associated with their poor health. Now do they believe that because of their experience in the Gulf? In many cases, probably.

I mean the alarms as we all know went off all the time- many times regardless of what kind of chemical was in the air,- whether it was vehicle exhaust or maybe even the fine dust that was in the Gulf and many of these ideas that the veterans have were reinforced by what the national media has been saying about Gulf War illnesses.

Q: Talk about some of the problems of the exaggeration..... What, for instance, might be the downside of somebody saying that people who served in the Gulf had a risk of having deformed children?

A: The Dept of Veterans Affairs has reported that in that in one epidemiology study they're conducting, in one health survey that's being conducted, a majority of male Gulf War veterans responded that they've delayed having children because of reports of excess birth defects in the Gulf War veterans population. That -- that's a tremendous change in behavior and that's been affected by these reports that there --

Q: What kind of reports? Media reports?

A: Sure, the media. I mean that's how most people get their information and particularly pictures. You look at the Life Magazine article two years ago and the impact it would have. I'm a Gulf War veteran, I'm in good health and I've had a child since the Gulf War yet I had relatives copying that thing and mailing it to me, very, very concerned about my daughter's health yet so far we haven't found an excess in birth defects in the Gulf War veterans children's population.

So should Gulf War veterans be concerned about their children's health? Sure. You should always be concerned about your children's health from all the different things that can happen to your children, but we just haven't found the evidence yet and we're looking.


Interview with Dr. Stephen Joseph, Assistant Secretary of Defense for Health Affairs, 1994-1997. Joseph, a veteran public health physician, led the DOD's medical investigation of Gulf War syndrome. Interview conducted October 1997

Q: Can you talk about the media and how they covered the story ?

A: I think it varies. I think you had different segments if you will of the media. You had, I think, a group in the media that were looking for sensational aspects -- what could be more sensational than this? "U.S. Soldiers Gassed in the Gulf," or, "Mystery Illness Strikes Down American Military After the War," or whatever. And there was a good deal of sensationalism. I think there was some rather cynical self interest in some of the media approach.

I think the media in general did a very poor job, both the print and the electronic media, did a very poor job of covering what the medical facts and what the scientific realities were. There was a kind of period where there was the Disease of the Month. Anything that some Congressman could think up as might be a cause of mystery illness would be in the headlines or on the videotape as, The Cause of a Mystery Illness. There was not the kind of coverage you would expect had you had science reporters. The story from the beginning was not done by science reporters, or medical reporters. I think that's a very important fact. It was treated as a political story rather than a scientific or medical story. I think perhaps that's inevitable, but that's what happened.

Q: Take something like the Life Magazine piece. What do you think as a public health officer when you see that?

A: I think the Life Magazine piece was both a charade and very cynically done. We knew that a piece was in preparation. We talked to the people at Life Magazine, told them what the scientific data showed, told them that within a week or two of their proposed publication that there would be a scientific journal article in the most prestigious medical journal in the country that showed there was no evidence for congenital defects, asked them if not to delay publication until the scientific article came out, to balance their story with the information that was there. They went ahead and published in the most sensationalistic way anyway. I think they did a great disservice to not only the people who served in the Gulf, but to their families. I think they scared a lot of people. There was no basis, no scientific factual basis for their story. It was just a cover and a headline and I think represents the worst kind of journalism.

Q: What was the antidote to this kind of journalism though? Where was the other side being heard?

A: I don't think the other side was heard well and for that perhaps you can criticize all of us, including the medical people. It was a difficult message to get out. It was, as I've said, complex, it was not particularly palatable, and there was some uncertainty to it. That's hard to portray as a message against the kind of single-minded certainty of a sensationalistic easy answer. In addition, messages from the government and messages from the Department of Defense don't often have a great deal of credibility. I think, on any given day, all other things being equal, John or Jane Q Citizen is going to believe the worst rather than the more balanced account.

This is an enormous, this is probably the most significant public health problem of our time, i.e., how you convey complicated probabilistic information in a way that is acceptable and understandable by the public. I don't think we did a particularly good job with this. I'm not trying to put the blame on the side of the receiving public. It's not an area where public health does a pretty good job in general. You can look at AIDS, you can look at Legionnaires', you can look at any of the environmental threats to health, and you see the same thing again and again. We need to learn to get much better at this, both in terms of conveying scientific information and in marketing the information in a palatable way. But in this case, in the Gulf War issue, it was not at all successful.

Q: The DOD emerged from the Gulf War victorious....but then seemed to lose their credibility so quickly and so totally. What do you think contributed to that?

A: I think there's plenty of blame to go around. I think in part it rests on the clumsiness with which the government, and the DOD in particular, tried to convey, first of all concern, which needed to be conveyed. And second of all, what the data was showing. I think part of the blame rests on those who continued to whip up the issue. I think there were certainly those in the media. There were pseudo scientists. There were individual members of Congress who just would dredge up the most fantastic hypotheses and explanations without, absolutely without a shred of what I would call acceptable scientific rationale behind them, and throw them out there and blow them up in headlines and in video footage of GIs in gas masks. If I have seen once I have seen 50 times that same segment of soldiers in MOPP gear, in chemical protective gear, entering a slit trench, and it's always shown in absolutely no context. Just whenever there's a Gulf War issue you'll see that same piece of footage.

So there were those in the media. There were those who had axes to grind for their own scientific research, and I think, most regrettably, there were individual Congressmen, members of Congress, who just kept blowing this thing up, I think created a great deal of anxiety, and also made it much harder to get the message out. And then there were the vets. These people, the 20,000, 60,000, whatever number you want to use. They were hurting. They were ill. They were worried about it. They were anxious about what the future of their health was. And they also wanted answers, as we all do. They wanted answers that were most acceptable to them. They wanted medical labels. I'm the same way. When I have something that hurts I want a medical label on it and hopefully I want a direct and complete therapy that will cure that symptom. And in this case, especially with this most important combination of psychological stressors and physical symptoms, this was a message that was not, and is not today, palatable to the vets. They don't want to hear that. You have to understand that.

But at the same time you also have to recognize it as a position that makes it more difficult, both for them and for the rest of society. If we could only find a way to get all of us, not just those who are suffering from the symptoms, but the entire -- to accept that message, to understand that. When the Presidential Advisory Committee brought out this issue, as I think they were very correct to do, of the importance of psychological stress in this whole equation, they were shouted down. There was a program from the "Wisdom" of members of Congress and in the media. Why? Why is it so difficult to accept the message that, when you put young Americans, or anyone, in a situation that is uncomfortable, dangerous, and uncertain, that a number of those people come back from that situation with a combination of physical symptoms and psychological symptoms. I think we all know that. We look at ourselves in the mirror, everyone of us knows that and understands that in our lives. When you wake up in the morning and don't feel well and don't want to go to work because you have something unpleasant that's going to happen to you at work that day. You understand this combination of physical symptoms, whether it's sleeplessness or depression, or pains in your joints, or pains in your stomach, and what's going on in your psyche.

So we all know this, but we can't face -- it's kind of the last taboo of being unable to face the truth about this. And it's very sad because, if there is an area where we need to do a better job of protecting our young people when they go in harm's way, and they will again, this is the area that we need to make progress on. And it's very difficult when we consciously blind ourselves from talking about it and facing it and understanding it.

Q: There's been quite a lot of messengers in this story. There's been five blue ribbon panels, various studies. Pretty much all the scientific messengers present a fairly consistent message, and they've all tended to be treated the same way, haven't they? Am I correct?

A: I think so. But I think that's the nature of the issue. Let's talk about both sides of it. One is the consistency of the message. There's an old saying in medicine that says: When you hear hoofbeats in the street and you look out the window expect to see horses and not unicorns. As the data has piled up and piled up it's pretty clear that what we're look at are horses in this situation. There is no unicorn here. There is no mystery illness. That has been a consistent message in all the groups that have looked carefully and scientifically at this.

Another problem that we have as scientists and public health people however, is that we live by probabilities. And we are always reluctant, and for good reason, to say something is certain when we know that there's some degree, some small degree of uncertainty attached to it.

Now the rest of the world, the media and the public, and Congress, they live by certainties. They like to have things clearly black and white, yes or no, up or down. And we need to get better in my profession, we're not very good, at conveying those uncertainties to people. So when the scientist says, this was very clearly evident in the early days of the AIDS epidemic: "No, AIDS is only transmitted through these ways and not by those. 'Are you sure doctor?' Well, I'm almost certain, or it is highly probable." But I mean, how many times have you heard people like me say, "It's almost certain, or We're quite sure, or It's highly probable." Well when the public or the media hear that, what they hear is the uncertainty side, and they focus on that as an indication that this is not sure or not true or more than uncertain.

And of course, when people have reasons for wanting to hear the uncertainty, either because they can't face the reality of the psychological/physical symptoms combination, or because they want to make headlines the next day, then it's easy for them to discredit the argument.


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