FACOG FACP, Center for Fertility and Reproductive Endocrinology, Virginia Mason Medical Center, FC-11, Seattle, WA 98119, USA
* Email: chowletterie{at}comcast.net
Sir,
The article by Child et al. (2004) gives expression to a dynamic every reproductive endocrinologist faces on a daily basis. That dynamic is this: in spite of our best intentions to provide expert counsel, more than a fair share of patients express an interest in multiple gestations. Why do intelligent, informed couples have this preference? This desire may be in part related to costs and a one-stop shopping attitude: a multiple gestation for many couples offers the opportunity to have a family of four (or more) nearly instantaneously with a minimal financial impact at the front end. Aggressive formal education (as the authors suggest) will hopefully enhance our patients' understanding and place multiple gestations in their proper clinical perspective. However, the opinions of our patients are shaped by a number of information streams. Our counselling and discussions are but one line of information and an increasingly diluted one at that.
Our patients increasingly look to the news media for insight about the latest technology, medical devices and trends in treatments. Have no doubt about it, medical information in the news holds considerable sway in shaping a family's perceptions of medical options. In a recent survey, 75% of those polled relate that they rely on media coverage for medical information that figures heavily in their decision making (Steinbrook, 2000). In some settings, that information is held side-by-side with that offered by their medical providers. There are several reasons for this power. News media, whether written or televised, present information in a format designed to appeal to our patients: easy access, understandable language and an extensive menu of options. These aspects would be an ideal educational format for patients were the coverage even handed and balanced. However, differences in data quality and presentation both bold and subtle can undermine this sought-after precision. Contemporary agendas of the news media have evolved away from a traditional vehicle for informing the public as a watchdog to a venue for attracting audiences (Johnson, 1968). In this capacity, multiple gestations are a treasure trove. The public is engaged by stories of good will, science and family. Multiple gestations combine all three aspects in a single package; and the fascination has increased markedly in recent years.
Until the early 1970s, multiple gestations were considered an interesting oddity by the press. As the number of higher order multiples and the intrigue with technology behind these outcomes increased, the press paid more attention. The McCaughey septuplets became a media spectacle and point of discourse on multiple gestations. A parade of news articles flowed from this event (Klotzko, 1998). The news stories and the public's response ushered in a new era of media's interest in multiple gestations. This coverage was notable for how disarmingly these events were portrayed. Descriptions such as ...bespoke a neighborliness that seems to have vanished in much of America... (Time December 1, 1997) and ...a gamble on fertility drugs won them a seven figure jackpot... (People December 8, 1997). Barbara Walters described this event as ...nothing short of a modern medical miracle... (ABC Special Report August 23, 1998). Various episodes followed describing families with high order multiples. The story lines appeared to emphasize the promise and minimize the peril of multiple gestations and assisted reproductive technologies.
To evaluate the impact of the news media on our patients' perceptions, we reviewed reports on multiple gestations from two major newspapers for the year 19992000 and reported these data in abstract form (Letterie, 2003). The articles were reviewed with attention to outcomes, data contained, attributed sources of quotes and recommendations, literature citations and outcomes. Approximately half of the articles contained only interviews with families and contained no scientific or medical data. Though these articles cited potential complications, the complications were described in non-numerical, qualitative terms. Only 15% described in specific, quantitative form adverse outcomes, and 2% contained discussions of long-term follow-up. However, the data extracted from these articles are only part of the picture. The subjective, between the lines impression was one of a two is better than one mentality, and that other than number, they were really no different from singletons. Perhaps not by design, the hard edge of the clinical reality was softened. Specific descriptions of developmental or motor delay or perinatal morbidity and mortality attributable to the prematurity were lost in the details and descriptions.
Understandable, cogent communication of medical treatments and outcomes is an extremely complex task. Our news media have provided extensive coverage of the treatments and outcomes in our specialty, and we have all benefited. An awareness of these lay publications and media coverage has become an essential aspect of our practice. The article by Child et al. rightfully suggests that open discussions and face-to-face counselling are the best defence against changing these perceptions regarding multiple gestations. Open discourse remains the tried and true method of care and counselling. Our task is somewhat more complicated in our specialty as our patients have the advantages of several databases for review. This added information may cut both ways and both ease and complicate our attempts at counselling.
References
Child TJ, Henderson AM and Tan SL (2004) The desire for multiple pregnancy in male and female infertility patients. Hum Reprod 19, 558561.
Steinbrook R (2000) Medical journals and medical reporting. N Engl J Med 342, 16681671.
Johnson T (1998) Medicine and the media. N Engl J Med 339, 8792.
Klotzko AJ (1998) Medical miracle or medical mischief? The saga of the McCaughey septuplets. Hastings Ctr Report MayJune, 58.
Letterie GS (2003) News media reporting of multiple births [abstract]. Fertil Steril 3S, S41S42.