Unhealthy Conspiracy of Silence

After reading this important transcript of a conference to which I was not invited, about media coverage of Ariel Sharon's hospitalization, I wish to address some of the important public and moral questions raised by this affair

"Kasheh ach yatziv: hatikshoret, harof'im umachalot manhigim ("Serious But Stable: The Media, the Doctors and the Illnesses of Leaders"), edited by Yechezkel Rachamim, Tel Aviv University Press and the Chaim Herzog Institute for Communications, Society and Politics, 57 pages

First off - a disclaimer: The writer of this review is not an impartial observer. On the contrary, this is a one-sided, personal and very biased review. And now, the full story ...

From January 2006 on, I was involved, along with Haaretz reporter Tamara Traubman, in the intense coverage of former Prime Minister Ariel Sharon's admission to the Hadassah University Hospital at Ein Kerem, Jerusalem. Our coverage made us the target of sharp criticism. However, when the Israel Medical Association (IMA), the department of communications and the Chaim Herzog Institute for Communications, Society and Politics at Tel Aviv University (TAU), headed by Prof. Yoram Peri, decided to hold a conference on the work of the media during Sharon's collapse, neither I nor any other representative of Haaretz were invited to participate, although it was clear that much of the discussion (and the tough criticism) would be focused on myself and on the newspaper.

The same happened at another conference on the subject, held in July at the Mishkenot Sha'ananim Center for Ethics in Jerusalem. There, too, organizers of the event refused to invite me to speak or to confront the representatives of Hadassah. Ultimately they agreed to have Haaretz editor-in-chief David Landau address the conference on the paper's behalf. Landau strongly protested the fact that I had not been invited to appear at the conference, explained the reasoning behind the newspaper's editorial choices in this affair and defended the series of stories covering Sharon's illnesses.

The booklet discussed here contains a transcript, edited by Yechezkel Rachamim, of the talks given at the TAU conference on media coverage of Sharon's collapse. This booklet is of public importance and of interest to anyone who wishes to understand what has preoccupied the media, the medical establishment and even the administration of Hadassah Hospital with regard to the prime minister's care. And yet, judging by what is written here, some of the important public and moral questions raised by this affair were not debated at the conference (or afterward). These questions involve the conduct of the hospital's administration, the senior physicians who provided Sharon's medical care and the staff of the Prime Minister's Bureau.

Other important questions not addressed in the booklet involve the performance of the media themselves, which at first bought the "spin" claiming that "Sharon is progressing," as the prime minister himself suggested after his first stroke last December, in phone conversations he had with political correspondents from his hospital bed. (Subsequently it was revealed that the calls, late at night and just a few hours after the stroke, were made against the medical advice of the Hadassah doctors). I'd like use this review as a chance to offer answers and comments to the speakers at the TAU conference, in lieu of the platform I was not given at the conference itself.

Spoiling the party

At the conference, IMA chairman Prof. Yoram Blachar expressed surprise at claims made in the media to the effect that the medical establishment (including himself) was critical of the media coverage of the affair because the doctors were engaged in a cover-up - trying to conceal vital information from the public.

"What might have been true many years ago has no anchor in reality today," Blachar said, claiming that not only had the "conspiracy of silence" been dissolved long ago - so that there was no longer any problem receiving information about medical cases - but that "there is, in fact, an entire discipline of doctors that have trained themselves to provide opinions of this kind."

Here one has no choice but to spoil the party: The conspiracy of silence among physicians, and especially within the medical establishment, is alive and well at Israel's health-care institutions, in some cases under the leadership of the IMA itself. Take, for example, the case of the committee that investigated the illegal and immoral experiments that were conducted on thousands of patients at Kaplan Hospital in Rehovot and at Harzfeld Geriatric Hospital in Gedera. As Haaretz has reported, the IMA managed to force the hand of the Health Ministry's administration here, turning the committee from one whose findings were supposed to be made public under the Patients' Rights Law into a body operating under a different article of the law, which mandates that its findings remain confidential. And this is not the only example.

Contrary to what Blachar claims, there are still many areas of medicine in which there is a high possibility of complication and a high potential for medical malpractice; in these fields, it is still extremely difficult (today, although not in the distant past) to hear an opinion from a doctor that is unfavorable to his or her colleague. This is true for heart surgery, for neurosurgery and for some cases involving fertility treatment in which there are allegations of malpractice.

Prof. Shlomo Mor-Yosef, director general of Hadassah Medical Center, gave an interesting presentation at the TAU event regarding his own work vis-a-vis the media during Sharon's hospitalization. He criticized some of the media, including Haaretz, saying that "certified medical testimony by a source involved in Sharon's care" - which appeared in this newspaper - turned out to be baseless. Mor-Yosef further claimed that, "Haaretz is a newspaper whose specialty is not to reveal sources, based on journalistic ethics that say you do not reveal your sources. So, please, how can I deal with this? I did not want to deal with it, but when the facts are untrue ... I had no choice."

Probing questions

Prof. Mor-Yosef was referring to the main headline of Haaretz from January 10 of this year, which claimed that only during Sharon's second hospitalization (that month) - and not during the first one a month earlier - was the prime minister diagnosed as suffering from a vascular condition that affected his brain, a condition that makes it more likely for a patient to suffer a stroke during treatment with blood thinners (which Sharon was receiving). By the following day, the information has been corrected, and the Haaretz headline declared that the disease had already been diagnosed during prime minister's first hospital stay.

The correction, however, did not make it any less necessary to ask some probing questions of Hadassah. On the contrary. This includes questions regarding the medical care itself (for instance, concerning why the doctors decided to treat Sharon with anticoagulants despite his condition). There are also graver, more numerous questions regarding the conduct of the Hadassah physicians and administrators and of Sharon's private doctors while releasing information to the public at two press conferences, which were held by the top hospital physicians that were treating him.

Also troubling is the nature of the information that Sharon's doctors released to the media, such as during the interviews that the prime minister's private physicians gave to Yedioth Ahronoth's Nahum Barnea and Shimon Schiffer. These interviews led Yedioth to publish a page-one story on December 23, 2005, claiming that "Sharon is a healthy man" and that, "He may soon undergo a catheterization procedure for a heart defect, [a procedure] from which ... he can emerge within a few hours."

These details were given to the newspaper by Dr. Shlomo Segev of Sheba Medical Center, Sharon's personal physician. Sheba's Dr. Boleslav Goldman, another one of Sharon's private doctors, said at the time to Yedioth that there was no reason to rush ahead with the catheterization.

While speaking at the conference at TAU, Prof. Mor-Yosef did not address troubling questions regarding the incomplete and deficient information that the Hadassah doctors passed on to the public, while presuming to provide a complete and credible report on Sharon's condition. Nor has Mor-Yosef answered these questions on other occasions, such as during interviews for the "Tik tikshort" ("Media File") and "Uvda" ("Fact") television programs. It seems as though the Hadassah director general wishes to avoid at all cost the questions that still await his explanation.

Recently Haaretz's TheMarker business supplement received an invitation from Hadassah to interview Mor-Yosef about the hospital's economic development. The main condition for holding the interview was that no questions be asked about Sharon's medical care. The offer was turned down.

'Due disclosure'

At the TAU conference, Prof. Avinoam Reches, head of the IMA's ethics bureau, provided a very interesting account of the way the Sharon affair unfolded, both in medical terms and in the context of the media, and surveyed some of the thorny questions it raises for both the media and Hadassah. Reches noted that he had been offended by the Haaretz headline about allegations made by a "senior Health Ministry official, a member of the ministry's top administration." Reches said about this: "How many doctors are members of the Health Ministry's administration? The situation was like that during the day when the Twin Towers came down in New York."

Reches declared at the opening of his remarks, as a matter of "due disclosure," that while he was speaking as the head of the IMA ethics' bureau, he also receives a salary from Mor-Yosef (who gave a "fascinating talk," as Reches said) for being a senior physician in Hadassah's neurology department, whose doctors have been the focus of the Sharon controversy. But that is precisely the problem with his remarks: As a Hadassah physician, what he had to say was of great interest - but why did he insist on speaking as a representative of the IMA ethics bureau (and not only at this conference) about an affair in which his department and his colleagues played such a crucial and problematic part?

Finally, a comment on remarks by Channel 1 political correspondent Ayala Hasson, who claimed at the TAU event that it was an act of "ugly and unnecessary voyeurism" to mention Sharon's body weight since, as she claimed, "it really makes no difference whether he weighs 100 kilograms, 188 kilograms, or 140 kilograms ... We could all see that this was not a particularly slender man ... Is it really necessary to invade his body and demand to know the condition of his hemorrhoids ... How much exactly does he weigh?"

The problem, however, is not whether the public needs to know what Sharon weighs, although it is clear that for a man as severely overweight as he is, weight is a significant medical parameter. The problem is the lies or half-truths transmitted to the public through the media. This is not a trivial or voyeuristic detail: The non-credible, confusing information released about Sharon's weight reflects, and in fact epitomizes, the incomplete, misleading picture that some of his doctors presented to the public. This picture made the prime minister out to be a healthy man suffering only from a small congenital heart defect - the kind that the doctors could fix in a few hours, and then presto! He would be able to go straight from the hospital repair shop to the Prime Minister's Bureau. Good as new.