Is There a “Do No Harm” For Reporters and Editors?
At graduation, physicians recite the Hippocratic Oath, some versions of which include the famous injunction “Primum non nocere” (First, do no harm). It is not the case, however, that only healthcare professionals need to remember this warning.
Last December 9 and then again on February 4 The New York Times published two articles that are causing a stir in the world of suicide prevention and research (note that Critica will not post links to either article for reasons that will become clear). The first article detailed a website that gives advice on how to kill oneself and the second tells readers about a chemical that can be bought online that is increasingly used by people trying to kill themselves (again, Critica will not list the name of the website or of the substance). Between these two articles, a piece appeared online in Medium by four academic suicide researchers titled “The New York Times might have increased suicide deaths. Here’s what it can do to fix it.”
The authors of the first Times article, dealing with the website, apparently worked for a year researching the site and uncovering cases of people who seem to have been motivated to kill themselves by it. It is accompanied by a warning, “This article focuses on suicide and contains details about those who have taken their own lives. If you are having thoughts of suicide or are concerned that someone you know may be, resources are available here.” But the article then goes on to explain in detail how to find the suicide-promoting website. We had no trouble finding it with a simple Google search and although the site says it is only for people over 18, there is of course no real way to prevent children from going on it. Once there, they will find postings by people seriously considering suicide and advice on how to take one’s life.
Uncovering a “Dark Corner” of the Internet
According to one report (again, Critica is not providing links), the Times authors considered the ethics of describing the website in detail because they felt compelled to bring to light a “dark corner” of the internet. If people are following the advice of this website and dying, then a thorough public investigation may be warranted to allow authorities to consider regulating it. The Times story identified 45 people whose deaths by suicide involved the website and noted that “The site now draws six million page views a month, on average—quadruple that of the National Suicide Prevention Lifeline…” They decided to name the website in their story and the substance used in many of the suicides “in order to fully inform readers about the dangers they pose, particularly to the young and vulnerable.”
But the four suicide researchers who authored the Medium article remind us that “Decades of research have also shown that when news and entertainment media share information about suicide method and location, there is a short-term increase in suicide deaths.” Over 30 years ago Madelyn Gould and David Shaffer of Columbia University were among the first to show in an article in the New England Journal of Medicine that media depictions of suicide can lead to imitative suicide attempts. The New York Times named the website, gave many details about the people who had supposedly killed themselves because of the website, and named a means of attempting suicide that some of them had used. Critica is deliberately withholding links to the articles that do this because we believe the research showing that doing so can in fact lead to an increased risk for suicide among some vulnerable people.
Guidelines for Reporting Suicides
That research by Gould, Shaffer, and many others has led to the development of suicide reporting guidelines, which, among other things, recommend against printing the method by which someone ended their life. This was clearly violated by the second New York Times story, which details a method apparently being used with increasing frequency and how to obtain it. Again, we had no trouble finding the substance on Amazon and could easily have purchased it.
The Medium article authors, writing about the first of the two Times articles, stated that “While we were grateful that this investigation could lead to the website and the novel method being shut down, we were equally concerned that disregarding the suicide reporting recommendations could result in more suicide deaths.” The authors then urged The New York Times to conduct research to find out if in fact their articles are associated with an increase in suicides. “If the journalists and editors believe that publishing this piece was in the service of saving lives,” they wrote, “then it is imperative for them to follow through in the ways outlined…”
Of note, the Medium article authors say that The New York Times refused to publish their article.
More Reporting Guidelines are Needed
When journalists write their stories, they are undoubtedly interested in getting a maximum number of readers. Some are also interested in producing work that will advance a public good. But do journalists and editors consider their potential to do harm? Reporting on suicide is one of the ways that journalists can indeed do harm, but guidelines that may minimize that harm are inconsistently followed. There is also evidence that reporting on mass shootings can encourage copycats and guidelines have been issued for better reporting of mass shootings as well. It would be interesting to learn the extent to which these guidelines are followed.
During the Covid-19 pandemic, we have seen that misinformation about vaccines can lead people to delay or refuse getting vaccinated. Thus, we know that what people see and read influences their behaviors. Journalists and editors, therefore, must be aware of the potential they have for causing harm if they do not carefully think through the ways that they report about important health issues.
Imagine the following possibility: There is consensus among medical experts that high blood pressure (hypertension) increases the risk for adverse cardiovascular and cerebrovascular events, like heart attacks and strokes. If diet and exercise do not lead to improvement, antihypertensive medication may be necessary for many people. A finding reported in a medical journal might identify a previously unknown but rare adverse side effect from one such medication. A reporter might think it their duty to make that adverse side effect known to the public in the spirit of informing people about the risks of their medications. That is an understandable thought. At the same time, however, will the journalist consider that the way they report on the adverse event might make people overestimate a rare risk, generalize the adverse side effect to all antihypertensive medications, or become distrustful of their doctors’ advice to continue taking their medication? Does the journalist think about the potential for their article to have the unintended consequence of motivating some people to stop taking necessary medication, risking serious adverse consequences?
It is unclear to what extent journalists and editors are aware of the potential their communications have to do harm, although there has been considerable discussion among journalists about the adoption of stronger editorial codes. A Hippocratic Oath for journalists has even been suggested. We believe that a broader set of guidelines is needed around ensuring that what journalists write about and post in the areas of science and health are in the service of the public’s health. Then, we need to work on incentives that will motivate journalists to follow them. Critica is prepared to work with journalists and editors to craft such guidelines and incentives.