About AST

How to respond to an outrageous article?

I know many of you have been disturbed by an article in Saturday’s Wall Street Journal (March 10, Life and Culture, What You Lose When You Sign That Donor Card, by Dick Teresi). Quite frankly, the article is so far outside the bounds of informed discussion regarding organ donation that it is difficult to know how to respond. A little background: Teresi is an author who writes about life and science, always provocatively. The article appeared in the book review (not OpEd) section of the WSJ, immediately preceding the launch of Teresi’s latest book earlier this week. Obviously, it was written to generate controversy and book sales. I fault the editorial staff, however, for publishing such an outlandish, potentially hurtful, piece without at least vetting it with someone active in the field in the current millennium. If the article contributes to even one family’s second thoughts about donation and another death on the waiting list, may both writer and publisher bear the disgrace.

How to respond appropriately when response will just generate more publicity and controversy? Just this blog will likely stimulate some to read the article who otherwise would not have been aware of its existence. It may be most appropriate to allow the community to handle it, as they are already doing quite capably. Seems to me there are two other potential approaches. The first would be to decry the irresponsible journalism this article represents (see above). The second would be to refute the misinformation presented, item-by-item, a difficult challenge in a letter-to-the-editor format.

Thoughts?

Robert S. Gaston
 

Comments

Point-by-point, with kindness, though there is such a thing as righteous anger. The editors of the Wall Street Journal should not have published this.

On Behalf of Rebecca Dodd- Sullivan, RN, CPTC, Senior Organ Procurement Coordinator - CA. This article is fundamentally flawed in accuracy and it's recent publication severely discredits the WSJ. Mr Teresi states that "current" criteria for brain death, or death by neurologic criteria, were set by a Harvard Medical School commmittee in 1968, failing to also state that The Quality Standards Subcommittee of the American Academy of Neurology published a landmark paper in 1995, and then an update in 2010, delineating clear and updated practice parameters for determing brain death. These reports outline diagnostic criteria for the clinical diagnosis of brain death and are meant to set the medical standards for the determination of death. They are not "simple" as Mr Teresi ineptly states in paragraph 6 of his unfortunate article. Every neurosciences physician in the US who has ever taken the time to carefully assess a patient for the clinical diagnosis of brain death, and then wrote a careful note explaining his findings, should be outraged by Mr Teresi's misleading comments. Additionally, Mr Teresi has a penchant for citing old and poorly referenced materials in this article. He states that Gail A. Van Norman's article from a "peer reviewed" medical jounal, embarrassingly published in the journal "Anesthesiology" in 1999, is proof that a 30 yo patient was "breathing" at time of organ procurement. If you look at her article, Van Norman's own words state the following: " During an educational course for anesthesiologists, a participant described a case, not independantly verified by the author (Van Norman) in which a 30 yr old patient was admitted to a level 1 trauma center......" and then goes on to say that the anesthesiologist noted that the patient was "breathing" at the time of procurement. So, this Van Norman has taken an unverified, second hand report that the patient was spontaneously breathing while intubated and on a ventilator. I am not sure that I would feel as comfortable as Mr Teresi in citing work by a physician with such shoddy data reporting abilities. And, if the patient were actually exhibiting "breaths" on the ventilator, did this "second hand" source anesthesiologist assess for the confusing phenomenon of ventilator auto-triggering, which is caused by supersensitve ventilators which register the transpleural pressure changes of the hyperdynamic brain dead heart, as patient mediated respiratory effort and subsequently delivers ventilator mediated breaths which are often augmented in size by the addition of pressure support dialed in on the ventilator settings? There are MANY reports in the literature of ventilator autotriggering and why it occurs in a brain dead patient. To this end, the properly administered apnea test is the gold standard for assessing spontaneous respiratory effort. It is also interesting that the same author, Van Norman, who is so oft cited by Mr Teresi as an expert, implicitly states in the same 1999 article that an EEG is no longer a reliable test in the assessment of brain function. Mr Teresi for some reason is still advising his readers to ask for this test to be administered in brain death assessments. Why is Mr Teresi picking and choosing information from this already dubious and outdated source article? Clearly it's to write a muck-raking piece meant to confuse the lay public and sell more of his books full of fallacies. These are just a few easily spotted tidbits of misleading rubbish put forth by Mr Teresi. My sincere hope is that the WSJ endeavors to do the real research required to check Mr Teresi's assertions, then issues a retraction followed by an apology for misleading the public sector. If not, the WSJ is at risk for losing all future credibility. Rebecca Dodd- Sullivan, RN, CPTC, Senior Organ Procurement Coordinator - CA.

thanks for the clarification about the context of these comments. It reinforces the premise that there is no such thing as bad publicity. The WSJ is on a bit of a roll: last month they had an article by the former FDA Commissioner who suggested that FDA approval of new drugs be based on safety alone with demonstration of efficacy to come later. http://online.wsj.com/article/SB1000142405297020364600457721540339935087... Of course, that would toss the concept of risk: benefit out the window and I can only imagine how that would play out in the today's economic climate.

The paper has gone downhill since Murdoch took over. I leave it to the community to respond. Among the readers should be some donors as well as recipients.

Actually, the Fresh Air interview was with Rich Freeman, from Dartmouth, who did indeed do an excellent job setting the record straight regarding care and concern for donor and donor family, as well as informing listeners why we find transplantation so compelling.

Thanks to all who have commented. It became obvious over the course of a few days that, indeed, the community response was quite adequate. The WSJ published only one letter to the editor Saturday (March 17), a very well written response from transplant colleagues in New York. The NPR piece is interesting. Look at all the comments to the book on Amazon, as well! This episode serves as a reminder of the diligence required of us in helping maintain the public's trust. It is a privilege to be part of this community.

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