Novel LSTs such as ECMO typically attract considerable media attention in Taiwan . In this study, we investigated the medical information on ECMO use presented in newspapers and on Internet web pages. We identified that: 1) Internet web pages were more likely to reproduce or duplicate the survival of ECMO patients than newspaper articles; and 2) the survival rates for ECMO use reported in newspapers and on Internet web pages were both over-optimistic as compared to those published in journals and the ECLS 2014.
Media and life-supporting treatment
In 1996, Diem et al. investigated the depiction of CPR in three popular television medical dramas in the United States, and observed that the medical information, such as the immediate survival rate of patients who received CPR, provided to the public by the medical dramas was over-optimistic . However, three other studies conducted to evaluate the CPR survival rates shown in television medical dramas failed to identify significant differences from the survival rates provided in the literature [11–13]. The findings of the present study, based on newspapers and Internet web pages, are consistent with Diem and colleagues’ findings from television medical dramas, in that medical information provided by newspapers and the Internet to the public is over-optimistic as indicated by the survival rate of the patients sustained using LST, and may mistakenly convince the public that an aggressive LST (such as CPR and ECMO) can rescue patients from all life-threatening conditions. Although the portrayal of the survival of patients receiving aggressive LST on television medical dramas remains controversial, it is apparent that such media outlets can substantially influence the public [14–17].
A study by Moynihan et al. investigated the coverage of three medications in the US news, observing that 60% of the news stories reported the potential benefits of the medications, whereas 47% of the news stories reported the potential harms. The study concluded that the coverage of the three drugs focused predominantly on their benefits . Bartlett et al. reported that medical journals generally provide equal coverage of the positive and negative results of medical research, whereas newspapers are more likely to publish the negative results . For example, one study concluded that jogging is significantly associated with beneficial effects on health  and another study showed that the risk of acute myeloid leukemia is significantly increased in cockpit crews . Newspapers would tend to report the results of the second study rather than the first. Our study results showed that the survival rate of the 60 patients in newspapers and 182 stories in newspapers were both significantly higher than the average survival rates in the four ECMO studies in Taiwan, which suggested that newspapers are likely to provide over-optimistic medical information on ECMO use as a LST.
For ECMO use shown on the Internet web pages, we found two ways that the medical information was over-optimistic: First, writers or bloggers of Internet web pages were more likely to select the alive ECMO users than the dead, as indicated by the significantly higher survival rate of the 55 patients on the Internet than the highest survival rates of ECMO use (p = .01) in the four studies in Taiwan; Second, writers or bloggers were more likely to reproduce or duplicate the alive ECMO users shown by other Internet web pages than the dead ECMO users, as indicated by the higher survival rate of the 237 stories on the Internet than that of the 55 patients on the Internet (p = .31). Writers or bloggers of the Internet web pages may not have particular interests in reporting, reproducing or duplicating optimistic outcomes of ECMO use. Instead, they may report, reproduce or duplicate stories of their own personal interests or those which are effective in attracting readers’ attention.
Medical decisions to request aggressive LST is frequently discussed in the field of medical ethics. Physicians assist with a patient’s or family member’s medical decision-making by providing medical information and suggestions based on scientific and humanistic principles, and with respect for patient autonomy. Patients usually make medical decisions depending on the medical information and suggestions given by the physicians, personal values, personal preferences, and past medical experiences . Therefore, the over-optimistic survival rate of ECMO users reported by the newspaper articles and Internet web pages may potentially influence patients’ and family members’ personal values and personal preferences, thus encouraging them to request ECMO being performed on themselves or their relatives while death is imminent.
None of the laws associated with clinical practice in Taiwan (e.g., Physicians Act , Medical Care Act , Hospice Palliative Care Act ) forces physicians to provide aggressive LST which is considered inappropriate to patients even if patients/family members request them. Therefore, physicians theoretically can decline the request of inappropriate LST based on their professional judgment. However, if the family members are influenced by the over-optimistic survival rate of the inappropriate LST users reported in newspaper articles and Internet web pages, and thus strongly request the inappropriate LST to be performed on the patients, physicians, usually in fear of litigation or the burdensome process of litigation [26, 27], are more likely to perform that LST without carefully deliberating its clinical indications.
Strengths and limitations
This study evaluated the medical information on ECMO use presented in newspaper articles and Internet web pages. According to the 2010 Annual Report of Mass Media by Shih Hsin University College of Journalism and Communications , 97.3%, 74%, and 71.3% of adults in Taiwan, aged between 15 and 64, acquired health-related information by watching television, reading newspapers, and searching the Internet, respectively. Readers of the Liberty Times, the Apple Daily, the United Daily News, and the China Times constituted 16.9%, 15.9%, 7.7%, and 6.1% of Taiwanese people who read newspapers, respectively . Medical information on ECMO use in the four major newspapers and on Internet web pages may, thus, influence a large proportion of the Taiwanese population.
Our study has two major limitations. First, our results might not be applicable to other newspapers in Taiwan and elsewhere in the world, or to other Internet web pages not using traditional Chinese language. Second, we obtained our data for analyses from newspapers in Taiwan and the Internet web pages. The stories of ECMO use reported by newspaper articles and Internet web pages might not contain all the variables we needed in this study. Therefore, some variables in this study inevitably had missing values.