Perspectives on 3D Printing and Fake News
February 2020 Issue
Anyone who has been paying attention to critiques of the media over the past few years is aware of the phenomenon of fake news. Despite the recent increase in the use of this phrase, the label is not new. It was first used in the 1890s, and similar accusations have been traced as far back as the 16th century.1 This label is typically used to describe the intentional misrepresentation of the facts in order to manipulate the audience and further a specific agenda.2 In the current political climate the label is often attached by proponents of a particular viewpoint (on each side of the political spectrum) to news reports that advocate for a view that they disagree with. The perception of ideological bias in reporting can cause skepticism of any news report and strong emotional reactions to stories believed to be misleading or factually inaccurate.
The increase in the application of 3D printing technology to prosthetics in the early 2010s caught the attention of the news media, giving rise to what some in the profession may consider fake news. Designs for prosthetic devices became publicly available, and individuals and organizations with no education or training in traditional prosthetic care were featured in the popular media for creating innovative designs and devices. Many of the stories seemed to follow a formula: A group of high school or college students (often with an interest in engineering) were providing prostheses for individuals (generally children) with limb absence who did not have access to traditional prosthetic care because of the cost or some design deficiency. These reports frequently contained inaccurate and misleading information, including misrepresentations of the cost, availability, and utility of 3D-printed and traditional prosthetic designs. 3D-printed designs were regularly presented as superior to traditional designs. While the initial interest appears to have waned, similar stories continue to appear weekly in local and national media.
Many prosthetists have an understandably strong reaction to these reports. Not only do they include an implied criticism of the clinical expertise of prosthetists, but they misrepresent the functional capabilities and day-to-day usefulness of 3D-printed devices provided by untrained individuals. Additionally, while our field remains engaged in the long and hard battle for professional recognition and the patient protections provided through licensure, our scope of practice is threatened by individuals with no education or training. This article offers some perspectives on medical journalism and stories about 3D printing that may help prosthetists respond effectively to common misrepresentations.
Human Interest and Limited Expertise
Journalists are under constant pressure to produce relevant and interesting stories for mass distribution. By its very definition as "anything that interests a large part of the community and has never been brought to its attention before," news requires the communication of something novel and interesting to a relatively large audience.3 Reporters have the responsibility of identifying, processing, and communicating this information.3 According to Timothy Johnson, MD, MPH, a former medical editor for ABC News who is currently affiliated with the Harvard T.H. Chan School of Public Health, "the process that leads to the official designation of information as news—meaning that the information makes it into print or onto the airwaves—is far more haphazard and idiosyncratic than outsiders might ever imagine."3
It is not surprising that journalists overwhelmed with the challenge of sorting through hundreds of potential stories choose to focus on those with the most immediate and mass appeal. According to sociologist Dorothy Nelkin, "To create a human-interest angle, journalists look for personal stories and individual cases, though this may distort research that has meaning only in a broader statistical context."4 Johnson says, "Anecdotal evidence, which is on the lowest rung of the evidentiary ladder in science, is often the basis of general news reporting; indeed, the anecdote…is often the entire focus of a general news report."3 There has always been an appetite for information about prosthetic technology and care, and many O&P practices benefit from this when their services and products are the focus of news reports. The combination of cutting-edge technology, groups of bright students making the world a better place, and the provision of prostheses for disadvantaged children must seem like a trifecta of human interest to reporters looking for stories with mass appeal.
Steven Woloshin, MD, MS, co-director of the Center for Medicine and Media at The Dartmouth Institute, points out that "many health journalists lack the medical or statistical training needed to appraise research critically. Curiously, many fail to approach medical research with the same skepticism they routinely apply to political reporting."5 Research by Melinda Voss, MPH, co-founder of the Association of Health Care Journalists, confirms this lack of expertise by reporters. Voss surveyed 115 "health reporters at daily newspapers in five Midwestern states" about their perceptions of "their ability to report health news."6 Respondents rated their confidence in their abilities in a variety of domains. "Results strongly suggest that health reporters are aware that they lack proficiency and want help. Only 31 percent and 9.7 percent, respectively, felt very confident in reporting health news and interpreting health statistics. In contrast, between 66 percent and 85 percent of respondents assessed of five critical skills required for sound health reporting as sometimes difficult to nearly always difficult. Four troublesome skills for respondents are understanding key health issues, putting health news in context, producing balanced stories on deadline, and interpreting statistics."6 There was no statistical difference in the confidence based on the size of the newspaper, but, interestingly, reporters "with less experience reported higher perceived ability."6 More than fifty percent of the respondents "agreed that the news media often do not provide context for health stories."6
Heartwarming human interest stories provide a pleasant change from the disputes, scandals, and fraud that are considered newsworthy by most news outlets.4 Unlike reports on complex medical diagnoses or treatments, the application of 3D printing and prosthetic care may appear fairly straightforward to reporters, not requiring expertise or an awareness of context and nuance. It complicates matters when researchers overstate the positive aspects of their work because of their strong belief in its value and to make topics more attractive to journalists. According to Woloshin, "When it comes to exaggeration of health hazards and medical breakthroughs, there is plenty of blame to go around. Researchers contribute to the problem…. The combination of strong beliefs and self-interest can be an irresistible recipe for exaggeration…."5 This tendency to present our own work in the most favorable light is most likely also true of organizations and individuals focused on disseminating designs and connecting untrained individuals who are interested in providing 3D-printed prostheses. Presenting traditional prosthetic care as inaccessible or ineffective while offering an innovative, low-cost solution attracts the attention of reporters and consumers of news reports. It is understandable that reporters on tight deadlines who lack the expertise required to understand a complex healthcare delivery issue would latch on to the simple human interest appeal of the story.
While all parties involved in disseminating health information to the public may share the goal of improving health and healthcare decisions, the goals of researchers and clinicians differ in important ways from those of journalists.
Nelkin believes that "both scientists and journalists are committed to communicating truth, and the tensions over science reporting have less to do with accuracy than with style. Media constraints of time, brevity, and simplicity preclude the careful documentation, nuanced positions, and precautionary qualifications that scientists feel are necessary to present their work…. Furthermore, readability in the eyes of a journalist may be oversimplification to a scientist. Many accusations of inaccuracy can be traced to reporters' efforts to present complex material in a readable and appealing way."4
In their article titled "Helping Journalists Get it Right," authors who included a physician, psychologist, and medical reporter advise: "Instead of viewing journalists as antagonists, physicians are better served by viewing healthcare reporting as a collaborative process in which both parties bear responsibility for producing fair and accurate news stories."7 Their article contains guidance on writing news releases, how to handle calls from reporters, and how to prepare for an interview, some of which is adapted in the sidebar at right. They quote another author, who advises: "Approach the reporter as you would a student…. Think of the interview as a teaching opportunity, and as such, communicate to the student (the reporter) in language he or she can understand…. By taking the time to educate the reporter and provide him or her with all appropriate background material, you are making an investment in more thorough, more accurate news coverage."7
Getting the Story Right
The tension between medicine and media is more serious when it relates to healthcare issues where more is at stake than in prosthetic care. Public perceptions of potentially deadly diseases and life-preserving treatments can be unduly influenced by inaccurate media reports. The media "help to create the unarticulated assumptions and fundamental beliefs that underlie personal decisions, public policies, and clinical practices. They influence the perceptions of a public increasingly sensitive to the social and ethical implications of science and inclined to question the credibility of scientists and technical institutions."4 The trust between prosthetic practitioners and individuals with limb loss is a vital component of effective decision-making and care. There are many important factors that influence prosthetic design options and a patient's decision to use a prosthesis, and these must be considered in the context of a trusting patient/provider relationship. News reports that do not consider these factors undermine that important relationship, and may reduce the level of confidence in the information provided by qualified professionals. According to Voss, "Inadequate, misleading, or incomplete news reporting…can lead people to make misguided choices that may put their health at risk or influence policymakers to adopt inadequate or harmful laws, regulations, or policies."6 This final possibility became a reality in mid-2019 when politicians in Ohio announced plans to modify that state's licensure law to exempt 3D-printed designs.8
It is unlikely that news stories about 3D-printed prostheses are intentionally inaccurate or manipulative, and so do not warrant the label of fake news. As frustrating as the unintentional misrepresentations are, there are several constructive responses for practitioners to consider. First, continuing to provide prosthetic care responsibly, and building trust with current patients, caretakers, and referral sources ensures that patients will continue to have a reliable resource for ethical prosthetic care. Second, accessing resources within our profession, such as the American Orthotic and Prosthetic Association's comments to the US Food and Drug Administration on 3D printing and other thoughtful, professional perspectives can guide our individual responses.9 Third, making investments in the education and training required to become proficient in 3D printing will allow the appropriate combination of technology and clinical expertise required to apply this technology in the most meaningful way. Finally, it's worth considering how we should modify our perspective of the news. Michael Crichton described the tendency of experts to believe "news articles on topics outside of their fields of expertise, even after acknowledging that articles written in the same publication that are within the experts' fields of expertise are error-ridden and full of misunderstanding."10 He describes this tendency as a form of amnesia: "You open the newspaper to an article on some subject you know well…. You read the article and see the journalist has absolutely no understanding of either the facts or the issues…. You read with exasperation or amusement the multiple errors in a story, and then turn the page to national or international affairs, and read as if the rest of the newspaper was somehow more accurate about Palestine than the baloney you just read. You turn the page, and forget what you know."11
If the media reports about 3D printing help us to focus on building trust with our patients and referral sources and expanding our expertise to integrate this innovative technology, they will have served a valuable purpose. They may serve another, very different purpose if they cause us to question our confidence in our opinions about issues in which we have limited expertise.
John T. Brinkmann, MA, CPO/L, FAAOP(D), is an assistant professor at Northwestern University Prosthetics-Orthotics Center. He has over 25 years of experience in patient care and education.
1. Merriam-Webster. "The Real Story of ‘Fake News.'"https://www.merriam-webster.com/words-at-play/the-real-story-of-fake-news.
2. The Center for Information Technology and Society. "What is Fake News." https://www.cits.ucsb.edu/fake-news/what-is-fake-news.
3. Johnson, T. 1998. Shattuck Lecture. Medicine and the Media. The New England Journal of Medicine 339(2):87-92.
4. Nelkin, D. 1996. An uneasy relationship: the tensions between medicine and the media. Lancet 347(9015):1600-3.
5. Woloshin, S., L. M. Schwartz, B. S. Kramer. 2009. Promoting healthy skepticism in the news: helping journalists get it right. Journal of the National Cancer Institute 101(23): 1596-9. doi:10.1093/jnci/djp409.
6. Voss, M. 2002. Checking the pulse: Midwestern reporters' opinions on their ability to report health care news. American Journal of Public Health 92(7):1158-60.
7. Stamm K., J. W. Williams, P. H. Noël, R. Rubin. 2003. Helping journalists get it right. Journal of General Internal Medicine 18(2):138-45.
8. Cleveland.com. "Ohio officials seek to promote 3D-printing of prosthetics via law change." https://www.cleveland.com/open/2019/06/ohio-officials-seek-to-help-3d-printing-prosthetics-charity-via-law-change.html.