Primum non nocere. On the Virus and Ethics

By Ivan Radev

Иван РадевIvan Radev is a journalist with more than ten years of experience working for Bulgarian and foreign media. He has worked as a correspondent of Romanian news agency Agerpres. He is a board member of the Association of European Journalists in Bulgaria.


In September, the Bulgarian Medical Union, BMU, issued a critical statement in which it opposed “the promotion of controversial views in the public space and news media, especially by fellow doctors.”  The statement cited two quotes:

“I don’t see a point in [wearing] these masks, except for their psychological effect. In addition, these masks create the deceptive feeling that we are protected…”

“Coronavirus is a common viral infection that is self-limiting. The cured are not cured. These are people who simply went through the illness.”

Although his name is not mentioned, both opinions belong to Dr Atanas Mangarov, head of the children’s ward at the Infectious Diseases Hospital in Sofia. In recent months, Dr Mangarov has become the main public figure to express an unorthodox opinion regarding the new coronavirus and the need for public health measures. His views oppose the general consensus in medical and scientific circles on these issues.

According to the professional organization, these allegations are “offensive, demotivating, devoid of medical ethics and professional collegiality”, against the background of the “inhuman efforts, stoicism and devotion of all medical professionals fighting against COVID-19”.

How the media choose their sources

But how does this issue look from the media’s point of view? Should they give a platform to such unconventional opinions?

Usually, the media seeks all legitimate points of view. In this case, “legitimate” is a key concept. Everyone has the right to an opinion, this is a basic human right. But in order for this opinion to deserve media attention, it must be supported by facts and expressed by someone who has the necessary knowledge to back it up. Seeking the opposite opinion just for the sake of it — an approach quite popular in Bulgarian media — is not the task of journalists and is not a necessary condition for ensuring pluralism. For example, if an astrophysicist is invited on to a show, its producers shouldn’t, for the sake of balance, also invite a person who believes that the Earth is flat.

However, when the opposite opinion is expressed by someone who has the necessary qualifications as a doctor and a specialist in a given field, things become more complicated.

The media shouldn’t ignore such experts just because their standpoint contradicts the existing consensus. It’s known that breakthroughs in a given area are often made by people whose beliefs differ from what was previously accepted. Going back to the Earth example, the famous “Yet it spins” phrase was uttered at a time when scientists thought otherwise and challenging their view could even lead to being burned at the stake.

Today times are different. Media and social networks now allow any uninformed, wrong, or even deliberately manipulative opinion which somehow manages to resonate with the emotional state of large groups of people to gain wide publicity. Thus, misinformation, false news, and conspiracy theories have come to play a significant role in modern public life, threatening to undermine the foundations of democracy in many parts of the world.

Outright nonsense is repeated so many times that it begins to sound plausible,

or at least many people tell themselves, “If I hear it so many times, there must be some truth to it.” Meanwhile, fact-based opinions are lost in an ocean of misinformation. Social media such as Twitter, Facebook, and YouTube have begun to take action and delete content that they define as misinformation.

In one popular example, these platforms took down Plandemic, a film in which the American physician Dr Judy Mikovits promoted a conspiracy theory about COVID-19. The film, however, gained immense popularity and can still be found in various places online. Each of Mikovits’ claims has been refuted by facts from other scholars. Meanwhile, disturbing details regarding her academic career have also surfaced. Still, many still believe that Plandemic tells the truth and official science is lying about the virus.

Unlike Dr Mikovits, Dr Mangarov, the Bulgarian symbol of an alternative point of view, has a good professional biography.

And it’s not surprising that the media gives him a platform. However, the issue is about balance. Is the attention that Dr Mangarov and the few doctors who share his opinion receive proportional to that given to all other specialists with similarly impressive professional biographies?

“Let’s look out the window”

If someone claims that it’s raining outside while someone else claims that the sun is shining, the journalist’s job is not to quote both of them, but to look out the window and find out what is true. That’s what Jonathan Foster, a professor of journalism at the University of Sheffield, says.

However, when it comes to medicine and especially the debate over a new and unknown virus, “looking out the window” could turn out to be very difficult, as journalists have to be arbiters in a field that is, in most cases, completely unrelated to their professional expertise. What makes reporting on this issue even more challenging is that humanity is still studying and finding out more about the disease.

Tracking previous statements by relevant experts and which of their assumptions have been confirmed or rejected over time would help reporters in choosing the right sources. When it comes to public health safety, a journalist should try to do everything possible to warn their audience of possible contradictions.

For example, when Dr Mangarov is quoted, it can be qualified by stating that his prediction that the coronavirus will disappear by June has not come true.

During a global health crisis, giving context, avoiding unnecessary sensationalism, and questioning controversial statements are key. If more news media adopt this approach, on the one hand, experts won’t be silenced or ignored, and on the other, readers, viewers, and listeners will be able to judge how much to trust a new recommendation, forecast, or opinion.

Another way for a journalist to “look out the window” is to verify the sources quoted in someone else’s statement. Then, they should try to assess how reliable these sources are and whether they have been quoted correctly.

Misinformation through “facts”

A few hours after the Bulgarian Medical Association published their statement, Dr Antonia Parvanova was invited to Face to Face, one of the most watched programs on bTV, a leading television channel in Bulgaria. Parvanova is a public figure — a doctor who has studied medicine abroad with a serious political career in both the Bulgarian and the European Parliaments. In addition, she herself had COVID-19 and recovered from the illness. The topic of her interview was called

“A new wave of COVID-19 — myth or fact?”

During the interview, Dr Parvanova repeatedly promised that she would stick to the “facts and data from research studies”. However, her position is somewhat different from the official one based on a scientific consensus. With a series of claims citing exact dates and specific documents, Dr Parvanova tried to convince the audience that the real situation was different from that portrayed by the authorities, who were trying to prolong the state of epidemic emergency.

The first authority cited by Dr Parvanova was the American Center for Disease Control (CDC). Six minutes into her interview, she said: “On August 24, the US Center for Disease Control issued an overview saying that a PCR test could not be trusted and was not recommended. Therefore, it’s not advisable to test healthy people because they can be misdiagnosed.”

The CDC is without a doubt the leading government institution when it comes to fighting the coronavirus in the United States, and therefore a completely legitimate source. It turns out that on August 24, the organization indeed published guidelines on testing — both with PCR and with antibody tests. But the same publication

does not say that a PCR test is not recommended, nor that it is not reliable.

In fact, it clearly shows how to properly sample such tests, and highlights which people have to be tested — people with symptoms, those who have been in close contact with a sick person, and those who have been referred by their health providers. Finally, it’s specified that not everyone needs to be tested.

In none of its publications does the CDC express doubts about the reliability of the PCR methodology. On the contrary, on September 18 the agency updated its guidelines, emphasizing the need to test people without symptoms who have been in contact with a COVID-19 patient. This is due to the significant frequency of asymptomatic and pre-symptomatic transmission.

Dr Parvanova continued to build on her claims about the unreliability of PCR tests, using ‘verbal equilibristics’, the logic of which is quite difficult to understand. Excluding large groups of the population as carriers of the virus, the former member of parliament tried to say that in general, the probability of someone carrying the virus prior to being tested is less than 1 percent, so with a positive result the probability of spreading the virus is less than 50 percent. This leads to the conclusion that half of the tests are “false”, given that 50 percent of the positive results are actually false positives. This conclusion was repeated several times by the programme’s host Tsvetanka Rizova.

The presumed certainty of this conclusion is also worrying, especially since in many countries the proportion of false-positive PCR tests is unknown. In the United Kingdom, for example, it’s estimated to vary between 0.8  and 4 percent, according to an article published by the prestigious British medical journal The Lancet.

Undoubtedly, no test is 100 percent certain and all tests could give false negative and false positive results.

However, it should be noted that the diagnosis is not made solely on the basis of test results. Doctors also take into account other factors, such as the presence of symptoms, a history of contact with one or more COVID-19 patients, and other tests. Is it ethical to suggest that more than half of the tests give false positive results? Such fabricated interpretations prompt patients not to comply with quarantine rules, which can seriously endanger the life and health of others and of society as a whole.

Dr Parvanova backed her argument against public health measures by referring to the positions of international organizations such as UNICEF. According to her, four reports by the organization, again quoted with dates, talk about the negative impact of anti-epidemic measures on the welfare of children around the world. Dr Parvanova uses relatively correct statistics, which are actually present in UNICEF publications. But she draws a conclusion that cannot be found anywhere in the organization’s reports — that the measures have caused these problems.

Asked by the presenter whether the threats to children outlined by UNICEF were due to the coronavirus, Dr Parvanova was adamant: “Because of the measures, not because of the coronavirus.” She even pointed out that UNICEF has launched an initiative aimed at imagining a “world without measures”. This contradicts not only the specific documents she cited, but also the overall policy of UNICEF. According to its website,

the organization supports the fight against the pandemic and has been working towards explaining and implementing the measures in many countries around the world,

especially with regard to children. Verification of these facts takes time and is hardly possible for a presenter to do during a live broadcast. But Dr Parvanova had previously made similar statements and published numerous posts on Facebook before her appearance on the Face to Face programme. Her social media posts are easily accessible and allow media and journalists to vet their sources and fact-check arguments before giving Parvanova a platform.

Primum non nocere is a basic principle in medical ethics, derived from the Hippocratic oath. It can be translated as “First, do no harm” or in other words, “If you can’t help, at least don’t do any damage”. During a pandemic, and not only then, we, the journalists, could be guided by this principle. It encourages us to be careful and not to contribute to the spread of misinformation which could cost a human life.

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