Suppose that a new study about an "intervention" showed that those exposed had a 50% likelihood of emotional exhaustion and depersonalization, with 11% occurrence of suicidal ideation. Those figures are frightening at face value - and were it a new drug associated with those findings. One would expect both FDA restrictive actions and congressional hearings to be likely responses.
In fact, those observations were reported last month in the Annals of Internal Medicine (149: 334) by Dyrbye and colleagues - their article was entitled "Burnout and suicidal ideation among U.S. Medical Students". This publication was based on a survey of students about the phenomenon of burnout and related concerns, with several interesting outcomes of potential utility for school administrators.
For purposes of this discussion, it is tempting to speculate that a "proportionate response" for these findings of medical student risks and those of similar "side effects" from a drug would not be contemplated...... can you picture "recalls" and closures of med students programs until the risks were better understood and improved detection and management practices put in place? It's also interesting to look at the relative inattention of the lay media to this study as a puzzling juxtaposition to the amplification of any new drug safety report (regardless of validation), for findings of much lesser magnitude..... certainly, young doctors are not viewed by the press as merely "necessary fodder" for the war against disease. But some alternate explanation for their silence on this matter is not clear.
Having been a survivor of medical training "last century" during a time when on call hours and similar demands were likely more onerous than at present, it comes as no surprise that health care occupations with high stress job content can be challenging at best and threatening at worst; such conditions deserve more careful attention by training programs (beyond just having applicants sign informed consents that "med school may be hazardous to my health").
If one searches for root causes to the apparently disparate reaction to suicidality findings from drugs versus stress, it is possible that, similar to lay public understanding of diseases, the perception of dread is inversely proportionate to actual risk - people tend to fear that which we do not fully comprehend and do not believe we can control - and respond disproportionately. This skewed observational bias is also documented in public views of the actual versus perceived risk of hepatitis vs. AIDS, and in the proportionate attention given in the press to what is dreaded vs. truly threatening.
Perhaps current efforts by regulators and industry to provide more balanced attention to benefit-risk considerations will pave the future path to uniformly tempered responses to any new findings with drugs or other factors; until that time, our public health policy views will continue to be whip-sawed by amplification of every isolated factoid out of context - let's all endeavor to model that kind of balance going forward.
