This answer represents a dangerously outdated notion of how complex industries insure quality. It reminds me of a conference I attended on medical-error reduction in which a hospital safety officer reported on the reluctance of surgeons to include patients in simple safety measures like, say, putting an “X” on the knee slated for surgery. Over time, such defensive attitudes in medicine have eased. Like the nuclear power industry, the health-care industry is accountable for public safety and works closely with government regulators on meeting those obligations. But the once secretive health-care industry today publicly reports death rates by hospital, as well as incidents of system failure such as hospital-acquired infections or medication errors in recognition that transparency aids the pursuit of quality.

The argument advanced by surgeons at that long-ago conference (an argument that happily fell of its own ludicrous weight) was that the mere suggestion that patients collaborate in error prevention would cause needless anxiety and undermine their confidence in the health care system.

Closed-loop environments breed this sort of self-justifying reasoning and, more importantly, cut insiders off from valuable public feedback. In requesting this Arbiter , NEI’s media relations chief, Steven Kerekes, wrote that the industry is ”well accustomed to tough media scrutiny and coverage that we feel tilts negative.”

Perhaps fuller disclosure of issues in the public interest would be more effective at turning around any image problems than slamming the messenger.

Irene M. Wielawski , a former staff writer and investigative reporter for the Los Angeles Times, is now an independent writer and editor. She's a founder and current board member of the Association of Health Care Journalists. Her work can be found at irenewielawski.com.