Published: 08/01/2004, Volume II4, No. 5886 Page 23

The new year headline which I hope you enjoyed as much as I did concerned the British woman who had a heart scare on a flight to the US. Is there a doctor on board, the anxious crew asked? No less than 15 cardiac surgeons rose in their seats. If only real life could be like this.

The festive headline which caused most alarm was health secretary John Reid's latest promise to crack down on health tourism, a favourite of politicians for more years than I care to remember. It surfaced in an interview he gave to the highly respectable Sunday Telegraph, whose hawk-eyed staff had spotted an exchange in the Lords on the issue, initiated by former Commons Speaker Betty Boothroyd.

But the announcement (which followed consultations) had already been planned for the Christmas quiet period and spread like wild fire. Health tourism costs the NHS up to£200m a year, although the Department of Health admits it has no figures of its own.One US academic working in Britain got£750,000 worth of free medical help for his son from the NHS which tackled the boy's complicated genetic disorder, we learned.

Tut, tut. Yet the odd thing was that the ministerial pledges - to close the loopholes in April - did not play well in the media.

John Hutton's hesitant performance on Radio 4's To d a y programme (on holiday in distant Barrow, he seemed under-briefed) will not have helped.Nor did the fact that the story had already surfaced in the Sunday papers. It goaded To d a y into producing its own story, challenging ministerial claims.

Mr Hutton was much better by the time he faced Jeremy Vine on Radio 2 at noon, I am told.

Too late for the media cycle. The Guardian's leader writer fretted that health tourism is a minor issue compared with, say, delayed discharge, and concluded that it was another example of a government 'running scared' on the asylum-bashing tabloid agenda.

Alas, the Daily Mail, No 1 bully on the tabloid block, was also unimpressed.

'You can't win with us, ' a Mail colleague told me with a sheepish grin.

Build 'em up, knock 'em down is a popular Fleet Street trick.

The incident prompted me to turn to the King's Fund Health in the News report, which I put aside last autumn and finally read on a flight home with prime minister Tony Blair (this time it was that day trip to Basra) at the weekend. It brought several telling points into sharp focus.

The most obvious was that the BBC and the newspapers (the authors monitored the Mail, Mirror and Guardian) tend to highlight 'NHS in crisis' stories (notably waiting lists and times) and health 'crisis' stories like Sars or the MMR jab row which are relatively low risk threats to most of us. AIDS, which is a far closer danger, is apparently no longer news.

Yet the improvement of public health is a preventive and probably cheaper alternative to pouring those extra billions into healthcare.

The Wanless reports make much of this and, in fairness, the media may be starting to change.

It still underplays the bad effects on smoking and, especially, excessive drinking (not drugs), but it is currently strongly engaging on obesity.

Crucially, as the authors correctly report on behalf of their expert health witnesses, their media interviewees - and the wider media - are not yet sufficiently 'willing to acknowledge that 'news' is largely constructed by the media'. It is what they consider to be important or interesting.

After nearly 40 years in the trade that is my conclusion too. We under-report our own intermediary role. More media transparency is needed. After all, we urge transparency on others all the time.

What has this to do with Mr Reid's attack on health tourism? Well, the King's Fund report notes how voters react to the media agenda (for example, on MMR), but also how policymakers 'sometimes take their cue' from us too, even when the media is barking up the wrong tree, not (as it claims) alerting readers and MPs to upcoming problems.

This sort of collusion, which is sometimes very explicit, can lead to politicians diverting money to tackle a media-driven target, say waiting lists. That in turn drives the media into even greater efforts to show how not enough is being done. More money follows in a vicious cycle. Sounds familiar? You betcha.

My man at the ministry says it is a real problem, but admits that Whitehall is a bit like Fleet Street in the quiet patch over Christmas:

'Number 10 demands Christmas stories, not day-to-day business.' This time they got a lot more than they planned for.Oh dear! Let us all be even more vigilant in 2004. Happy new year.