- Email: [email protected]
Media misinformation and health behaviours
Cancer and Society
Media misinformation and health behaviours
For more on the Medical Journal of Australia paper see Med J Aust 2005; 183: 247–250; http:// www.mja.com.au/public/ issues/183_05_050905/ cha10589_fm.html
For more on the Daily Telegraph article on resveratol see http:// www.telegraph.co.uk/news/ uknews/2262150/Red-winecould-help-prevent-breastcancer.html For more on the Cochrane review see Cochrane Database Syst Rev 2001; 4: CD000389; DOI:10.1002/14651858 For more on the Daily Telegraph article on alcohol and breast cancer see http://www. telegraph.co.uk/news/ uknews/1585095/A-littlealcohol-increases-breast-cancerrisk.html For more on the media’s coverage of trastuzumab see J R Soc Med 2008; 101: 125–132; DOI:10.1258/jrsm.2007.070115 For the Daily Mail Oncological Ontology blog see http:// dailymailoncology.tumblr.com/
For more on the World Cancer Research Fund report see http:// www.wcrf-uk.org/audience/ media/press_release. php?recid=63
848
In this issue, The Lancet Oncology launches a series examining the evidence behind popular beliefs and claims about cancer. It is easy to dismiss such work as trivial, but in reality, two powerful lobbies—the supplement pill industry and the media—present a significant and neglected public health problem. They mislead the public on specific issues, but they also undermine the public’s understanding of how we know if something is good for us, or bad for us. The Daily Telegraph recently reported that red wine may prevent breast cancer, in a story based on speculative in-vitro laboratory data studying the effect of a molecule in grape skin on the activity of an enzyme involved in oestrogen metabolism. 3 months earlier the same health reporter had written, in the same newspaper, the apparently contradictory claim that every extra unit of alcohol per day is associated with a 10% increase in the risk of breast cancer. One UK newspaper, the Daily Mail, has a popular reputation for covering such stories, and there are even websites monitoring the issue. The Daily Mail Oncological Ontology blog reports that in the past month (at July, 2009) items suggested to cause cancer in this newspaper include divorce, wi-fi, toiletries, and coffee, while things suggested to prevent cancer are crusts, red pepper, liquorice, and coffee. We should be aware of the effect such stories may have in aggregate. A recent survey of 2404 people commissioned by World Cancer Research Fund found that 52% of people believe scientists are “always changing their minds” about healthy living advice (although in reality such advice has remained largely unchanged for at least a decade). Worryingly, 27% of all respondents said that because health advice always seems to be changing, the best approach is to “ignore it all and eat what you want”.
Such data have their limitations, but there is growing evidence that what people read in the media can affect their health behaviours. A 2005 study in the Medical Journal of Australia examined the impact of media coverage about Kylie Minogue’s breast cancer on self-referral mammogram bookings. Media coverage on the issue of breast cancer increased by a factor of 20 during this period, bookings rose by 40% during the 2-week peak, and 6 weeks later they were still up by a third. The increase among previously unscreened women in the 40–69 year age group was 101%. A systematic review from the Cochrane Collaboration found five studies looking at the use of specific health interventions before and after media coverage of specific stories: each found that favourable publicity was associated with greater use, and unfavourable coverage with lower use. This is important not just in the context of alternative therapies, and media claims, but also mainstream pharmaceutical products: a quantitative analysis of all media coverage for the drug trastuzumab from 1998 to 2006 found that it was characterised by uncritically positive reporting. Three newspaper articles went so far as to claim that the drug had no sideeffects at all. But while it is important to consider the consequences of the public being misled on individual issues, there is also the wider problem of the public being misled on the very nature of evidence-based medicine: put simply, how we know if something is good for us or bad for us. Methodological issues are often only popularly discussed when they are contentious, and in this context, erroneous criticisms of basic principles of evidence-based medicine can be made by lobby groups. These erroneous assertions are then prominently and uncritically disseminated.
Systematic review and meta-analyses provide an excellent illustration. In such studies, clear protocols are followed to determine how evidence is found, what evidence can be included, and how it should be graded. However, when a meta-analysis produces a result that is inimical to the views of a particular lobby—eg, antioxidant supplement pills, organic food, and homoeopathy—the widely reported and false criticism is that the individual papers for the systematic review have been selectively “cherry picked”, for reasons of political allegiance or frank corruption, and contradictory evidence deliberately ignored. This is unfortunate. The notion of systematic review—looking at the totality of evidence—is quietly one of the most important innovations in medicine over the past 30 years, and should be popularly celebrated for that reason alone. But more than that, we need the public to understand how we obtain evidence, to promote participation in both trials and observational epidemiology producing further evidence, and also to improve individual treatment choices. Modern medical decision-making, at its best, is done collaboratively with the patient, discussing treatment options and evidence where possible, and encouraging people to be engaged with improving their own health. At the very moment when these changes are afoot in medicine, it seems the media, and various corporate interests, may be sabotaging the public’s understanding of such evidence. While it is excellent to see The Lancet Oncology taking up the challenge to counter individual false claims, we may also need to be imaginative in promoting the public’s understanding of the wider principles underlying our work.
Ben Goldacre [email protected]
www.thelancet.com/oncology Vol 10 September 2009
Media misinformation and health behaviours
For more on the Medical Journal of Australia paper see Med J Aust 2005; 183: 247–250; http:// www.mja.com.au/public/ issues/183_05_050905/ cha10589_fm.html
For more on the Daily Telegraph article on resveratol see http:// www.telegraph.co.uk/news/ uknews/2262150/Red-winecould-help-prevent-breastcancer.html For more on the Cochrane review see Cochrane Database Syst Rev 2001; 4: CD000389; DOI:10.1002/14651858 For more on the Daily Telegraph article on alcohol and breast cancer see http://www. telegraph.co.uk/news/ uknews/1585095/A-littlealcohol-increases-breast-cancerrisk.html For more on the media’s coverage of trastuzumab see J R Soc Med 2008; 101: 125–132; DOI:10.1258/jrsm.2007.070115 For the Daily Mail Oncological Ontology blog see http:// dailymailoncology.tumblr.com/
For more on the World Cancer Research Fund report see http:// www.wcrf-uk.org/audience/ media/press_release. php?recid=63
848
In this issue, The Lancet Oncology launches a series examining the evidence behind popular beliefs and claims about cancer. It is easy to dismiss such work as trivial, but in reality, two powerful lobbies—the supplement pill industry and the media—present a significant and neglected public health problem. They mislead the public on specific issues, but they also undermine the public’s understanding of how we know if something is good for us, or bad for us. The Daily Telegraph recently reported that red wine may prevent breast cancer, in a story based on speculative in-vitro laboratory data studying the effect of a molecule in grape skin on the activity of an enzyme involved in oestrogen metabolism. 3 months earlier the same health reporter had written, in the same newspaper, the apparently contradictory claim that every extra unit of alcohol per day is associated with a 10% increase in the risk of breast cancer. One UK newspaper, the Daily Mail, has a popular reputation for covering such stories, and there are even websites monitoring the issue. The Daily Mail Oncological Ontology blog reports that in the past month (at July, 2009) items suggested to cause cancer in this newspaper include divorce, wi-fi, toiletries, and coffee, while things suggested to prevent cancer are crusts, red pepper, liquorice, and coffee. We should be aware of the effect such stories may have in aggregate. A recent survey of 2404 people commissioned by World Cancer Research Fund found that 52% of people believe scientists are “always changing their minds” about healthy living advice (although in reality such advice has remained largely unchanged for at least a decade). Worryingly, 27% of all respondents said that because health advice always seems to be changing, the best approach is to “ignore it all and eat what you want”.
Such data have their limitations, but there is growing evidence that what people read in the media can affect their health behaviours. A 2005 study in the Medical Journal of Australia examined the impact of media coverage about Kylie Minogue’s breast cancer on self-referral mammogram bookings. Media coverage on the issue of breast cancer increased by a factor of 20 during this period, bookings rose by 40% during the 2-week peak, and 6 weeks later they were still up by a third. The increase among previously unscreened women in the 40–69 year age group was 101%. A systematic review from the Cochrane Collaboration found five studies looking at the use of specific health interventions before and after media coverage of specific stories: each found that favourable publicity was associated with greater use, and unfavourable coverage with lower use. This is important not just in the context of alternative therapies, and media claims, but also mainstream pharmaceutical products: a quantitative analysis of all media coverage for the drug trastuzumab from 1998 to 2006 found that it was characterised by uncritically positive reporting. Three newspaper articles went so far as to claim that the drug had no sideeffects at all. But while it is important to consider the consequences of the public being misled on individual issues, there is also the wider problem of the public being misled on the very nature of evidence-based medicine: put simply, how we know if something is good for us or bad for us. Methodological issues are often only popularly discussed when they are contentious, and in this context, erroneous criticisms of basic principles of evidence-based medicine can be made by lobby groups. These erroneous assertions are then prominently and uncritically disseminated.
Systematic review and meta-analyses provide an excellent illustration. In such studies, clear protocols are followed to determine how evidence is found, what evidence can be included, and how it should be graded. However, when a meta-analysis produces a result that is inimical to the views of a particular lobby—eg, antioxidant supplement pills, organic food, and homoeopathy—the widely reported and false criticism is that the individual papers for the systematic review have been selectively “cherry picked”, for reasons of political allegiance or frank corruption, and contradictory evidence deliberately ignored. This is unfortunate. The notion of systematic review—looking at the totality of evidence—is quietly one of the most important innovations in medicine over the past 30 years, and should be popularly celebrated for that reason alone. But more than that, we need the public to understand how we obtain evidence, to promote participation in both trials and observational epidemiology producing further evidence, and also to improve individual treatment choices. Modern medical decision-making, at its best, is done collaboratively with the patient, discussing treatment options and evidence where possible, and encouraging people to be engaged with improving their own health. At the very moment when these changes are afoot in medicine, it seems the media, and various corporate interests, may be sabotaging the public’s understanding of such evidence. While it is excellent to see The Lancet Oncology taking up the challenge to counter individual false claims, we may also need to be imaginative in promoting the public’s understanding of the wider principles underlying our work.
Ben Goldacre [email protected]
www.thelancet.com/oncology Vol 10 September 2009