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Medicine and the Media - a case study

The Controversy

10th October 1997

A blazing row has broken out over the leaking of vitally important findings on the link between breast cancer and hormone replacement therapy.

The study published in The Lancet shows that HRT increases a woman's risk of getting breast cancer by an almost negligible amount.

Researchers from Oxford, UK, sponsored by the Imperial Cancer Research Fund, looked at the results of research on a total of 160,000 women and found the risk of cancer increased by just 2.3 per cent per year.

This is equivalent to about one case for every 1,000 HRT users every four years.

The findings are crucially important because the fear of breast cancer is one of the biggest deterrents to the taking of HRT - which is supposed to be protective against heart disease and brittle bones.

A weekend report in a British paper was out by a factor of 100 - claiming bizarrely that the study showed the risk increased by 2.3 times.

And in his journal, the editor of The Lancet Richard Horton has launched a blistering attack on the ICRF.

Horton called for the British Charity Commissioners to investigate the Imperial Cancer Research Fund. The Charity Commissioners are responsible for regulating the activities of British fund-raisers.

"ICRF staff have pitted themselves against one another, decisions have been driven by greed for publicity and the fundraising image of ICRF seems to have become the charity's over-riding priority," writes Horton in the current issue.

Asked by Englemed for its response to The Lancet, The Imperial Cancer Research Fund replied as follows:

Ardi Kolah, the Head of Communications said: "Last week's commentary from Richard Horton in The Lancet regarding the paper on HRT and breast cancer is intemperate and draws inaccurate conclusions.

"We will be communicating with The Lancet in due course."

The Backlash

The ICRF's promised reaction came in the letters page of The Lancet on November 29th 1997.

In a letter, the ICRF director general Mr Paul Nurse writes: "The inaccuracies, the failure to check facts and the intemperate language of Horton's commentary are distressing. ICRF deserves an apology."

He states that the charity was not involved in leaking its research results to a Sunday paper but adds that a senior member of staff did respond to the paper's questions - in breach of the embargo.

Nurse says that the charity sought to release its findings "responsibly" and aimed to minimise anxiety and distress.

The doctors and scientists behind the study were fully involved in its release, he writes, and it was the job of the director of clinical research, Dr Peter Selby, to oversee the release.

Horton however hits back in the same issue, pointing out that in 1994 the UK Charity Commission claimed that the ICRF's procedures for control of research results were "not entirely unsatisfactory".

He alleges that the charity's communications department was involved in devising the "spin" for the release long before final details of publication in his journal had been settled.


That HRT Leak - Bad Reporting, Good Journalism?

The fury expressed by Richard Horton, the editor of The Lancet, at the leaking of research to be published in his journal is understandable.

The leak achieved two things. It broke the embargo applied by medical journals to work they are to publish. But it also distorted the findings of the research. A risk of 2.3 per cent was somehow magnified one hundred times.

Since the research sought to come up with a definitive answer to the emotive question of whether hormone replacement therapy gives women breast cancer, the distortion of the findings was a serious matter.

Horton points the finger at the Imperial Cancer Research Fund, the sponsors of the research. He claims there is internal conflict within the organisation and that its press office has been taken over by the fundraising department.

Breathing fire, The Lancet talks of sanctions including the ostracism of journalists involved in the leaking of research before publication.

Here Englemed must depart company from Horton. British scientists and doctors are already uniquely bad at communicating research findings. Too often peer reviewed publication is used as an excuse for secrecy and straightforward arrogance.

There is a specific role for sanctions. Journalists have access to a great deal of embargoed medical research. Those embargoes must be kept sacrosanct and Englemed, like others, endeavours to observe them. To break an embargo for the sake of an exclusive story - as can happen - is nothing short of shoddy.

But the leaking of the HRT research to the Sunday Times took place several days before the release of the embargoed paper.The notion that sanctions could be applied against journalists for showing enterprise will merely add gripe water to those who are too lazy to communicate their work well.

The serious matter was the distortion of the findings of the research. Allegedly the journalist misunderstood the conclusions. That is astonishing for someone who has been reporting medicine for the best part of five years.

British journalism is second to none in flair and verve. This must be retained as the profession reinvents itself to play a role in 21st century methods of communication. But there is also, even among so-called quality publications, a cavalier attitude to facts and statistics that reflects poorly on recruitment and training practices.

The danger of this new medium is not that information, rumour and opinion is too free but that it might be too tightly controlled. If independent media fail to make the transition, only official sources will retain credibility with readers.

That is why Englemed does not subscribe to the Health on the Net principles. In practice Englemed observes them, far more than most other on-line medical news services. For instance, our reports are not only sourced but linked to source where possible.

But Health on the Net presumes that medical news should be mediated by medical professionals. The existence of a medical profession has many merits but there must be those who stand outside it and examine its doings dispassionately. Medicine is no longer something that is communicated purely from doctor to doctor.

In return our readers are entitled to expect basic numeracy - and a good read. Horton's fury should be directed at the inaccuracy rather than the leak.

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