Medical researchers need to stop hamming it upBMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39399.443461.59 (Published 15 November 2007) Cite this as: BMJ 2007;335:1046
- Mark Lawson, BBC presenter and Guardian columnist, London
We probably agree, don't we, that the media are bad at medicine. For example, on a recent edition of the Victoria Derbyshire phone-in show on BBC Radio 5 Live, which likes to bill itself as “the nation's conversation,” the country was discussing the proposal to inoculate children against chickenpox.
A woman who called in was against the idea, warning that, having been encouraged to catch the virus from her sister in what used to be parental practice, she had gone on to develop meningitis and septicaemia and been given the last rites. But despite this she had later developed chickenpox for a second time in adulthood. When Derbyshire, with the fast radar for barminess that becomes natural to phone-in hosts, expressed surprise at this medical history, the caller explained that the first occasion had involved an “inner” symptomless virus but that she had later suffered an “outer” bout.
Derbyshire ended the conversation as quickly as if there were botulinum bacteria on the receiver and then, in the way of her programme, read out two contrasting emails, along the lines of “Jack in Cardiff says jabs are bad: we must allow the body to build up its natural defences; but Wendy in Leicester disagrees: be safe, inoculate.”
I am not a doctor. My only qualifications for writing in this publication are lifelong hypochondria and having watched almost every episode of Holby City and House. But there's something I need to expectorate here. The radio exchanges quoted above are a perfect example of the media's “irresponsibility” on medical issues about which doctors so often complain. The listener could only be baffled (is their child's illness “inner” or “outer”?), while the BBC's rules of “balance” left the impression that the half-rhymed slogans of non-qualified medical practitioners (“jabs are bad” versus “be safe: inoculate”) are equally valid contributions to the debate.
Such hysterical relativism is standard in the mainstream media's coverage of medicine. One day the front pages scream that red wine will kill you, the next that cabernet sauvignon is a life saver. In the same week in November, headlines yelled that being overweight gave you cancer but also that additional fat raised the survival rate from infections and operations.
In the past I've argued that these confusions are the fault of journalism. Failing to acknowledge that medical science is a system of advocacy, in which prosecution and defence teams test a theory to destruction, newspapers have tended to present theory and argument as if they were fact, turning footnotes into headlines. They have also failed to understand, or explain, the mathematics of risk.
Given a report that researchers in Ottawa have discovered that consumption of (let's say) toffee apples has been shown to raise the risk of bowel cancer by two thirds (and here I add a warning to phone-in show researchers: this is a fictional example), the reader believes that their occasional fairground treat has a 66% chance of killing them, whereas the truth is that the general population's already relatively small risk of such tumours may be just very slightly higher.
Recently, though, something has changed, and I've come to a second opinion: some quacks are now as bad as hacks in this regard. Take the recent row over whether bacon gives you cancer. This was the conclusion most media outlets drew from the World Cancer Research Fund's report into the causes of cancer (BMJ 2007;335:897 doi: 10.1136/bmj.39373.676204.BE). But, having looked at the report, I think the problem is not irresponsible journalists but irresponsible medical researchers. The report really seems to have said that cured meats are likely to put us beyond a cure.
This suggests that the problems of exaggeration and simplification now lie with the doctors. Keen for publicity and funding, research groups now treat individual drinks and foods as if they were nutritional Osama bin Ladens. Coming to believe that hysteria is the only language the media understand, medicine has become fluent in such gibberish itself.
The problem is, though, that such inflated rhetoric is likely to have the effect of leading patients to believe that medical advice is cyclical and cynical: that, if we wait a few years, another report will come along arguing that any parent who fails to stuff junior with a bacon butty every morning is guilty of neglect. As I understand it, advice to general practitioners is to make targets for patients reasonable and achievable: start by losing a kilogram rather than four. And as the British cancer specialist Karl Sikora has said—arguing that the World Cancer Research Fund's views on bacon are “too severe”—such scaremongering reports make themselves too easy to ignore.
On another recent radio phone-in, a doctor ranting about the “obesity time bomb” and the “alcohol time bomb”—and very possibly the bacon sandwich nuclear bomb—was reduced to silence when the presenter asked why, despite all these explosive devices on our dinner tables, life expectancy in the West keeps rising. The truth is that health is a complex pattern of genetics, environment, lifestyle, and plain bad luck. And, if they want to save their bacon, medical researchers need to stop hamming it up.
Keen for publicity and funding, research groups now treat individual drinks and foods as if they were nutritional Osama bin Ladens