Intended for healthcare professionals

Letters

Media influence on suicide

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7387.498 (Published 01 March 2003) Cite this as: BMJ 2003;326:498

Television programme makers have an ethical responsibility

  1. Andy Howe, specialist registrar in public health (andyhowe{at}clara.co.uk),
  2. Vicci Owen-Smith, specialist registrar in public health,
  3. Judith Richardson, director of public health
  1. Department of Clinical Strategy, Greater Manchester Strategic Health Authority, Manchester M60 7LP
  2. South Manchester Primary Care Trust, Withington Hospital, West Didsbury M20 2LR
  3. CancerBACUP, London EC2A 3JR
  4. Cancer and Public Health Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  5. Department of Psychiatry, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, China
  6. Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong Special Administrative Region

    EDITOR—We agree with Hawton and Williams that training courses for careers in the media offer the potential for improved portrayal of suicide in the media.1 The media, however, clearly can affect many facets of health related behaviour.

    We recently reported the effect of the death from cervical cancer of a character (Alma) in the television soap opera Coronation Street on the NHS cervical screening programme in the north west of England. 2 3 Our studies showed an excess of 14 000 cervical smear tests performed as a result of the storyline (a 21% increase on the previous year), although only 2000 of them were in women whose test was overdue or who had had no previous smear test. The remaining 12 000 smear tests were performed on women attending for an early, unscheduled test or who were due a smear test anyway and brought their appointment forward.

    The large increase in the number of smear tests led to a strain on local laboratories, with the time taken to report results increasing to beyond acceptable quality assurance limits—a factor likely to provoke excess anxiety in women. We also found that many women were prompted to attend for a cervical smear test because the storyline made them worry.

    This anxiety generating approach contrasts with current initiatives to encourage women to make an informed choice about screening.

    Television programme makers should realise the power of such stories not only to achieve maximal viewing figures but also to cause fear and anxiety, as well as the consumption of scarce healthcare resources. Those responsible for promoting health need to engage programme makers in a full ethical debate.

    References

    1. 1.
    2. 2.
    3. 3.

    Media influence behaviour

    1. Rachel Hardyman, research officer (rhardyman{at}cancerbacup.org),
    2. Geraldine Leydon, lecturer and MRC fellow
    1. Department of Clinical Strategy, Greater Manchester Strategic Health Authority, Manchester M60 7LP
    2. South Manchester Primary Care Trust, Withington Hospital, West Didsbury M20 2LR
    3. CancerBACUP, London EC2A 3JR
    4. Cancer and Public Health Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT
    5. Department of Psychiatry, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, China
    6. Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong Special Administrative Region

      EDITOR—Hawton and Williams's study provides evidence that supports an argument for (increased) awareness among media producers and editors about their potential influence on the public over health matters.1 Howe et al in response note the effect on the NHS cervical screening programme of a television character's death (Alma in Coronation Street) from cervical cancer (letter above). We examined the impact of the same television story and related tabloid newspaper reporting on inquiries made to CancerBACUP's helpline (the United Kingdom's leading cancer information charity, http://www.cancerbacup.org.uk/).

      The change in the volume and content of calls during the three months between the story “breaking” in the Sun newspaper and Alma's eventual death, compared with calls received in the three months before the story, supports Hawton and Williams's work.1 Peaks in inquiries about cervical cancer occurred on three occasions, directly coinciding with developments in the storyline (figure). The story triggered up to 300 additional weekly enquiries to CancerBACUP. Evidence corroborated Hawton and Williams's suggestion of a similarity between media stimulus and the viewer in terms of age, sex, and nationality.1 Data showed a slight increase in the proportion of calls from women in their 50s and 60s; the actor who played Alma was 63 years old.

      Figure1

      Inquiries about cervical cancer to CancerBACUP telephone helpline, April-June 2001

      In the three months before the storyline just 6.7% of people telephoning CancerBACUP about cervical cancer said that they had first heard about the charity via a newspaper or the television. This percentage rose to 41.8% while the storyline was in progress. Furthermore, the proportion of inquiries from homemakers and retired people more than doubled compared with calls during the previous three months.

      Our research has questions left unanswered. What, for example, became of the people whom the Coronation Street story worried but who did not contact CancerBACUP? Did they contact other information services or their general practitioner, or did they remain concerned, probably unnecessarily, about the risk of cervical cancer? What is clear is the potential for media to impinge on the viewing public in a marked, and in this case measurable, way.

      The trend for giving information at the end of potentially delicate television programmes seems not only responsible but necessary. In our study making such information available led to the use of a cancer helpline by a broad and, in part, previously untapped group.

      References

      1. 1.

      Media's role is double edged

      1. Kathy P M Chan, adjunct associate professor (chanpm{at}ha.org.hk),
      2. Dominic T S Lee, associate professor,
      3. Sing Lee, professor,
      4. Paul S F Yip, director
      1. Department of Clinical Strategy, Greater Manchester Strategic Health Authority, Manchester M60 7LP
      2. South Manchester Primary Care Trust, Withington Hospital, West Didsbury M20 2LR
      3. CancerBACUP, London EC2A 3JR
      4. Cancer and Public Health Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT
      5. Department of Psychiatry, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, China
      6. Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong Special Administrative Region

        EDITOR—The alarming escalation of charcoal burning suicide in Hong Kong supports Hawton and Williams's call for guidelines on the reporting of suicide.1 We previously reported on the emergence of this new method of suicide in Hong Kong.2

        In November 1998 a 35 year old woman committed suicide by burning charcoal in a barbeque grill in her sealed and cramped apartment. Compared with jumping, which accounts for most local suicide deaths, suicide by burning charcoal was romanticised as an easy and comfortable way of dying. The incident was pictorially reported in the media. Two months after its appearance charcoal burning became the third commonest method of suicide in Hong Kong, where carbon monoxide poisoning was previously uncommon.2 In 2001 it replaced hanging as the second commonest method of suicide, accounting for 25% of all deaths from suicide.

        People committing suicide by charcoal burning were often middle aged and were portrayed as debt ridden because Hong Kong was experiencing its first recession after two decades of economic boom. Charcoal burning was represented as a legitimate way out of the person's financial predicaments. Our coroner's court findings were highly consistent with these media representations.2

        The influence of the media on suicide is contentious and has not been taken seriously in public health. 3 4 In the case of suicide by charcoal burning in Hong Kong, concerns have been raised by researchers and healthcare workers about the potentially contagious impact of media reporting. However, news editors have expressed reservations and remain unconvinced about the guidelines published by the World Health Organization on suicide reporting.

        The first suicide intervention and prevention centre in China, funded by the Chinese government, was opened in December in Beijing. Media publicity was rightly adopted as one of the key strategies for raising public awareness.5 None the less, given that the handy use of pesticides claimed most of the suicide deaths in rural China, the possible effect of such publicity deserves monitoring too.

        References

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        4. 4.
        5. 5.
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