Select Committee on Science and Technology Minutes of Evidence

  Examination of Witnesses (Questions 326-339)




326. Good morning, lady and gentlemen. Thank you very much for coming along. We are looking forward to an interesting session this morning. For the record, could you please introduce yourselves. Following that, if you have any opening statements to make now is the time to do so, before we get into the questions. Mr Ghosh, would you like to start.


(Mr Ghosh) My name is Pallab Ghosh. I am Science Correspondent for BBC News and I am also currently Chairman of the Association of British Science Writers, a group of 800 science journalists and communication specialists in the UK.

(Sir Kenneth Calman) I am Kenneth Calman, Vice-Chancellor at the University of Durham, with a long interest in health and medicine, recently published in areas around risk, perception of risk, and trust.

(Dr Bryant) I am Gerry Bryant, I am a Specialist Registrar in Public Health, currently acting as CCDC in Leicestershire Health Protection Team.I have a background of 10 years as a GP, communicating about risk to individuals. I am now in public health, where I have been involved in the cluster of cases of variant CJD in Leicestershire, then our major TB outbreak. I am currently also working with CDSC over developing communications materials relating to the CJD incidents.

327. Are there any opening comments any of you wish to make or shall we go on? We will go on with the questions. I will, as usual, take the first one. How can we improve the way in which health care professionals and organisations communicate with the public?—a nice broad question. Who would like to start? Mr Ghosh?

(Mr Ghosh) Thank you. This session is timely for me because I am in the process of drawing up the BBC's strategy for how we tackle bio-terrorist attacks, so in some ways it is testing the system to its limits. I thought that maybe talking about that a little bit might draw up some of the issues from a media point of view. I think in this process it is clear to us all in the BBC and more widely—I know my colleagues in print feel the same—that with bio-terrorist attacks or any infectious diseases, the media is one of the instruments for spreading psychological fear, and none of us wants to do al-Qaeda's work for it but clearly there is a balance to report clear and accurate information. In an attempt to do that, we have contacted the various bodies and made sure we have our own list of contacts, but I do feel from government, and particularly the Department of Health, for obvious security reasons, that they might have been a little backward in coming forward. I was one of the people consulted by various people within government as to what the strategy should be.We mentioned a few things—this was back in November—like having a hot-line number in the incidence of an attack. A few of us, particularly in the broadcast media, who were prioritised as the first point of call to send out clear and accurate messages, were asked what we needed, and one thing was an emergency hot-line number. We have had the Ricin attack and there is still no emergency hot-line number. When I deal with the Department of Health and the press officers, they are extremely helpful but I sense that when they receive a query they need to go through, as Sir Kenneth will know, a bureaucratic process which limits the speed at which they can respond, and in the case of any infectious disease, particularly in the case of bio-terrorist attacks, minutes are crucial. In the case of Ricin, my colleagues were asked to get on the set at News 24 almost immediately. There are very good systems in place, such as the PHLS website, but a colleague found he could not get on because everybody was trying to get onto that website. I sort of feel that, where there are issues that are known about, there is a lack of pro-active planning. I think there are people who intend to carry out pro-active planning—I know for a fact they do—but somehow they are thwarted. In the case of dealing with the bio-terrorist issues, perhaps there is a case for having a series of briefings for some of the key journalists concerned. There is a crucial need for a hot-line number—goodness knows why that has not been set up!—but also, more generally, there should be a hot-line number to deal with infectious diseases. Those are some of the main points which I felt I needed to make at this stage. There is the issue of training, but I gather you are going to be asking about that later.

(Sir Kenneth Calman) The question is: Can it be improved? and the answer is yes to that. I think there is a series of ways in which that can be done. The first and most obvious one is to recognise that something might happen and, as Pallab has said, to be prepared. There are lots of ways in which you can do that. I sent in, as one of my documents, a chapter which gave a sort of list of things which might be helpful. The second part I think it is important to say is that that kind of communication is good for the public and very good for the professionals. So I do not think there is a problem about doing it, but it does need quite a lot of planning and preparation, and that is sometimes what is missing. There are issues in that list—and I will not necessarily go through it all—about what the message is: Are you clear about that message? Have you avoided jargon? Is the language appropriate? Have you considered all those who might be affected in the message? One of the strengths of the way the Leicestershire issue was handled was, indeed, how well they communicated with a lot of people before it became public. That takes a bit of time. Where things are required to be communicated immediately—the comment Pallab has made—then bureaucratic procedures should not get in the way of being able to make statements rapidly about something, which may indicate uncertainty but which can then be followed up. Key to much of this, I think, is the concept of trust, to which we might return later.

(Dr Bryant) I would agree with many of the sentiments that have already been discussed. I think the key to this is: Can communication be improved? We need to test against what is good communication. Good communication has to be a two-way process: there has to be both giving of information and understanding of that information and feedback, and it is often those loops which we fail to putin place. Looking at health care professionals,in particular, and health care professional organisations, if you look at who the public trust, they trust their friends, their families, but doctors still fare quite highly on that, and therefore we shoulduse doctors who are good communicators in communicating our messages to the public. Quite often—particularly this could be the case with acute trusts, it is not a doctor who is put forward to give the messages, it is somebody else. I think if we try to explore the reasons why that should be, doctors should be good communicators but not all are. If we actually look through the process of selecting people at the very outset to go to medical school, they are selected not on the basis of communication but on the basis of academic record. If you look at progression through a career, it is on the basis of academic record rather than on communication. Therefore we should be sub-selecting, almost, a cohort of people who are inherently good communicators and training them to be specialist communicators to convey our messages to our audience. Investment of time is obviously a very, very important factor as well. It is very easy to have the conversation and the communication when it is with a group of people with whom and of whom you already have a relationship and a knowledge. That requires investment of time, which is not always acknowledged in work programmes or appreciated by superiors and managers. I think there needs to be a culture change, in that communication is an inherent and important part of the job and should be appreciated as such.

328. One of the traditional ways of communicating information about medicine and science, of course, has been to publish in scientific journals. There seems to be a degree of trying to circumvent that these days, of research workers making claims long before they have been verified or repeated or even subject to peer review. There are various reasons why people do that, but, as communicators yourselves, is there any way that one can dampen down some of these wild claims and cures for this, that and the other, based on rather flimsy and unconfirmed evidence?—as, in science, we all expect our work to be confirmed by someone at least before it is finally accepted.

(Sir Kenneth Calman) In one of my previous existences, I was a specialist in the area of cancer medicine, and, not surprisingly, on a weekly basis there was some new thing in the press which would change the world. It is very difficult to get to the bottom of these sometimes. Patients want to know—this is the point Gerry has made—and if you cannot get access to that because it is just a comment in the press about something that will happen, it makes it very difficult indeed. Perhaps the only thing I would want to say is that there are a number of medical schools—one of which just happens to be Durham!—in which the selection of students will be done differently in the future and will take into account these more holistic and humanely-based aspects, like communication skills and team-building. They will be important criteria for entry and, indeed, members of the public around the medical school are very much a part of that process. So I think things can and should change.

(Mr Ghosh) I would like to point out that the first phase of the MMR scare started with a paper that was published in the Lancet. I think it is perhaps beyond the scope of this particular Committee but I personally am concerned about some of the quality of material that is published in scientific and medical journals, partly out of the competition between them, and there is an awful lot of supposed on-line material that gets published. As a science correspondent I quite often find myself having to convince news editors, that even though something has been published in a journal it does not mean that the BBC ought to be doing it, and I feel I should not really be having to have those conversations. You made the point about cures for cancer and that sort of thing, and, again, a lot of that is pressure from cancer charities. You should see some of the press releases that cross my desk, about which I have to inform myself so that I can make an argument. Often with programmes they say, If you are going to do this story, do bear in mind the consequences that it might have on the people listening" and we do try to adopt a fairly responsible attitude to these things. I think that for big news events, like variant CJD or MMR, journals are too slow a mechanism for getting information across. You do not start looking through your references when something happens: a story breaks, an incident happens, and you want information very, very quickly, particularly as a broadcaster, particularly for 24-hour news outlets. I would like to suggest that organisations look at the mechanisms they have in place and the people they have with the ability to respond to that, and also—I mean, I have found that the BBC has changed at a bewildering speed, even in the past two years—at whether those individuals really are aware of the way in which news works these days. I think there is a lot of education to be done in terms of understanding the media and what is required for responding to the fast-moving, breaking story, which has far more impact in terms of media coverage than small scientific papers.

(Dr Bryant) I think there is good and bad science, both published and unpublished, and I am not quite sure how discriminatory our current peer review or scientific journal systems are. If I could actually use as an example our variant CJD investigation. That was a local investigation, locally led, it was for a local audience, primarily, albeit conducted in the milieu of international media interest. Because our report had to be produced for a specified deadline to a local health authority, our scientific work was published in that manner. It was also, I would argue, peer reviewed by both the SEAC Epidemiology Sub-Committee and the full SEAC Committee. It remains unpublished in the peer reviewed journal because it is no longer newsworthy; it is argued that it is already in the public domain and therefore cannot be published. I rest my case.

Chairman: Are there any further points on this question or may we move on to Lord McColl.

Lord McColl of Dulwich

329. Continuing on the same theme, what do you think the role of the media should be in promoting health messages?

(Mr Ghosh) I think it should be responsible, but it is not the news media's primary role. I suspect that behind that question is possibly the coverage of MMR, where there were several messages, several agendas that were reported, and I think there is a lot of criticism from the scientific and medical community as to the way in which that was covered. It was a difficult issue but I felt it was an issue that was not really handled very well. Very quickly, because of the absolutist statements that were made by some people from the Department of Health, people looking for a story were able to turn to this piece of research or that piece of research, and it very quickly became another story about the Government maybe trying to cover something up. Also, part of the story was the genuine anxieties of some of the people concerned. Part of the story was also about a perceived lack of choice. I think central to all of that was to present the vast bulk of evidence about the MMR vaccine, but equally there were other things going on that had to be reported.

330. What about the role of the soap operas and The Archers in getting over these messages?

(Mr Ghosh) I should think they are just as important, if not more so, than the news media, because I think people can relate to individual characters in soaps in a way in which they do not necessarily with the news media.

(Sir Kenneth Calman) The question is: Do the media have a role? and the answer is very definitely yes, and it can be an extraordinarily positive one, either through the presentation of information which will help individuals change their behaviour, for example, or by answering questions. The role of the `agony aunt', for example, at which I looked when I was elsewhere, is actually quite an important one. They answer questions. Particularly for teenagers, there is huge amounts of information which can be passed on in that kind of way. The soap opera, again, is quite important. There have been two issues in EastEnders, one is dementia and the other is HIV infection, both of which were, I think, handled very sensitively. On the other hand, of course, if the media choose to change that message . . . I think the classic for me was a particular newspaper and HIV infection: it made the point that the two were not related and continued with that for something like two years, early on. It made it very difficult to change that message when a particular newspaper was always trying to say: There is no relationship between the two, they do not matter." That of course was quite difficult.

(Dr Bryant) The primary role of any media is obviously to sell its product. There is, therefore, the potential for conflict relating to that. However, we are all citizens and as citizens we have both rights and responsibilities, and I would argue that all of our media have a responsibility to promote health and healthy messages. I would actually rephrase this as healthy" messages. Particularly in our broadcast-news type media, there may be a presentation of all of the angles of a health message, but I would argue that perhaps there is a duty to go beyond that and to promote the healthy message. Yes, I hate to say it, but I think our soap operas probably do have an important role to play for many groups who are not readers of broadsheet newspapers or watchers of debating television programmes but who watch their soap operas in the evenings.

Chairman: Could we move on now to Lady Finlay.

Baroness Finlay of Llandaff

331. You have partly answered the question over the social responsibility, but there is a difficulty. If the media has a social responsibility, is it to present with equal weighting all sides of the argument, and how do you then make that happen?

(Mr Ghosh) I do not think it is about equal weighting, because there are some pieces of evidence that have more weight than others.

332. I was meaning equal weighting not in termsof making everything equally weighted but to givea properly balanced view rather than a sensationalistic view.

(Mr Ghosh) Balance is something that we do strive for, and obviously there are instances where we do not achieve it. I suppose a classic case of that was the GM crops thing three years ago, when Arpad Pusztai commented on the media that he had concerns that it could stunt your growth. Clearly here was a scientist from a reputable institute making these claims. I was confronted at 10 o'clock at night by the Today programme saying The Daily Mail was going to run with that story, so I was faced with how to deal with it. I spoke to Professor Pusztai. I did not know him but I knew the Rowett, I did not feel him to be a crank, so it was about making my own judgment, and part of that judgment was whether it had been published or not and also a realisation that even the most eminent researcher could make a mistake and things should not be overstated until it has been properly scrutinised. But clearly it was a story and it had to be dealt with accordingly. So we do endeavour to put things in their proper context.

Lord Turnberg

333. May I follow that up. The example that always sticks in my mind is from the MMR debate. On television we saw two people being interviewed, one was the mother of a child with autism who had been vaccinated at some point, who deserved a lot of sympathy, who said, MMR gave my child autism," and the other was a minister who said, All my scientific evidence says, and all my advice is, that there is no relationship between the two." That was a balanced argument, but, in practice, the two arguments were not balanced, and yet the television, not unreasonably you would think, would present the human angle from an individual and the scientific evidence from a minister who, by and large, tends not to be believed. I think that sort of balance can do harm. I do not know how you get round it, but it is very difficult.

(Mr Ghosh) It was a very tricky story because part of the story was the fact there were some people who were concerned that the vaccine posed a risk to their child and there is no more emotive issue than that. I mean, I cannot think of an easy way round it but I do feel that the handling of it could have been better.

334. Yes.

(Mr Ghosh) There were very unequivocal, unsympathetic statements—and for all the right reasons—by people in the Department of Health, saying that the vaccine was absolutely safe, that it was better to take it in one jab, and there was a perception, not just by the public but by some of the programme editors, of Here we go again." It was corporate need ahead of individual safety and that was an argument that a lot of newspapers and programmes wanted to test. And the consequence of that was a lot of children getting measles. I do not know what an easy answer is.

335. I think putting the minister up was not the best way.

(Mr Ghosh) No.

Baroness Finlay of Llandaff

336. If I may just pick up on that, because actually if you are going to present something in a balanced way then perhaps to have the mother of a child who had had measles and, indeed, had been very sick with it might have been a good counterweight to the mother who perceived her child had been damaged. But it does not feel as if the media choose that type of equally poised presentation, and that there is much more a sensational story in reporting scandal or creating scandal. I am not saying the BBC do it but I think some of the newspapers, in particular—as was said, they want to sell their papers.

(Mr Ghosh) I did not see the particular programme concerned, but one technique at the BBC, as in these select committees, is to try to put the minister under as much pressure as possible. There is no better device than having that sort of emotional statement and saying, What do you say to her, minister?"—which, on the one hand, you can see as a legitimate view but, as you have pointed out, can be unbalanced as well.

(Sir Kenneth Calman) Could I step back a little bit from the particular issue and make the general comment that there are probably three phases inthis whole process. The first is, if you like, the anticipatory phase, in which it is not clear whether there is or is not a problem. It seems to me legitimate in that period, when there are hypotheses, when people are debating the issue, for people to look at that—indeed, the media have a very strong and important role in that. But there is the next phase which says: Actually, we have looked at this, the evidence has built up, and there is or is not evidence. Once there is real divergence which shows that all the evidence is that there is no evidence that MMR is related to autism or Crohn's, that is the point at which the media should say: Okay, we understand that now; we will promote that. I think the third phase—one that is often forgotten—is, if you like, the audit phase, of looking back in terms of: Could we not have done it better? So there is a legitimate bit, in areas of controversy and new hypotheses, new information—maybe even not any detailed evidence but Could this have happened?" and the answer is: Good idea, let's look at it"—that is the time for the media to be involved. Once the data becomes clear, at that point they should say, We have moved on," and let the media then present what is the real issue; that is, we need children vaccinated in this country.

Lord Lewis of Newnham

337. It seems to me we are assuming that fairness is the factor that comes out in all this but I am a little bit sceptical. I do believe there are certain aspects of the media that do not want to be fair. Good news is no news: bad news is good news. I think, to a certain extent, sensationalism, which is after all a potential in this particular area, must be considered. How far can one construct a system that allows for this and allocates blame where it is duly attributable at a later date? I think this is part of my problem with it: I hear a thing said by the media which quite clearly as a scientist I know to be incorrect, but it is certainly spectacular and it certainly will sell newspapers, if I may put it crudely, or attract attention from the public. That is the side that worries me. It is not the honest group of people which is out there doing it; it is the potential in the whole of this area for sensationalism to come into play, and for this to do things within the media which perhaps would not normally be expected of the media if it were working on an absolutely fair basis.

(Mr Ghosh) I would like to think that sensationalism is not the norm, but you cannot legislate for it. I suppose all you can do is go through the processes within those organisations to try to complain, to point out inaccuracies and to work within the system to try to ensure that does not happen. I have to say that it is only one or two front pages of certain tabloids that tend to do it, but if you actually look inside at the health sections, the health pages, they do provide very good advice—and even on those front pages, it is usually the headline and the first three or four paragraphs. From conversations I have had with colleagues who work on tabloids, I think they have learned certain lessons about the consequences of those headlines. Those tabloids have to sell, it is a fierce battle. But it is a slow process and all I can say is that if you are concerned then going through the complaints procedure does make people think again next time. Those front pages are a consequence of having a free press.


338. Following up on Lord Lewis's comments, is there or should there be mechanisms by which the media can be held to account for dissemination of a message that is ultimately found to be false or is in fact a false message and for which there may be damage to human health, for example, either individually or in society.

(Sir Kenneth Calman) I think that is an important question. My concern is the proof by which you would establish that. I think the MMR gives us actually some proof that things have changed, so you could legitimately do that. I suspect with HIV infection in the late to mid-eighties there was a very real problem with particular sections of the press. So I think you need the proof at the end, and perhaps it is the long-term consequence which is as importantas anything. Whether there is a mechanism forthat, other than through the Press Complaints Commission, I am not very sure. I can say that it is extraordinarily difficult to get good news into the press. One of the things on which we have touched already is the issue of trust: People very rarely trust you if all you say is bad news. Part of the things we wanted to do when I was in the Department of Health was actually to begin to present good stories: you know, you could get to know the public better. Actually they are not interested at all in that, but if it is controversial they are very pleased. It makes it difficult to present good news.

(Dr Bryant) Several very disjointed points, really, reflecting on some of the conversations. The headline- writer is a totally different person from the writer of the article and does not have the same background and training and interest in the article itself. Headline-writers have the major interest in selling the headline and perhaps it is they who should be held to account. Headlines often bear no relationship to the article, which may be quite well written. Just reflecting on the point Lord Turnberg raised on the dichotomy of positions between a child with autism, the parent claiming having been damaged, and the scientific response. If you actually look at the psychology of the individual to whom those two messages are addressed, I would reflect that the scientific argument would fall on deaf ears in current society, which has a much more emotional reaction to anything compared with our previous stoical English attitude of war time and post-war eras. I think we have to acknowledge that our society is very different now from what it was and that it will continue to evolve, and we need to respond to the group with whom we are communicating.

(Mr Ghosh) I would say that there is an invisible process at work, which is a system of values within the journalistic community and particularly among science correspondents. The individual who wrote those HIV stories was regarded as a pariah among the rest of us and you may wonder what he is doing now. At the end of the day, we all like to get accurate stories, we do like to get scoops and we do like to do well, but if the opposite happens then it is hugely damaging to one's career. For a medical practitioner, if they do a number of things wrong, to the outside world it may seem as if they have got off scot-free but internally they have suffered severe damage to their reputation, and I can say that there is a vigorous process within the ABSW of knowing who is good, who is not, and that does count for a lot. So I think nurturing a set of standards and values within our own community can do an awful lot as well. There are just a couple of points I would like to take up. As well as the Press Complaints Commission, there are internal complaint systems within each organisation, whether it is New Scientist, the BBC or even The Daily Mail. Usually the individual journalist will be asked the question and asked to respond to it, which has a value in itself, and I think that is worth pursuing. Finally, on Sir Kenneth's point about good news messages: it is difficult to get good news messages onto front pages but I think the health sections of the tabloids have done very well. They are perhaps more popular, well-read and taken in by people than some of the stuff on the front pages, which I think, frankly, is often discounted.

Chairman: Thank you very much. Lord Rea.

Lord Rea

339. I think the supplementary questions on the last question, particularly from Lord Turnberg, have ventured well into the territory of this question, but I will ask it even so. What is the evidence, have studies been done, to show that failing to communicate risk effectively to the public leads to the failure of the Infectious Disease Programme? Perhaps failure" is the wrong word. Shall we say, the diminished effectiveness thereof.

(Sir Kenneth Calman) If I could turn it round, because I think there are some real successes. Influenza in the over-60s and vulnerable groups I think has been very positively handled in the year and I think the meningococcal vaccine again has been very positively handled. The failures—and I would not like to put them in those terms, as it happens—are ones which I think we have discussed already this morning.

(Dr Bryant) There are some additional, probably much more low-key, failures. If you look at tuberculosis—of which we certainly see an awful lot in Leicestershire—there is a perception among many members of the public that BCG vaccine is the best control measure for tuberculosis, whereas actually identifying and treating people with TB is top of the list and BCG is down at the bottom. The public actually have an inversion of that. I think that is partly due to failure to prioritise and promote messages around TB detection, treatment and prevention. Malaria: there are many people who travel abroad on a routine basis, to visit family particularly, who are not aware or ignore messages or messages are not communicated well to them about the need to take malaria prophylaxis. Some of the messages round sexually transmitted diseases, particularly among some vulnerable groups. We have various small and scattered outbreaks of hepatitis-A among injecting drug users, and the messages to them are not being communicated. I think it is about failure in many of these rather than bad publicity.

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