I Think You'll Find It's a Bit More Complicated Than That (39 page)

Guardian
, 10 October 2009

Last month I had a
debate at the Royal Institution
with Lord Drayson, the Science Minister, in which he argued that I was too harsh on British science coverage, which is the best in the world. During this event our chairman (excellently, Simon Mayo) pulled out a health front page from the
Express
, and asked what we thought about it. I said the article might well be accurate, but it’s also quite likely to be a work of fantasy. As a serious matter of public health, I would urge people to be extremely sceptical about health information on the front page of the
Express
. Lord Drayson thought this was cynical and unfair. He warmly encouraged us to trust this newspaper.

Here’s the latest front-page story from the same paper: ‘Jab
“as deadly as the cancer”
’. ‘Cervical drug expert hits out as new doubts raised over death of teenager’, said the subheading, although no such new doubts were raised in the article. Here is one whole paragraph from that story. Almost every single assertion it makes is false.

The cervical cancer vaccine may be riskier and more deadly than the cancer it is designed to prevent, a leading expert who developed the drug has warned. She also claimed the jab would do nothing to reduce the rates of cervical cancer in the UK. Speaking exclusively to the
Sunday Express
, Dr Diane Harper, who was involved in the clinical trials of the controversial drug Cervarix, said the jab was being ‘over-marketed’ and parents should be properly warned about the potential side effects.

The story seemed unlikely for three reasons. Firstly, Professor Harper is not a known member of the anti-vaccination community, which is vanishingly small. Secondly, it was on the front page of the
Sunday Express
, which is always cause for concern. Lastly, it was by specialist health journalist Lucy Johnston, whose
previous work includes
‘
Doctor’s MMR fears
’, ‘Exclusive: Experts Cast Doubt on Claim for “Wonder” Cancer Jabs’, ‘Children “Used as Guinea Pigs For Vaccines” ’, ‘Dangers of MMR Jab “Covered Up” ’, ‘Teenage Girls Sue Over Cancer Jab’, ‘Jab Makers Linked to Vaccine Programme’, and so many more, including the memorable front-page exclusive: ‘Suicides
“Linked to Phone Masts”
’.

I contacted Professor Harper. To avoid any doubt, I will explain her position on this issue using only her own words: ‘I did not say that Cervarix was as deadly as cervical cancer. I did not say that Cervarix could be riskier or more deadly than cervical cancer. I did not say that Cervarix was controversial, I stated that Cervarix is not a “controversial drug”. I did not “hit out” – I was contacted by the press for facts. And this was not an exclusive interview.’

Professor Harper did not ‘develop Cervarix’, as the
Sunday Express
said, but she did work on some important trials of Gardasil, and also Cervarix. ‘Gardasil is not a “sister vaccine”, as the
Express
said, it is a different compound. I do not know of the side effects of Cervarix as it is not available in the US.’ Furthermore, she did not say that Cervarix was being overmarketed. ‘I did say that Merck was egregiously overmarketing Gardasil in the US – but Gardasil and Cervarix are not the same vaccines.’

And here is the tragedy. Academics are often independently-minded about the interventions they work on, and Professor Harper – who worked on Gardasil – is critical of Gardasil. More specifically, she is critical of how it is being marketed.

Briefly, her view (which was already
published a long time ago
) is that we do not yet know how long the protection from these vaccines will last, and that this will therefore affect the cost-benefit calculations. She is concerned that aggressive advertising aimed directly at the public (which is not permitted in Europe, with good reason) may lead people to falsely believe they are immune to HPV, which causes cervical cancer, and so neglect other precautions. Lastly, she suspects from modelling data that, for the specific and restricted group of women who are punctilious about attending every single one of their cervical-cancer screening appointments, vaccination may have little impact on their risk of death from cancer; but she also says that even this group will still benefit from the reduction in reproductive problems caused by treating precancerous changes in cervical cells, and from avoiding the unpleasantness of screening and treatment.

The article has now
disappeared from the
Express
website
, and Professor Harper has complained to the PCC. ‘I fully support the HPV vaccines,’ she says. ‘I believe that in general they are safe in most women. I told the
Express
all of this.’

Her criticisms of some aspects of cervical-cancer vaccination are nuanced and valuable: but they don’t fit into the black-and-white hysteria of British news media. It would be nice if we could have a serious public discussion about the relative risks and merits of different vaccine options. Sadly, with this kind of ugly reporting, scientists around the world may learn that such a discussion is not currently possible in the UK media. That is the greatest tragedy.

Health Warning
: Exercise Makes You Fat

Guardian
, 29 August 2009

Why would you listen to a government health message, or your GP practice nurse, when the
Sunday Telegraph
has much more exciting news? ‘Health Warning: Exercise Makes You Fat’ is the kind of full-width headline you want to see across a broadsheet page: it’s affirmative, it’s reassuring, and it gives you clear permission to sit on your arse all day. ‘Re-programming body fat is the key to weight loss, not working out.’ Praise be. ‘Is it possible that all that exercise is doing nothing to make us slimmer?’ Please, let the answer be yes.

The
Telegraph
produced three lines of research for this claim. Firstly, more people are spending more money on more exercise than before, but there is also more obesity around in the UK than before: explain
that
with your science. Then there was some speculative laboratory research about interfering with brown fat in animal models, using stem cells and things: interesting to read, but very far from the headline claim.

To properly examine whether exercise really will make you fat, the paper described two trials.

The first one, I can tell you right now, is cherry-picked. The Cochrane Library is a non-profit collaboration of academics who produce unbiased, systematic reviews of the medical literature, and they have a systematic review of all the
forty-three trials
that have been done on
exercise for weight loss
. This produces clear evidence that exercise is beneficial, albeit more modestly than you’d hope. ‘Exercise plus diet’ was compared with ‘diet alone’ in fourteen trials: both groups lost weight, but 1.1 kg more in the exercise group. High-intensity exercise was compared with low-intensity in four trials: high-intensity exercise came out better in all of them, with extra weight loss of 1.5 kg. There are also improvements in blood pressure, cholesterol, blood sugars, sense of well-being, and so on.

The
Telegraph
quoted one trial from Dr Timothy Church of Louisiana University, which compared three different levels of exercise with a personal trainer in overweight people. There were no significant differences between the weight lost in any of the groups, including the ‘control’ group, who were not given a personal trainer at all. So while it is true that exercise did indeed have no benefit, in the one single trial the
Telegraph
quoted, it has also ignored the vast, overwhelming majority of published literature examining the same question. Dr Church speculates that the explanation for his finding is that people who exercised more also ate more. Dr Church is speculating in order to explain the odd results of his one single trial. I think the most helpful suggestion he could make here would be: ‘Our unusual results are probably a fluke, because almost all other trials using similar methods found a completely different answer.’

Then there is the
Telegraph
’s second trial. ‘Another study due to be published next month in the
Journal of Public Health Nutrition
by researchers at the University of Leeds draws similar conclusions. Professor John Blundell and his colleagues found that people asked to do supervised exercise to lose weight also increased the amount they ate and reduced their intake of fruit and vegetables.’

I have this trial in front of me. It’s simply not true that participants increased their food intake. A tiny proportion did (15 per cent), but that’s hardly an issue, because what the
Telegraph
doesn’t tell you – bizarrely – is that overall, participants doing supervised exercise in this trial lost more weight. Much more weight: 3.2 kg more, on average, over just twelve weeks.

Prof Blundell says: ‘The
Telegraph
article was a complete distortion of the facts of our investigation, which showed that exercise is very effective for weight loss. They completely reversed the outcome of our study.’

You might well view my work as pointless: like Sisyphus in an anorak, fighting my way up a greasy waterslide, defeated by the torrent of sewage, desperately trying to scratch one grumpy correction into yesterday’s chip wrapper. But journalism like this is a genuine public health problem. Research has repeatedly shown that people change their health behaviour in response to what they read in the media, and just this month, the World Cancer Research Fund commissioned a survey from YouGov: a proper survey, in a representative sample, from a reputable data collector, where anyone is allowed to see the questions and the results.

Half of all respondents said they thought scientists and doctors were constantly changing their minds about healthy-living advice, although in reality healthy-living advice hasn’t changed at all for at least a decade (don’t smoke, do some exercise, eat more fruit and veg). And a quarter of all respondents said that because scientists keep changing their minds, you might as well eat whatever you want, because it won’t make any difference anyway.

Have another pastry and put the telly on.

The Caveat
in Paragraph Number 19

Guardian
, 16 October 2010

You will be familiar with the
Daily Mail
’s ongoing project to divide all the inanimate objects in the world into the ones that either cause or prevent cancer. It’s hardly worth documenting the individual cases any more: you can appreciate the phenomenon in bulk, through websites like the
Daily Mail
Oncological Ontology Project
and
Kill Or Cure
, with its alphabetised list: from almonds, apples and artificial light; through horseradish, hot drinks and housework; to wasabi, water, watercress, and more.

But occasionally one story pops up to illustrate a wider issue, and ‘Strict diet two days a week “cuts risk of breast cancer by
40 per cent
” ’ is a good example. It goes on: ‘A strict diet for two days a week consisting solely of vegetables, fruit, milk and a mug of Bovril could prevent breast cancer, scientists say.’

Now, if you read
the academic paper
which this news article is describing, from the
International Journal of Obesity
: it’s not a study of breast cancer, and it does not find that the risk of cancer is reduced by 40 per cent. The press release wasn’t exactly a masterpiece of clarity either, but in any case, the study doesn’t even measure breast cancer as an outcome, at all.

If I was to leave it there, the journalist would correctly complain: because after all the grand and misleading claims, firstly, briefly, in the body of the piece, it does mention that the outcome is not cancer, but some hormones related to cancer (with no explanation of how tenuous that relationship is). Then, finally, at the very bottom of the piece, comes the reality. Although it’s not spoken in the authoritative third person of the paper itself, it’s there, in a quote, at paragraph number 19: