Why do we have to turn a scare into a crisis?

The recent Pill panic led to 3,000 abortions. Should the public always be told immediately about new research findings? By Roger Dobson
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Indy Lifestyle Online
When Catherine Clark woke up one morning in October to hear a dramatic health warning about the Pill on the radio, she panicked and threw away her own pack of contraceptive pills. Two months later the 31-year-old economics adviser discovered she was pregnant. After some weeks of pain and persistent sickness, she was admitted to hospital for an abortion.

Ms Clark was one of thousands of women who stopped taking some of the most popular brands of Pill after a shock announcement based on new research that they increased the risk of blood clots. The panic that followed is estimated to have led to about 3,000 abortions in Britain, while a baby boom is predicted for June and July. This week, it emerged that more than 800 extra abortions were carried out by the British Pregnancy Advisory Service alone, which also said that 41 per cent of women stopped taking the Pill immediately and 61 per cent did not finish their course as a result of the scare.

So could the Government have handled it better? Catherine Clark still feels angry about her experience, and argues that the way she got to hear about the findings made her panic unnecessarily. "I remember it was really difficult to get an appointment to see the doctor that Thursday and Friday - I think everybody was trying to do the same thing," she recalls. "I had a very bad pregnancy, I was quite ill and I underwent an abortion where the risks to my health were far greater than those of the Pill."

The announcement that turned her life upside down was based on three separate studies that showed that seven brands of Pill, taken by 1.5 million women, were twice as likely to cause blood clots as other brands. But although the risk was increased it was still small: 30 per 100,000 for women on the high-risk brands. The panic, which led to 100,000 women losing confidence in the Pill according to a survey from Exeter University, is just one of a number of incidents that have led to complaints about the way new research findings are handled. It has also led to calls for the Government to tighten up on the way any health "alert" is delivered, with doctors and health agencies saying that they should be better prepared, in order to provide counselling and advice.

Another crisis occurred earlier this month, with leaked news of a faulty testing procedure for HIV. The test manufacturer, the Chicago-based Abbott Laboratories, had suspended distribution of the test on 25 March, but no announcement was made by the Department of Health. News of the faulty tests - with four positive results falsely testing negative in more than 2.5 million tests worldwide - leaked out just before Easter, when helplines were jammed with calls for advice. The National Aids Helpline had more than 5,000 calls in three days, and the Terrence Higgins Trust had more than 1,000 calls. Other agencies involved said that the DoH should have anticipated the alarm and set in place ways of dealing with the expected response.

Many health scares have two ingredients in common. The first is that the increased risk is often relatively small; the second is that people get their primary information from the media rather than from their doctors. When theCommittee on the Safety of Medicines, the Government's drug watchdog, issued its Pill warning, it said women taking the seven brands should not stop but should see their GP. But many doctors were ill-prepared to cope; some surgeries were besieged with calls before they had received the announcement themselves.

Dr Christine Horrocks, head of family planning at the Frenchay NHS Trust in Bristol, says: "I think the whole thing was very badly handled. There have been complaints about the way doctors found out about it, and about whether it should ever have been the subject of a CSM warning. The risks are so very tiny."

The British Medical Association is also unhappy about the way the alert was handled. Dr Ian Bogle, chairman of the General Medical Services Committee, who wrote to the CSM and the Government about the problems, says: "I firmly believe that on those occasions when it is felt necessary to alert the profession to possible risks associated with the use of any drug, the profession must be alerted well before public statements are issued. This would allow time to prepare for the obvious anxieties which their patients will present to them."

Warnings that generate some fear and anxiety can, of course, be productive, as with smoking and lung cancer, cervical screening and breast cancer checks. They can, however, become counter-productive if perceived to be an over-reaction.

Sarah Stewart-Brown, director of the Health Services Research Unit at Oxford University, says that future health "alerts" should be backed up with educational material and advice. "If the committee made future announcements in this way it would support health professionals and encourage informed decision-making by the public rather than create panic and confusion," she says in a recent letter in the British Medical Journal.

Keith Tones, professor of health education at Leeds Metropolitan University, agrees: "It is a very good idea to let practitioners know in advance. Where doctors are working with people who are likely to be affected, they can provide some anticipatory guidance."

The other side of the coin is that the Government and its agencies are often criticised for not acting soon enough. There has been criticism, for example, over what are perceived to be failures to act over the alleged side-effects of a range of substances. The General Medical Council has been warning for some time about the effects of amphetamine-style drugs used by slimmers that have been linked to 15 deaths, but it is only now that the Government is considering a ban.

Donald Reid, chief executive of the Association for Public Health, believes the only answer is full disclosure. "We think the Government has a duty to publish good-quality scientific findings. If they don't they could be accused of concealing facts from the public. Unfortunately science changes and the Government can find themselves saying one thing one month and something different another. We are in favour of disclosure rather than keeping quiet."

CATHERINE'S STORY

Catherine Clark (left) was on Minulet, one of the pills in the extra-risk category, when she heard a radio report about it more than six months ago.

"I had three or four days to go until the end of the pack," she recalls. "I just stopped taking it because of all the publicity. It was a Thursday or Friday and I couldn't get an appointment to see my doctor, so I just decided to stop. I am 31 and I think this is the age when you start worrying about your health."

She and her partner switched to using condoms - but she became pregnant a few weeks later, in November. Her abortion was carried out the following month.

"The whole reason I was on the Pill was so that I would not get pregnant, so I decided to go ahead with the termination. I am in a long-term relationship and had made the decision not to have children.

"I was very sick during the pregnancy and I became very angry after all the panic had died down. I remember the warning on the radio talked about a 50 per cent increase in the risk, but in the cold light of day you realised it was 50 per cent on such a tiny number it didn't really matter.

"I had to have an abortion, which was not very pleasant, and I just think now how irresponsibly the whole thing was handled. I considered myself to be an intelligent, mature woman but I fell for it, I really did."

She now takes a different brand of Pill not implicated in the research. "But I still feel annoyed about the whole thing. I would think twice about any future health warnings."

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