The risks of telling all

The public must be kept informed without being panicked, says Sarah Stewart-Brown

The British Pregnancy Advisory Service has reported carrying out an extra 800 abortions in the wake of the Pill scare in October of last year, when the Committee on Safety of Medicines announced that women taking third-generation contraceptive pills had double the risk of thrombo-embolic disease. NHS health authorities have also reported increases in abortions, with Bristol, where a survey showed that 12 per cent of women stopped taking the Pill immediately, reporting a 100 per cent rise. Maternity units around the country are anticipating an increase in births in the summer months.

These statistics were predictable because previous Pill scares have been followed by the same problems. Research in Holland following the 1977 Pill scare showed a 22 per cent increase in the termination rate and a 6 per cent increase in births. In that country it took five years for the use of contraceptives and the abortion rate to return to the pre-scare rate.

The safety committee announced that women taking the third-generation pills had a rate of 1.5 cases of thrombo-embolism per 10,000 women years and less than two deaths per 100,000 women years. These rates are twice those of women taking the older pills, but they are also half those among pregnant women. So women who stopped taking the Pill and got pregnant increased rather than decreased their risk of the problem they were trying to avoid, as well as creating many other problems for themselves.

Surely there must be a better way of dealing with the problem of communicating the findings of scientific studies to the public? We know that the public has difficulty relating to the concept of risk and is easily scared into making irrational decisions by media announcements. We know that the press are hungry for good stories and tend to sensationalise news.

What is required is a code of conduct for the professionals and the media to prevent further events of this kind. The concept of risk is difficult but not impossible to grasp. It should be possible for people who are expert at communicating to work out how to communicate the results of scientific studies in a way that does not invite people to do things that are likely to cause them harm. For example, a hotline could be set up that would appraise journalists of comparative risks and help them to assess the public health consequences of different ways of reporting findings that they have come across.

As people will always want verification of what they read from doctors and nurses they know, the code of conduct should allow 24 hours for information to reach the professionals. And those who will be consulted in surgeries and clinics must be provided with written materials to explain the issues. In this way it should be possible to inform the public of things they have a right to know without creating greater risks through avoidable panic.

The writer is Director of the Health Services Research Unit at the University of Oxford.