Only a fortnight ago, newspaper headlines were telling us that “world experts declare HRT safe for women in early menopause” and “now HRT is safe after all”.
This week, it’s been headlines sounding the alarm about the possible links between HRT and breast cancer.
It’s worth unpicking these contrasting stories because they have some useful lessons for anyone wishing to make sense of media reporting of health issues – or indeed, any media outlets wanting to improve their coverage.
For starters, the source of the first flurry of headlines was a statement issued by the International Menopause Society (IMS) which was developed by a “global summit on menopause-related issues“.
This statement, based on what has been described as a pretty selective review of the scientific literature, puts a glossy spin on HRT, downplaying its potential harms. It also stresses the need to correct negative perceptions about HRT amongst the media, the public and health professionals.
It may not surprise you to learn that the statement carried at its end a small disclaimer – not repeated in any of the media reports that I saw – noting that the IMS had been able to hold the Summit thanks to funding from Wyeth Pharmaceuticals, Bayer Schering Pharma and Novo Nordisk Femcare.
In other words, this bears all the hallmarks of a classic PR campaign serving the interests of pharma and those sections of the medical profession whose careers have been built on prescribing and researching HRT.
By contrast, the most recent spate of headlines relate to a study published in the latest Medical Journal of Australia which is based on a careful analysis of an association between a drop off in HRT use and a reduction in breast cancer incidence among Australian women aged 50 or older.
Just to put it into perspective, the incidence rates in this age group were lower by 6.7% in 2003 compared with 2001, or the equivalent of 600 fewer breast cancers (out of about 9,000 incident breast cancers annually for women this age).
That’s a lot of trauma that’s been avoided (as well as a lot of HRT sales lost – the market shrank by 40% between 2001 to 2003.)
It’s important to note that this type of study is unable to prove cause and effect; it merely shows an association between two events. But when considered in conjunction with the broader body of evidence – including similar studies documenting falls in breast cancer in the USA and elsewhere after similar dramatic drops in HRT use – it reinforces the importance for caution in the use of these drugs.
And it sends quite a different message to that promoted by the IMS media campaign, that “doctors should be prescribing HRT more freely”.
It would be most unfortunate if the first set of headlines, those generated by the IMS, are the ones remembered by women and their doctors.
My concern is that the omission of crucial details and context from the IMS-generated articles is likely to perpetuate confusion about HRT. This is the precise goal of any industry in damage control mode – think of the tobacco, alcohol, and junk food industries’ success in this respect.
Of course, if journalists had joined up the dots re the IMS statement, their stories may not have got such a good run – the headline “drug industry promotes its product” is hardly news.
Let’s hope news managers keep this in mind when the IMS spruiks World Menopause Day later this year.
The IMS website makes it clear that a sophisticated PR campaign is backing the day, including prototypes of news releases promoting HRT, and a long list of suggestions for dealing with the media, including this telling one: “When faced with a question that includes negative words or phrases, do not repeat those words or phrases in your answer.”
In the meantime, anyone wanting balanced information about the benefits and harms of HRT are well advised to check out this decision aid produced by my colleagues at the University of Sydney.
My only reservation is that it refers readers to the IMS website.