BSA Decisions Ngā Whakatau a te Mana Whanonga Kaipāho

Complaint
Sunday – Hormone Replacement Therapy (HRT) – results of Women’s Health Initiative reported (WHI) – complainant participated in item as representative of WISDOM – item included minimal scientific facts – potentially frightening – confusing – unbalanced

Findings
Standard 4 – purpose of item to pose questions about use of HRT – no uphold

Standard 5 – while further information would have been useful, material presented not inaccurate – no uphold

Standard 6 – complainant’s views advanced – no uphold

This headnote does not form part of the decision.

Summary

[1] The potential health risks of Hormone Replacement Therapy (HRT) were examined during an item broadcast on Sunday on TV One at 7.30pm on 4 August 2002. HRT was considered in the context of the results of an international study known as the "Women’s Health Initiative" (WHI), of which the findings had been publicised recently, and which had led to the premature termination of the study.

[2] Dr Beverley Lawton complained to Television New Zealand Ltd, the broadcaster, that the item was unbalanced, inaccurate and unfair. Because of the absence of scientific facts, she wrote, the item was also potentially frightening and confusing.

[3] In response, TVNZ said that the intent of the item was to provide information to women who were confused because they had not been able to obtain full information from their doctor or the Ministry of Health. TVNZ denied that the item breached the standards.

[4] Dissatisfied with TVNZ’s decision, Dr Lawton referred her complaint to the Broadcasting Standards Authority under s.8(1)(a) of the Broadcasting Act 1989.

For the reasons below, the Authority declines to uphold the complaint.

Decision

[5] The members of the Authority have viewed a video of the programme complained about, read a transcript of the programme, and have read the correspondence which is listed in the Appendix. The Authority determines the complaint without a formal hearing.

The Programme

[6] The potential health risks of Hormone Replacement Therapy (HRT) were examined during an item broadcast on Sunday on TV One at 7.30pm on 4 August 2002. HRT was considered in the context of the results of an international study known as the "Women’s Health Initiative" (WHI), of which the findings had been publicised recently, and which had led to the premature termination of the study.

The Complaint

[7] Dr Beverley Lawton explained that she had been approached by Sunday to discuss the implication of the WHI results for another study in which New Zealand was participating and in which she was involved – the Women’s International Study of Long Duration Oestrogen After Menopause (WISDOM). She understood that the item’s intention was to provide balanced information to enable women to make informed decisions about HRT use. However, she wrote, that did not occur:

I believe the story was unbalanced, contained virtually no presentation of scientific facts and as a result potentially frightened and confused women.

The overall message of this programme seemed to be that women should not take HRT for any period of time lest they put themselves at risk of breast cancer, stroke and heart problems. While patients were advised to see their doctors, it was implied that doctors were unlikely to be informed and women were better off seeking information from women’s organisations.

[8] The complainant then listed eight specific concerns:

(a) The comments from two individuals without a clinical background but with a partial viewpoint on HRT, she said, were reported at length. On the other hand, the item contained little material from her or the other health professional interviewed (Dr Jessamine from the Ministry of Health), although both had been interviewed at length.

(b) The item treated in a similar fashion all preparations for HRT, contrary to the WHI approach.

(c) Stating that she had emphasised the importance of continuing the WISDOM study when interviewed, she said that approach was excluded from the item. Moreover, she stated, the other possible benefits of HRT, and the debate about the interpretation of the WHI results, were not dealt with, and those omissions led to the item’s lack of balance. Dr Lawton listed some of findings of the WISDOM study which were not advanced in the item which was broadcast.

(d) Referring to the small risks of breast cancer from HRT which the WHI disclosed, Dr Lawton said this point was not presented in a balanced way.

(e) As the fifth point, Dr Lawton wrote:

The WHI study results do not relate to short term use of HRT and this is clearly stated in the JAMA [Journal of American Medical Association] paper. This was not stated in the programme which incorrectly lumped all types of HRT (combined and oestrogen alone) together, and made no distinction between short and long duration use. This is inaccurate and misleading.

(f) Dr Lawton described as inappropriate the item’s implied advice that women should stop HRT regardless of medication.

(g) The item had not tried to explain the difference between statistical significance and trends, and thus the comment about the "trend" towards an increasing diagnosis of breast cancer was not adequately explained.

(h) Dr Lawton said that the item did not advance the perspective of women who choose to take HRT for relief of menopausal symptoms. Noting that the item declined to interview one of her patients who was continuing with HRT, Dr Lawton questioned whether that indicated that the item had an anti-HRT agenda.

[9] In conclusion, Dr Lawton wrote:

The WHI is an important study that gives us some further information about combined HRT but in many ways has also provided more questions than answers. HRT is a drug, and like any other drug has risks, benefits and side effects. By choosing to take a biased and sensationalist approach this programme has sadly missed an important opportunity to inform women about these results and their significance.

The Standards

[10] TVNZ assessed the complaint under Standards 4, 5 and 6 of the Free-to-Air Television Code of Broadcasting Practice. They read:

Standard 4 Balance

In the preparation and presentation of news, current affairs and factual programmes, broadcasters are responsible for maintaining standards consistent with the principle that when controversial issues of public importance are discussed, reasonable efforts are made, or reasonable opportunities are given, to present significant points of view either in the same programme or in other programmes within the period of current interest.

Standard 5 Accuracy

News, current affairs and other factual programmes must be truthful and accurate on points of fact, and be impartial and objective at all times.

Standard 6 Fairness

In the preparation and presentation of programmes, broadcasters are required to deal justly and fairly with any person or organisation taking part or referred to.

The Broadcaster’s Response to the Complainant

[11] TVNZ reported that the intention of the item was to provide more information about the WHI study to women who were confused because they could get little information from their doctors or the Ministry of Health. That intention, it added, was made clear early during the broadcast.

[12] It then dealt with the complainant’s eight points.

(a) TVNZ said that the two individuals referred to, Sandra Coney and Gill Sanson, had considerable experience in HRT specifically and health research generally. The item, it continued, took as given the WHI results and developed a discussion about them. Referring to the interviews with Dr Jessamine and the complainant, TVNZ also noted that it was not unusual for only brief extracts to be used from lengthy interviews.

(b) TVNZ maintained that the item distinguished between preparations of HRT. However, it also considered that it was appropriate that many women who were on HRT, whatever the preparation, had cause to pause and reconsider in view of the WHI results. This was made more important, TVNZ continued, as the item included an interview with a patient who considered that her doctor could not answer questions about the WHI study adequately.

(c) TVNZ said that the item dealt with the WHI results, not the WISDOM study. Nevertheless, the item noted that while the WISDOM study was on hold in view of the WHI results, it reported that the complainant believed WISDOM should continue.

(d) The item, TVNZ accepted, included comment that HRT should not be used long-term. TVNZ acknowledged that the increase in breast cancer risk might be small:

… but it understood that nevertheless the risk increase exists and that it was on that basis that the WHI study was prematurely halted.

(e) TVNZ maintained that the WHI did not define what was meant by long and short term use, but that it did refer to an increased risk of heart disease (29%) after a year on HRT. TVNZ observed:

It seems that among the experts this increase is considered insignificant by some, but outrageous by others.  As many women appeared to use HRT long term, TVNZ wrote, the comments in the item about the risks were appropriate.

(f) The message in the item, TVNZ maintained, was not that women should stop HRT regardless of the reasons for taking it, but that women should reassess their approach to HRT in view of the study. That message, TVNZ added, was also the one in magazines which had reported the results of the WHI study.

(g) TVNZ said the item did not have sufficient time to explain the difference between a matter of statistical significance and a trend. TVNZ considered the central point was the decision of the organisers of the WHI to terminate the study in view of the risk of breast cancer.

(h) On the basis that it was not the item’s role to validate HRT for women, TVNZ noted the matter (interviewing a woman who intended to continue with HRT) was raised during one of a number of conversations the programme producers had with Dr Lawton, but not mentioned again.

[13] TVNZ then examined the broadcast under each of the Standards. In regard to the balance requirement in Standard 4, it wrote:

It was not a programme which looked to reopen and debate anew the factors that led the WHI study to produce the results it did. That the report had come out with its expert findings was a starting point to examine how New Zealand women were reacting and should react to those findings. You were included to emphasise that HRT treatment is still valid, and to support the continuation of the British-based WISDOM study.

[14] Moreover, Standard 4 referred to the period of current interest and TVNZ said further views in the media about HRT were probable.

[15] On the basis that it could detect no specific inaccuracies, TVNZ declined to uphold the Standard 5 aspect of the complaint. It did not accept that the complainant had been dealt with unfairly and declined to uphold the complaint which referred to Standard 6. Overall, TVNZ declined to uphold the complaint.

The Referral to the Broadcasting Standards Authority

[16] When she referred her complaint to the Authority Dr Lawton stated:

I believe their [TVNZ’s] story was unbalanced and contained very little scientific fact, and as a result frightened and confused many women. This was our experience both from emails, telephone calls and consultations with patients, as well as from other health professionals.

[17] She asked the Authority to assess her complaint and TVNZ’s response, adding that she was willing to answer any questions which arose.

[18] In view of TVNZ’s comment that she had been asked to participate in the item because of her expertise in clinical menopause medicine, Dr Lawton said that she had been a Director of the Wellington Menopause Clinic for nine years, and was a senior research fellow at the Wellington School of Medicine working on Women’s Health in the Department of General Practice. She also stated that she had told TVNZ that she could not be a spokesperson for WISDOM.

TVNZ’s Response to the Authority

[19] In response to the complainant’s comment that she was not a spokesperson for WISDOM, TVNZ said the point should not be taken into account by the Authority as the matter was not raised in the original complaint. Moreover, TVNZ asserted that Dr Lawton had agreed to speak about the WISDOM study, and she signed her complaint to TVNZ as the "Principal Investigator" for WISDOM.

[20] In addition, TVNZ advised that the item nonetheless referred to Dr Lawton’s expertise in the area.

[21] TVNZ also objected to the complainant’s comment that the production team used props, stating that the props used were agreed to by Dr Lawton.

[22] TVNZ concluded:

We remain sorry that Dr Lawton found fault with the item. It is our view that Dr Lawton, who has perhaps not appeared in many current affairs items, expected that more of her interview would be used than was in fact the case. She was understandably disappointed. The reality of current affairs is that the editing and production process identifies from material drawn from a range of sources that which best and most clearly sets out the information the item is trying to convey.

The Complainant’s Final Comment

[23] Emphasising that the complaint focused on what she saw as the item’s lack of balance, Dr Lawton said that this imbalance had caused widespread misunderstanding and distress to a large number of women. The item was unbalanced, Dr Lawton continued, because the presentation of a negative and unscientific view of HRT lacked an adequate response from a scientific perspective. She wrote:

HRT is simply a drug and as such has risks, benefits and side-effects. Women must be informed of these and decide for themselves what actions they wish to take.

The Authority’s Determination

[24] The item broadcast on Sunday examined the use of HRT against the cancellation of a major study of HRT in the United States because the results indicated trends which were detrimental for women. The item included interviews with some New Zealand women who were using or had used HRT, some women’s health representatives and some health professionals. The item also told of the confusing situation women now faced as to whether or not to use HRT. The item did not resolve this confusion. Rather, it raised questions for women to consider when attempting to resolve the confusion for themselves.

[25] Dr Lawton listed eight specific concerns which, she believed, lead to the item’s lack of balance, to inaccuracies and unfairness.

[26] As to the extent of the participation of the people interviewed for the programme, the Authority notes that the measurement of time is only one factor in the balance equation. The Authority considers that the item presented a significant range of opinions, as required for balance, and that the points made by a number of contributors, including Dr Lawton, were made forcefully.

[27] The Authority agrees with Dr Lawton that the item failed to distinguish between the treatments involving oestrogen alone and oestrogen combined with progestogen. However, given the item’s focus on the need for women using HRT to reflect on their treatment, the Authority does not accept that the item’s omission to distinguish the treatments amounted to a breach of the standards.

[28] The Authority acknowledges that the item could have included further information about the WHI methodology, as suggested by Dr Lawton, but was of the opinion that there was sufficient information given the purposes of the broadcast.

[29] All the contributors to the programme spoke about the dangers of long term HRT use. Again, more information about the risks and benefits identified by the WHI study would have been informative. Nevertheless, again in the Authority’s view, the absence of such detailed material did not amount, to a breach of the standards.

[30] Dr Lawton pointed out that the item did not define short term use of HRT against long term use. The Authority notes that Dr Lawton did not offer a definition. It is apparent that "short term" and "long term" are accepted terminology in the HRT area and they may not be as precise as some would like. The Authority accepts that the item accurately reported and reflected the confusion women might well feel in trying to come to terms with the reports from the WHI, WISDOM, and the differing views advanced by some women’s health representatives and some medical professionals.

[31] Indeed, the item alerted women using or considering the use of HRT to be vigilant, to seek information, and to question doctors. It did not imply, as Dr Lawton complained, that women should stop HRT regardless of preparation they used.

[32] The complaint that the results were not presented in full has been considered above in paragraph [29]. The Authority agrees with Dr Lawton that some detailed results which explained more fully the risks and benefits of HRT would have been both useful and interesting. Nevertheless, it also reiterates its conclusion that because the item was designed to make women ask questions, the failure to present detailed findings did not breach the standards.

[33] The Authority reiterates these points in response to Dr Lawton’s final specific complaint. In view of the item’s purpose to highlight issues, the Authority does not regard it as the item’s task to validate the use of HRT. The failure to do so did not suggest that the item had an anti-HRT agenda.

[34] The Authority also considers that Dr Lawton’s expertise was adequately explained during the item.

[35] By way of a comment about the item and the complaint, the Authority notes that news items about scientific advances and risks can give rise to complaints from the scientists involved that the media have an insufficient understanding of the science involved and the effect of the advance or the risk. The media can respond by questioning the scientists’ understanding of the media’s responsibility in presenting news. In the Authority’s experience, both arguments have some validity. The parties to this complaint reflect the ongoing tension between science and journalism about such media reports. The Authority concludes that the programme overall did not breach the standards relating to balance, fairness and accuracy.

[36] The Authority observes that to find a breach of broadcasting standards on this occasion would be to interpret the Broadcasting Act 1989 in such a way as to limit freedom of expression in a manner which is not reasonable or demonstrably justifiable in a free and democratic society (s.5 of the New Zealand Bill of Rights Act 1990). As required by s.6 of the New Zealand Bill of Rights Act, the Authority adopts an interpretation of the relevant standards which it considers is consistent with and gives full weight to the provisions of the New Zealand Bill of Rights Act.

For the above reasons the Authority declines to uphold the complaint.

Signed for and on behalf of the Authority

Peter Cartwright
Chair
28 November 2002

Appendix

The following correspondence was received and considered by the Authority when it determined this complaint:

1. Dr Lawton’s Formal Complaint to Television New Zealand Ltd – 12 August 2002
2. TVNZ’s reply to the Formal Complaint – 3 September 2002
3. Dr Lawton’s Referral to the Broadcasting Standards Authority – 19 September 2002
4. TVNZ’s Response to the Broadcasting Standards Authority – 19 September 2002
5. Dr Lawton’s Final Comment – 21 October 2002