Ministry of Health and New Zealand Medical Association and Television New Zealand Ltd - 2000-145, 2000-146
- P Cartwright (Chair)
- J Withers
- R McLeod
- L M Loates
- Ministry of Health
- New Zealand Medical Association (NZMA)
BroadcasterTelevision New Zealand Ltd
Holmes – research findings on third generation contraceptive pill – danger to women of blood clotting – presenter told users to throw their pills away – inaccurate – unbalanced – caused unnecessary panic, alarm
Standard G1 – no inaccuracy – no uphold
Standard G6 – key issues isolated – opportunity for response given – majority no uphold
Standard G16 – health message presented – focus on individual stories – style of programme – no uphold
This headnote does not form part of the decision.
The release of research findings detailing the risks to women of taking the third generation contraceptive pill was the topic of a Holmes item broadcast on 16 June between 7.00-7.30pm. The presenter suggested that those who were taking several named varieties of the pills should throw them out.
Both the Ministry of Health and the New Zealand Medical Association (NZMA) complained to Television New Zealand Ltd, the broadcaster, that it was irresponsible for the presenter to advise women to throw away their pills, because it would put them at greater risk of unwanted pregnancy. The NZMA emphasised that the risk of suffering pulmonary embolism from taking oral contraceptives was an extremely important issue for thousands of New Zealand women, and that it was vital that it be handled in the media with the utmost responsibility.
TVNZ responded first that the story was broadcast in the public interest. It acknowledged that some viewers would have had the impression the presenter was advising them to throw out their pills. In fact, TVNZ noted, he had only said they should consider doing so. Further, it noted, the presenter twice, later in the programme, made the point that women should not go off the pill without first taking medical advice. It declined to uphold any aspect of the complaints.
Dissatisfied with TVNZ’s decision, both the Ministry of Health and NZMA referred their complaints to the Broadcasting Standards Authority under s.8(1)(a) of the Broadcasting Act 1989.
For the reasons given below, a majority of the Authority declines to uphold the complaints that standard G6 was breached. The Authority unanimously declines to uphold the other aspects of the complaints.
The members of the Authority have viewed a tape of the item complained about, have read a transcript and the correspondence which is listed in the Appendices. The Authority determines these complaints without a formal hearing.
Research findings pointed to an increased mortality rate due to blood clotting among users of the third generation contraceptive pill, according to a study commissioned by the Ministry of Health. Two women who had suffered blood clots while taking the pill discussed the issues with the presenter in an item on Holmes broadcast on TV One on 16 June 2000 between 7.00-7.30pm. Later in the item they were joined by a representative from the Ministry. During the discussion, which described the degree of risk involved in taking the third generation pills, the presenter suggested that women should throw their pills away. He said that, based on what the study revealed, he would not be prepared to take the pill himself.
The Ministry of Health and the NZMA complained to TVNZ that the broadcast would have caused unnecessary anxiety among women who were presently taking the third generation pill, and that it was irresponsible for the presenter to suggest that women throw their pills away.
The Ministry of Health’s Complaint
The Ministry advised that it had commissioned research on the pill to ensure that it had the best advice available for women taking oral contraceptives and that it had put "enormous effort" into ensuring that its advice to doctors and women of the risks of blood clots had been communicated in an appropriate way. It said that experience in the UK demonstrated that when this was not done, the result could be a pill scare, leading to unwanted pregnancies and an increase in the number of abortions. All of these factors, it noted, could be detrimental to a woman’s health and carried similar or greater risks of fatality than the use of the oral contraceptive pill.
The Ministry complained that the programme breached standards G1, G6 and G16 of the Television Code of Broadcasting Practice.
The New Zealand Medical Association’s Complaint
The NZMA said that for the presenter to tell women to throw away their pills was a breach of standard G16 of the Television Code of Broadcasting Practice. It emphasised that the risk of pulmonary embolism from taking oral contraceptives was an extremely important and sensitive issue for thousands of New Zealand women, and it was vital that it was handled in the media with the utmost sensitivity. In its view, it was not appropriate for the presenter to have made flippant remarks where women’s health was at stake.
The NZMA noted that the risks of taking oral contraceptives were "statistically miniscule" and much lower than the health risks associated with pregnancy. It argued that to suggest that women should throw their pills away was tantamount to telling them to risk an unwanted pregnancy and possibly, an abortion. It advised that doctors who worked at abortion clinics were in no doubt that an increase in abortion numbers in 1999 was attributable to "earlier sensational media coverage of this issue".
The NZMA advised that many international studies had confirmed that, for most women, the oral contraceptive was an extremely safe and reliable form of contraception. It endorsed the Ministry’s advice to women to keep taking the pill and to discuss their concerns with their GPs.
TVNZ’s Response to the Complaints
TVNZ assessed the Ministry of Health’s complaint under standards G1, G6 and G16, and the NZMA’s under standards G1 and G6. Standards G1 and G6 require broadcasters:
G1 To be truthful and accurate on points of fact.
G6 To show balance, impartiality and fairness in dealing with political matters, current affairs and all questions of a controversial nature.
The other standard reads:
G16 News should not be presented in such a way as to cause unnecessary panic, alarm or distress.
TVNZ began with the observation that the story was of significance and that it was in the public interest to report on the fact that the third generation contraceptive pills had potentially fatal risk factors.
With respect to the complaint that the presenter advised women to throw their pills away, TVNZ responded that what he had actually said was "you may consider throwing [them] out". While it acknowledged that it was possible that an incorrect impression had been left with some viewers, TVNZ emphasised that the programme later clarified the situation and, after the Ministry of Health spokesperson advised women not to throw their pills away, the presenter twice repeated that women taking the third generation pills should seek medical advice before ceasing to take them. In its opinion, viewers would have been left in no doubt that women should first consult their doctors before they stopped taking the pill.
TVNZ noted that the Ministry of Health spokesperson had had an opportunity to explain the potential risks of the third generation pill and to reassure women about its relative safety.
Turning to the complaint under standard G1, TVNZ argued that although the initial advice by the presenter "was perhaps not well put", the message had been conveyed that women should not throw their pills away.
TVNZ also concluded that standard G6 had not been breached, noting that the information had been balanced and that the possible ambiguity had been remedied by the end of the item.
As for the complaint under standard G16, TVNZ said in its response to the Ministry of Health that it might have had cause for concern had the programme not immediately corrected the misleading impression which had been left at one point. However, in view of the action taken within the programme advising women not to panic, TVNZ concluded that there was no breach of the standard.
The Referrals to the Authority
The Ministry of Health
In its referral to the Authority, the Ministry, through the Director General, took issue with TVNZ’s argument that the presenter’s advice to women had been qualified by his saying they "may consider" throwing their pills away. In the Ministry’s view, the presenter’s intent was very clear: he was telling women to throw their pills out. It argued that he had made it clear that he believed the fault lay with the Ministry, and that the pills should be banned from New Zealand.
It identified the following questions to its spokesperson as demonstrating the bias:
How many have to die before you do something and ban it? (asked twice)
What you are saying is that two deaths a year is acceptable?
Why are you protecting the industry?
Why allow it here when you are putting death in women’s way?
As far as the Ministry is concerned two deaths a year is acceptable?
In addition, the Ministry noted, the presenter had made his own views known when he said to its spokesperson:
Would you take [the pill] with all you know now? I wouldn’t.
This theme had begun with the introduction, the Ministry noted, when the presenter asked why women in New Zealand were still being prescribed third generation contraceptive pills, and why the Ministry had not advised them to throw their pills away when British research in 1995 had revealed that there was a problem with them. The Ministry objected to the presenter’s line of questioning, particularly in light of the fact that its media statement and media briefing had included advice to women that they should keep taking the pill and discuss their concerns with their doctors.
As a second point, the Ministry argued that the presenter’s two subsequent clarifying statements carried very little weight compared to the effect of his claims that the pills caused unacceptable harm and should be thrown out.
Turning to TVNZ’s response under standard G6, the Ministry argued that the programme had lacked fairness and impartiality. It contended that the presenter had a predetermined position and had made no effort to modify it despite having been given the facts about the pill. In its view, the bias in the item was unacceptable, particularly when combined with advice contrary to best medical practice and wisdom. It wrote:
The Ministry remains of the view that the advice by Mr Holmes was deliberate and clearly designed to increase feelings of alarm, panic or distress in any viewers actually taking the pill or with any family members or friends that did. In doing so Mr Holmes is clearly in breach of the code and could well be exposing any women taking his advice to greater risk from unwanted pregnancy and the attendant risks that poses.
This is a very serious complaint about the news coverage of a story that may well have harmful repercussions for many New Zealand women. The Ministry feels it was guided in its actions by the best interests of all the women concerned. Unfortunately the Holmes Show was not.
The New Zealand Medical Association
The NZMA began by noting that it had expressly complained that the item had breached standard G16, but that TVNZ had only considered it under standards G1 and G6.
The NZMA emphasised that the risk of pulmonary embolism from taking oral contraceptives was an important and sensitive issue for thousands of women in New Zealand, and that it was vital it was handled in the media with sensitivity. It maintained that it was not appropriate for the presenter to make flippant or dismissive remarks, or advocate irresponsible actions where health was at stake. It noted that other media reported the study’s findings with restraint and responsibility.
The NZMA reported that it had anecdotal information that a number of women took the advice contained in the programme to throw their pills away and subsequently sought the morning after pill. At this stage it continued, it was too early to know if the comments had resulted in any unwanted pregnancies and abortions.
To TVNZ’s argument that the presenter’s comments were balanced by the spokeperson from the Ministry of Health, the NZMA responded that in its view, his responses were tempered by the presenter’s "outrageous" suggestion that the Ministry was siding with the drug companies in promoting the pills. It added:
In the main item, the Ministry of Health’s advice about third generation contraceptives was read out by Mr Holmes at the end in a very offhand manner. His last comment ("But I’m sure you don’t need a man to be telling you that") further undermined the Ministry’s information.
In the NZMA’s view the presenter’s concluding comments, in which he advised women to see their doctors, did not fully redress the damaging comments which had already been made.
The NZMA itemised a number of statements which it said would have combined to cause alarm and distress among some viewers and to undermine people’s confidence in the Ministry.
Finally, the NZMA expressed its dissatisfaction with the response it had received from TVNZ. First, it noted, TVNZ had not assessed the complaint under the standard expressly identified by it as being relevant. Secondly, it complained about the apparent haste with which TVNZ’s inquiry was completed. It concluded:
Public health is an issue that must be dealt with in a fair and balanced way. We believe this did not happen on this programme, and serious health consequences may result.
TVNZ’s Responses to the Authority
TVNZ began its response to the Ministry of Health by noting that the referral to the Authority came from the Director General, whereas the original complaint had been signed by its media advisor. It suggested that had it taken a pedantic course it could have declined to accept the complaint, on the basis that the Director General had never lodged a complaint capable of being referred to the Authority. Secondly, it suggested that the referral from the Director General represented a significant change in emphasis from the complaint lodged by its media advisor. It submitted that in reviewing and investigating the complaint, the Authority’s decision should be based principally on the original letter of complaint and TVNZ’s reply.
TVNZ also objected to what it considered was a challenge to the presenter’s professional competence and that the Ministry had blamed the perceived shortcomings of the programme on him. It said it rejected the view that the presenter had advanced personal views, or that his approach had been premeditated.
Next, TVNZ objected to the list of questions which the Ministry said demonstrated its partial approach as they failed to acknowledge that the Ministry’s representative had had an opportunity to provide lengthy and comprehensive responses to each question. As a response to those questions, TVNZ pointed out that the spokesperson had made the following points:
- There were no safe medicines.
- New Zealand was one of the first countries to respond to British findings in 1995.
- The wording in information on contraceptive pill packets [in New Zealand] was the strongest in the world.
- The risk remained very small.
- The Ministry was not protecting drug companies.
- Women should not throw their pills out, but should seek medical advice.
With respect to the presenter’s suggestion that he would not risk taking the pills, TVNZ responded that it considered that remark was "fair comment" in the context of the item.
Next, TVNZ observed that the referral had not made reference to the article in The Lancet which was the impetus for the programme, and which had revealed there was a significant risk factor associated with the third generation pill. TVNZ also noted that the Ministry had made no reference to the two victims of blood clots who had appeared on the programme.
TVNZ said it acknowledged that the advice that women would want to consider throwing out their pills was unfortunate, but noted that it had been recognised as such and an opportunity had been given to the Ministry spokesperson to clarify it immediately. On two other occasions, the presenter had clarified the point further.
In its response to the NZMA, TVNZ explained the circumstances surrounding its dealing with the complaint under standards G1 and G6, and not G16. It apologised to the NZMA and proceeded to provide a full response.
First it commented on the NZMA’s claim that some women would have followed the presenter’s advice and thrown their pills away. In TVNZ’s view, that assumption "stretches credibility". It suggested that where there was conflicting advice between a television presenter and a doctor, "human reaction would be to take the doctor’s advice".
Next it dealt with the complainant’s criticism of TVNZ’s argument that the presenter’s comments were balanced by those of the Ministry’s spokesperson. The NZMA maintained that this argument was based on an assumption that viewers would give the two equal weighting. TVNZ responded that it was entitled to make such an assumption, noting that the two men were both experienced in current affairs debate and furthermore, that the Ministry spokesperson had medical qualifications and status and could respond on a more qualified basis than the presenter.
Responding to the NZMA’s criticism of the manner in which the Ministry spokesperson was interviewed, TVNZ argued that in the context of the release of findings which raised serious questions for some viewers, it was entirely appropriate that the interviewer adopt a vigorous question line. In its view, the spokesperson responded thoroughly to the points raised.
Turning to the complainant’s criticism of the presenter raising the question of a possible protection of drug companies, TVNZ responded that the question had to be raised as many cynical viewers would have been left wondering if the Ministry was protecting them. By asking the question, it continued, the Ministry was given the opportunity to refute that suggestion.
It listed some of the more significant points made by the Ministry’s spokesperson (recorded above) and suggested that any reasonable viewer would have concluded that he had been given a full and proper opportunity to respond.
As a final point, TVNZ suggested that the tenor of the complaint seemed to indicate some animosity towards the presenter. It pointed out that the programme was produced by a team of journalists, and was not "a one-man show".
The Ministry of Health
The Ministry responded first to TVNZ’s argument that it could have declined to accept the complaint on the basis that the original letter had been signed by the media advisor, and the referral by the Director General. It was, the Ministry contended, irrelevant who signed the complaint letters as the complaint had been made on behalf of the Ministry. It also rejected TVNZ’s contention that there had been a change in emphasis when the complaint was referred to the Authority.
As for the issues of professional competence and freedom of the press raised by TVNZ, the Ministry observed that while important, neither seemed relevant to its complaint or to TVNZ’s reply. It emphasised that its complaint was based on the fact that the Holmes programme fell far short of the standard set by the Television Code of Broadcasting Practice.
Next, the Ministry responded that it took no issue with the devil’s advocate approach of the presenter. It simply asked for fair treatment and an impartial interviewer, it wrote. For instance, it noted, both women interviewed revealed they had risk factors which raised questions about whether the pill had been appropriately prescribed for them, but this was not canvassed at all by the presenter. Further, it continued, the presenter made his own views known, which demonstrated his partiality. Neither of these points had been adequately addressed by TVNZ, the Ministry contended.
The Ministry took issue with TVNZ’s view that the presenter’s statement that he would not take the pill was fair comment in the context of the item. It maintained that it was not fair comment, as it was contrary to the expert advice received by the Ministry.
The Ministry continued:
Perhaps it is worth restating that the study reported in The Lancet was contracted and funded by the Ministry of Health in part to ensure the advice being given to women in NZ was correct. The principal author of the report Professor David Skegg took part in the media briefing organised by the Ministry of Health. Two Holmes show reporters attended that briefing. It was made very clear in the media briefing that the advice to women was that they should not stop taking 3rd generation oral contraceptives without medical advice. The paramount reason for this advice is that to do so potentially exposes women to more harm from the risks posed by an unwanted pregnancy. It is for this reason that the Ministry believes the Holmes Show was irresponsible in advocating women should throw away the pill. It is even more serious in that the advice from Mr Holmes was premeditated.
As for TVNZ’s point that the two women had a right to be heard, the Ministry repeated that this was a serious complaint about a story which might have harmful repercussions for many New Zealand women. It said it was guided in its actions by the best interests of all women concerned.
The New Zealand Medical Association
The NZMA reiterated that it stood by its original complaint that the presenter’s suggestion to women to throw away their pills breached standard G16. It then acknowledged TVNZ’s explanation as to how its response had been prepared so promptly and why it had not considered the complaint under standard G16. It repeated its view that the statements by the Ministry representative would not have gone far enough to undo the damage done by the presenter telling women to throw their pills away.
The NZMA acknowledged the presenter’s role as "devil’s advocate" but maintained that where the health of New Zealand women was at stake, it was extremely important to take a responsible attitude. It said it was baffled by TVNZ’s comment that it had failed to acknowledge that the research had raised some issues which were worrying to lay people. The NZMA emphasised that one of its key roles was to provide advocacy on behalf of patients.
With reference to TVNZ’s concern that its comments appeared to be directed at the presenter, the NZMA responded that it had referred to him because he was the person making the statements.
TVNZ’s Further Comment to the Ministry
TVNZ repeated its observation that the Ministry’s complaint appeared to have moved a long way from its original concerns, which had related to the presenter’s remarks being irresponsible. It noted that it had pointed out that the presenter’s advice had been modified three times within the programme. TVNZ also emphasised that the Ministry’s spokesperson had appeared on the programme to respond.
TVNZ also expressed its concern with an "apparent attitude" from the Ministry that its views should not be questioned. This it said was hardly appropriate in a country which valued free speech and a free press. It added:
Briefings of the sort provided by the department are very helpful, certainly, but journalists recognise that like all other briefings there is a particular "spin" attached to them which it is the journalist’s job to unravel.
It stressed again that the Ministry had been strongly represented in the item and that the views of its spokesperson had been clearly and strongly heard. "The need to modify the advice given by Mr Holmes was quickly recognised, and acted upon."
The Ministry’s Further Comment
The Ministry wrote:
The basis of our original complaint was that it was irresponsible of Mr Holmes to advise women to throw away their contraceptive pills when the risk of blood clots from doing so was greater than the risk they faced by continuing to take them.
It reiterated its view that despite the presenter’s "clarifying statements" the damage had been done by his initial comments.
The Ministry concluded with the observation that TVNZ’s comments about its apparent indignation at its advice being questioned did not seem particularly relevant.
The Authority’s Findings
The Authority begins with TVNZ’s assertion that the Ministry’s complaint could be regarded as invalid because different signatures appeared on the letters. As the original letter of complaint was clearly recorded as having been made by the Ministry of Health, the Authority finds TVNZ’s concerns to be unfounded.
The Authority now turns to the substantive issues.
Standard G1 – truth and accuracy
The Ministry contended that the presenter’s advice to women to throw their pills away inaccurately conveyed the extent of the risk involved in taking them, and that the item failed to provide women with all essential facts required to make an informed judgment about the risks of continuing to take them. It also objected to what it considered to be the suggestion that the Ministry was protecting the drug companies.
In assessing these remarks, the Authority notes the context in which they were made. The Holmes programme has a familiar format, and frequently relies on personal experiences to illustrate the topics covered. On this occasion, two women who had reacted negatively to the third generation pills were interviewed against the background of the research report which had been released by the Ministry alerting users to some risks in taking them. A representative from the Ministry spoke on its behalf, explaining from its perspective the seriousness of the risks posed and emphasising the need for women on the third generation pills to contact their own doctors who would assess their individual risk factors. The item followed a media briefing from the Ministry which, according to the complainant, reporters from the Holmes programme had attended.
With respect to the complaint about the presenter’s advice to women to throw their pills away, the Authority notes that the comments were made in the context of the relative risk of the third generation pills. It was made clear that all contraceptive pills carried some risks, but that the third generation pills carried the greatest risk of causing blood clots. In the Authority’s view, the presenter’s description of the third generation pills as carrying a greater risk was not inaccurate. In particular it notes that the two women who had suffered adverse consequences as a result of being on those pills were given the opportunity to explain their experience, and the Ministry’s medical advisor explained the steps that the Ministry had taken to obviate the risks. The Authority does not consider it was the programme’s function to be a conduit for the Ministry to disseminate its advice warning to the users of third generation contraceptive pills. The approach taken – which included incorporating the personal experiences of two women affected – was, in the Authority’s view, one way of conveying the information, and isolating the key issues for consumers. While the Authority acknowledges the Ministry’s concern that the tone of the interview would have alarmed pill users, it considers that the relevant information was, nevertheless, accurately conveyed. Accordingly, it declines to uphold this aspect.
Turning to the complaint about the suggestion – made by one of the women interviewed – that the Ministry was protecting the drug companies by not recalling the pills, the Authority notes first that this was the women’s genuine opinion, and presented as such. Secondly, the Ministry’s spokesperson had the opportunity to respond to this point and to clarify that the Ministry was not in league with drug companies. The Authority declines to uphold this aspect.
Standard G6 – balance
The Authority is divided in its conclusion on this aspect of the complaint. A majority of the Authority notes that an aggressive approach was taken by the presenter, who adopted a layperson’s point of view against that of experts, and who acted as advocate – to a degree – for two women who had suffered blood clots resulting from taking the pill. It was in this context that he advocated throwing out named brands of pills which were known to cause two deaths each year. The question for the majority is whether, by taking such a stance, the presenter exceeded his brief as an interviewer. On balance the majority concludes he did not. In its view, the presenter’s approach isolated the key issues for consumers, and the Ministry spokesperson was given the opportunity to respond to them. Furthermore, it was acknowledged by TVNZ that although it was possible that an incorrect impression might have been left with some viewers, the presenter had twice subsequently clarified the position by advising women to seek medical advice. In addition, the Ministry’s spokesperson had emphasised that women should see their doctors before taking any action. The majority concludes that the item fell short of breaching the requirement for balance, impartiality and fairness.
The minority disagrees. In its view, the item’s aggressive stance was not moderated by comments made by the Ministry spokesperson or by the presenter’s endeavour to retract his advice to women to throw their pills away. The minority considers that the injection of the presenter’s personal views resulted in the item being partial to the extent that it breached the standard. It also finds the presenter’s advice was irresponsible and potentially alarmist because it would have heightened some women’s fears and possibly have had negative implications for them. In reaching its conclusion on this aspect, the minority emphasises that it does not expect the media to accept without questioning a briefing paper or press release on such an important issue. However, in its view, the tone of the item and the approach taken were not compatible with the serious health question which was being discussed.
Standard G16 – panic, alarm and distress caused
The complainants contended that the manner in which the information about the third generation pills was conveyed would have distressed and alarmed viewers unnecessarily. As noted above, the Authority is divided in its view as to the item’s lack of impartiality. However, in its assessment of the complaints under standard G16, the Authority is unanimous that the item did not contravene this standard.
In reaching its decision on this point, the Authority takes into account that there is a range of media styles, and that the Holmes programme is known to present issues in an entertainment format and to use personal experiences to highlight key matters. On this occasion, the experience of the two women interviewed focused attention on the implications for them as individuals, and emphasised the possible risk for other women who had been prescribed the third generation pill. For the two women concerned the pills were potentially life-threatening. It was in this context that the Ministry spokesperson was invited to comment. The Authority does not consider the item’s tone was unduly alarming given that factual background. In addition, it notes, the presenter did pass on the Ministry’s message to women that they seek medical advice.
For the reasons given, a majority of the Authority declines to uphold the complaint that standard G6 was breached.
The Authority unanimously declines to uphold any other aspect of the complaints.
Signed for and on behalf of the Authority
12 October 2000
The following correspondence was received and considered by the Authority when it determined this complaint:
1. Ministry of Health’s Complaint to Television New Zealand Ltd – 3 July 2000
2. TVNZ’s Response to the Formal Complaint – 18 July 2000
3. Ministry of Health’s Referral to the Broadcasting Standards Authority – 25 July 2000
4. TVNZ’s Response to the Authority – 8 August 2000
5. Ministry of Health’s Final Comment – 18 August 2000
6. TVNZ’s Further Comment – 25 August 2000
7. Ministry of Health’s Further Comment – 4 September 2000
The following correspondence was received and considered by the Authority when it determined this complaint:
1. New Zealand Medical Association’s Complaint to Television New Zealand Ltd –
5 July 2000
2. TVNZ’s Response to the Formal Complaint – 18 July 2000
3. NZMA’s Referral to the Broadcasting Standards Authority – 11 August 2000
4. TVNZ’s Response to the Authority – 18 August 2000
5. NZMA’s Final Comment – 25 August 2000