BSA Decisions Ngā Whakatau a te Mana Whanonga Kaipāho

Summary  

[This summary does not form part of the decision.]

A segment on Sunday contained a story about two women suffering debilitating symptoms of menopause, and included a brief discussion with a doctor about the use of Hormone Replacement Therapy as a treatment option. The complainant alleged the broadcast breached the accuracy and balance standards as it inaccurately described HRT as ‘safe’, promoted HRT’s benefits for other health issues, contained a statement that a 20-year-old study linking breast cancer to HRT had been discredited as flawed, and failed to provide countering views on HRT’s safety and on the validity of the study. The Authority did not uphold the complaint, finding it was reasonable for TVNZ to rely on Dr Teagle as an authoritative source, the segment was materially accurate, the story was clearly told from a particular perspective, and the alleged harm did not outweigh the broadcaster’s right to freedom of expression.

Not Upheld: Accuracy, Balance

The broadcast

[1]  An item on Sunday, broadcast on 10 April 2022, included an edited down 60 Minutes Australia segment, on the experience of two women suffering severe symptoms of menopause. After five minutes of discussion with the two women about their experiences, the following dialogue between reporter Tara Brown, and Dr Kelly Teagle occurred:

Dr Teagle:      If they have debilitating symptoms that are really impacting their ability to function, you know, it's just devastating to see them putting up with that when you know that there's something safe and effective that could be so helpful to them.

Brown:           For the past 20 years, we've believed the shock headlines told the story of just how unsafe HRT is.

Several headlines shown:

HRT can double the risk of breast cancer

HRT pill triples risk of cancer

British study finds risk of breast cancer nearly tripled by combined HRT

U-Turn on the risk of HRT

HRT is not a danger to women

Women warned of raised cancer danger from HRT

Brown:           But that study, linking HRT to breast cancer, has since been discredited as flawed and, according to Dr Kelly Teagle, there are other health benefits to also consider.

Dr Teagle:      For example, we know that it helps to protect against the development of cardiovascular disease. It also keeps bones strong. We know that women actually die less often from COVID, and also it may be preventing Alzheimer's and things like that is being heavily researched.

Brown:           It's a revolution Jean Kittson is right behind. Her own shock experience of menopause was tempered by HRT.

[2]  At the end of the broadcast, host Miriama Kamo invited the audience to join her for a Facebook Live discussion on menopause, where, for almost 40 minutes, Kamo answered audience questions, and provided further information and advice, and links to resources people could access about menopause.¹

[3]  For the purpose of this complaint, ‘Hormone Replacement Therapy’ (HRT also known as MHT (Menopausal Hormone Therapy)) is used to mean combined Oestrogen and Progesterone Therapy.

The complaint

[4]  Sandra Coney QSO complained the broadcast breached the accuracy and balance standards of the Free-to-Air Television Code of Broadcasting Practice. The key elements of Coney’s complaint are:

Accuracy

• It was misleading to state HRT is safe and effective without providing any acknowledgment of the risks of breast cancer, blood clots, and other negative impacts. Medsafe’s guidance is that there is an “increased risk of breast cancer during treatment with all forms of [HRT], except low-dose vaginal oestrogen preparations”.²
• It was inaccurate to promote HRT for the treatment of cardiovascular disease, osteoporosis, COVID-19, and Alzheimer’s. Medical consensus is that HRT should not be the primary treatment for cardiovascular disease and osteoporosis as there are better and safer treatments, and it is not an accepted treatment for COVID-19 and Alzheimer’s.
• It was inaccurate to state the 2002 Women’s Health Initiative (WHI) study, linking HRT to breast cancer, was discredited as flawed. The statement was inaccurate on two points, firstly the study itself has not been discredited, and secondly, the inference from the statement – that the link between breast cancer and HRT had been discredited – is also inaccurate. The complainant noted: subsequent studies have found the same link between HRT and breast cancer; the Shapiro et al study which the broadcaster used to back its assertion was authored by scientists with conflicts of interest, and was later rebutted; and the 2002 WHI study is still used to inform subsequent research.³
• The headlines used in reference to the ‘flawed’ study, (which TVNZ has stated was the 2002 WHI study) were in fact related to other studies, and so were inaccurate.

Balance

• The broadcast discounted/dismissed the risks of using HRT to treat menopausal symptoms and provided no countervailing response or reference to any risks. The broadcast also failed to provide any alternative view to its assertion that the 2002 WHI study had been discredited as flawed. The long history of debate, and the ‘shock headlines’ the broadcaster used, show the safety of HRT is a controversial issue, and therefore further opinions should have been canvassed.

The broadcaster’s response

[5]  TVNZ did not uphold Coney’s complaint. Its response has been summarised as follows:

Accuracy

• ‘The characterisation of HRT as "safe and effective" was the opinion of Dr Teagle, an Australian GP specialising in women's health... Dr Teagle is a credible expert and there was no basis for Sunday to have doubted the accuracy of her perspective on HRT, which is echoed by relevant agencies.’
• TVNZ did not agree that Sunday ‘promoted’ the use of HRT as a treatment for ‘prevention for chronic diseases such as osteoporosis, cardiovascular disease and even reducing the risk of death from Covid.’ The programme was concerned with HRT as a treatment for menopause symptoms, and the brief reference regarding other potential benefits of HRT does not breach the standard, and would be unlikely to lead to adverse outcomes for viewers.
• ‘Sunday did not claim the link between HRT and breast cancer had been debunked, it argued that the 2002 WHI study which led to a significant decline in HRT prescription rates was flawed.’ ‘Experts from the British Menopause Society, the International Menopause Society and others, considered that the 2002 WHI study had shortcomings and so was flawed. A 2012 reanalysis by Shapiro et al found that the WHI study failed to meet criteria which would need to be met in order to establish causality. In effect, the conclusion was that HRT may or may not increase the risk of breast cancer, but the WHI study does not establish that it does.’

Balance

• The use of HRT to treat symptoms of menopause is an important issue to some viewers, but TVNZ did not agree the treatment of menopause with HRT is a controversial issue for the purpose of the balance standard.
• Even if it were found to be a controversial issue, the focus of the story was on two women going through menopause, and the broadcast’s discussion of HRT and characterisation of HRT as ‘safe’ was likely to have been interpreted as a summary risk assessment, in relative terms, rather than an absolute assurance of the absence of any risk.
• Similarly, the brief reference to the WHI study that gave rise to widespread reticence around HRT treatment was a summary reference, included for background context. TVNZ ‘believe it was appropriate to have framed the earliest iteration of the WHI study as flawed, because it distorted the risks associated with HRT (in the context of treating menopause symptoms) without properly accounting for its benefits.’ In this context TVNZ does not agree that there was an obligation to present alternative viewpoints about the study.
• Further, TVNZ considers it is reasonable to expect viewers to be aware of views about HRT that have been expressed in other coverage.

The standards

[6]  The purpose of the accuracy standard⁴ is to protect the public from being significantly misinformed.⁵ It states broadcasters should make reasonable efforts to ensure any news, current affairs or factual programme is accurate in relation to all material points of fact, and does not mislead.

[7]  The balance standard⁶ ensures competing viewpoints about significant issues are presented to enable the audience to arrive at an informed and reasoned opinion.⁷ The standard only applies to news, current affairs and factual programmes, which discuss a controversial issue of public importance.⁸

Our analysis

[8]  We have watched the broadcast and read the correspondence listed in the Appendix.

[9]  The starting point in our consideration of broadcasting standards complaints is to acknowledge the importance of the right to freedom of expression. This includes the right of broadcasters to impart ideas and information, and the public’s right to receive that information.

[10]  In Aotearoa New Zealand, principles of freedom of expression are enshrined in our constitutional law by the New Zealand Bill of Rights Act 1990, at section 14:

Everyone has the right to freedom of expression, including the freedom to seek, receive, and impart information and opinions of any kind in any form. [Our emphasis]

[11]  However, the broadcasting standards system recognises the right to freedom of expression is not an absolute right and it may be restricted, where such a restriction is reasonable and justified in a fair and democratic society. When we assess whether the exercise of the right ought to be restricted in broadcast content, we weigh the value of the particular broadcast against the actual or potential harm that may be caused by that broadcast, either to individuals or to society generally. We may only intervene when the limitation on the right to freedom of expression is reasonable and justified.⁹

[12]  In this case, the value of the broadcast is high. Menopause, and the serious symptoms some people experience are often not spoken about and, as depicted in the programme, many people are unsure and confused by what is happening to them. In this broadcast, the more severe symptoms some people experience were highlighted through the depiction of two women’s personal stories of their own experiences of menopause. The broadcast served to provide a level of comfort in knowing the experiences depicted are ‘normal’ and that those suffering with similar symptoms could seek help if they required it. Having found this broadcast to have high value, accordingly, we would require a correspondingly high level of potential harm to justify restriction of the broadcaster’s freedom of expression.

[13]  In this case, the alleged harm is that people might be misguidedly encouraged to seek HRT, by only receiving information on the benefits of HRT, while not being made aware of the risks. The harm alleged is serious, as breast cancer and blood clots can lead to invasive treatments and to death. We accept programmes such as this may contribute to an increased interest in, and accordingly uptake of, HRT treatments. However, we note this harm is moderated by the fact any person wishing to access HRT would first need to be assessed as to the appropriateness of the treatment for them by a doctor, who would have an obligation to provide that person with information on the risks of treatment, and assess the appropriateness of the treatment in their case. As such, the alleged harm of people initiating such treatment without sufficient information on the risk of breast cancer, clots, or other possible negative side effects is limited.

Accuracy

[14]  The requirement for accuracy does not apply to statements which are clearly distinguishable as analysis, comment, or opinion, rather than statements of fact.¹⁰

[15]  The item was presented as a human interest piece about the experience of two women going through menopause. Dr Teagle provided an explainer about the potentially beneficial impacts of HRT. While Dr Teagle used language reflecting her own opinion and evaluative judgement, we consider a reasonable viewer would have perceived the majority of her statements as factual, as many of the statements used definitive language and were presented by an expert.¹¹ Accordingly, we consider the standard applies in respect of Dr Teagle’s statements.

[16]  The narrated statement, ‘that study, linking HRT to breast cancer, has since been discredited as flawed’ was also provided in a factual manner, and likely to be perceived as factual. The standard is accordingly also applicable in respect of this statement.

[17]  It is not the Authority’s nor the broadcaster’s role to conclusively establish the safety of HRT, nor the veracity of the science supporting the level of risk in taking HRT as a treatment for symptoms of menopause.¹² To that extent, the standard states broadcasters should ‘make reasonable efforts’ to ensure accuracy; the standard is not absolute and focuses on what a broadcaster could reasonably do about an inaccuracy.¹³

[18]  Whether reasonable efforts were made to ensure accuracy includes consideration of the source of the material (such as whether it relies on an authoritative expert), whether there was some obvious reason to question the accuracy of the content before it was broadcast, and the extent to which the issue of accuracy was reasonably capable of being determined by the broadcaster.¹⁴

[19]  We have looked at the accuracy of, and reasonable efforts to ensure accuracy for each of Dr Teagle’s statements and the voiceover separately.

Dr Teagle’s statements (safe, effective and useful for other issues)

Were the statements inaccurate/misleading?

[20]  While we accept the complainant’s concern that Dr Teagle’s statements (without further clarification of the risks of HRT) could result in the audience being left with an incomplete understanding of the safety of HRT, Dr Teagle’s omission of references to possible risks does not in itself make the broadcast misleading or otherwise inaccurate. Audiences would understand most medicines (and treatment) carry some risk, and can cause side effects in some people.¹⁵ The question of safety for the public generally does not rely on excluding the risk of any side effects, but rather undertaking a risk-benefit analysis to ensure the safety profile is acceptable.¹⁶

[21]  We are also conscious the interview with Dr Teagle was only one-minute long, in the context of a seven-minute segment (which is relatively brief for a Sunday item) and which was focused predominantly on the personal stories of two women. The length and nature of Dr Teagle’s participation in the broadcast – as an explainer of a possible treatment for severe symptoms – meant viewers would not expect the level of additional detail contemplated by the complainant.

[22]  With regard to the accuracy of the specific statements:

HRT is safe and effective

• In Australia – where the broadcast was made, and where Dr Teagle practices – Government advice is that while there is a ‘slightly increased risk of developing breast cancer or thrombosis’, ‘[HRT] is usually helpful for people experiencing negative symptoms of menopause’ and ‘can prevent other conditions such as osteoporosis, heart disease, fractures, diabetes and some types of cancer.’ The Australian guidance further notes ‘current international recommendations say that the benefits outweigh the risks in women who are having significant symptoms from menopause, and that [HRT] is effective and safe for most healthy women.’¹⁷ While Dr Teagle’s statement may have benefitted from an acknowledgement of the risks of HRT, it is broadly consistent with Australian Government advice.
• The UK NHS states: ‘HRT is a safe and effective treatment for most going through menopause and perimenopause. Your GP will discuss any risks with you.’¹⁸
• While Medsafe has some caveats on how HRT is prescribed, its approval for use in NZ means it has ensured the safety profile is acceptable (ie, the benefits of the medicine outweigh the risks in appropriate cases).¹⁹
• Best Practice Advocacy Centre New Zealand (BPAC) states: HRT ‘use has been controversial, largely due to early research findings from the Women’s Health Initiative trials that raised concerns about the safety of this treatment. Evidence from longer-term follow-ups of these trials, as well as from other [Randomised Controlled Trials] and observational studies, has led to international consensus that the benefits of HRT are likely to outweigh the risks in most women with menopause symptoms affecting their quality of life if they are aged [less than 60 years] or within ten years of menopause.’²⁰
• Dr Teagle was recommending HRT for women suffering debilitating symptoms, such as the two featured in the programme. She was not suggesting all people going through menopause take HRT.
• As we have previously recognised, doctors speaking generally about medications on a broadcast would not be expected to provide the level of consumer specific information expected for informed consent to treatment.²¹

HRT protects against cardiovascular disease, keeps bones strong, and the benefits of HRT for COVID and Alzheimer’s being heavily researched

• As indicated in the Australian Government advice above, it is widely accepted HRT may assist in some circumstances with cardiovascular disease and does assist with osteoporosis.²²
• The complainant may be correct that in relation to cardiovascular disease and osteoporosis, HRT is not recommended as the primary treatment as the risks outweigh the benefits.²³ However, we do not agree the average viewer would have interpreted Dr Teagle to be advising the use of HRT as the primary treatment for either disease. Viewers would have understood her to be merely stating that protection against cardiovascular disease and osteoporosis may be an added benefit for those who do use HRT.
• In relation to the statement that the benefits of HRT for COVID-19 and Alzheimer’s ‘is being heavily researched’, we find this statement to be accurate. There is research being conducted into the possible benefits of HRT for both COVID-19 and Alzheimer’s, although there appear to be mixed findings on whether HRT is beneficial to either.²⁴

Materiality

• Further, given the nature of this segment – personal interest stories on two women and possible treatments for their debilitating symptoms – to the extent there is any inaccuracy or misleading component of Dr Teagle’s statements on this point it is not material. Any such inaccuracy in this brief comment was unlikely to significantly affect viewers’ understanding of the item as a whole.²⁵

Were reasonable efforts taken to ensure accuracy in relation to all of Dr Teagle’s statements?

[23]  Having found the various statements materially accurate, there is no need for us to go on and consider TVNZ’s efforts to achieve accuracy. However, for completeness, we note our view that it was reasonable for the broadcaster to rely on Dr Teagle for the accuracy of these points. Broadcasters cannot be expected to commission a systematic review of the differing medical opinions on the safety of HRT or the other issues, let alone appropriately interpret the results. Deferring to an expert like Dr Teagle allows the public to benefit from her expertise as a GP specialising on the issue.²⁶ We note further that a finding that the broadcaster was unable to rely on the statements of an expert in these circumstances would be a troubling precedent, potentially discouraging broadcasters from taking on such stories (and unduly limiting freedom of speech).

Voiceover stating a study linking breast cancer with HRT was discredited as flawed

[24]  The statement complained about is:

For the past 20 years, we've believed the shock headlines told the story of just how unsafe HRT is. But that study, linking HRT to breast cancer, has since been discredited as flawed.

[25]  In its submissions, TVNZ advised the ‘study’ it was referring to was the 2002 WHI study.²⁷

[26]  The complainant alleged the broadcaster’s voiceover was inaccurate, because (i) the study has not been discredited; and (ii) the inference made by the statement – that the link between HRT and breast cancer has been discredited – is inaccurate.

[27]  The Authority has first looked at the question of whether the statement the 2002 WHI study had been discredited as flawed was accurate, and secondly, at the complainant’s assertion that that the statement inferred the link between HRT and breast cancer had been discredited.

Was the statement that the study was flawed inaccurate/misleading?

[28]  The Authority notes that determining whether this is a fair description of the WHI study requires a level of expertise beyond our qualifications. Our decision on this point is accordingly based on what reasonable efforts were taken by the broadcaster to ensure accuracy.

Did the broadcaster exercise reasonable efforts to ensure accuracy?

[29]  While the complainant is correct that: (i) the authors of the 2012 Shapiro and others study all declared competing interests, (ii) there was a rebuttal by the WHI investigators, and (iii) the WHI study has gone on to be used to inform other credible studies (including the 2019 meta-analysis published in The Lancet, on which Medsafe has based its current warnings); the level of research to find that information, and the level of understanding of the issues is beyond what could be expected from the broadcaster.

[30]  While the Authority accepts the emphatic nature of the broadcaster’s words (‘that study… has since been discredited as flawed’) may not accurately represent the medical profession’s perception of the study, we are cognisant this was not an in-depth discussion of HRT and its history. For the purposes of this brief segment, the broadcaster’s reliance on a peer reviewed study and the recommendations of menopause societies amounts to sufficient efforts to ensure accuracy.

The link between HRT and breast cancer has been discredited

[31]  The complainant alleges the framing of the above statement would have left audiences with the impression the link between HRT use and breast cancer had been discredited.

[32]  The broadcaster submitted: ‘Sunday did not claim the link between HRT and breast cancer had been debunked, it argued that the study which led to a significant decline in HRT prescription rates was flawed.’

[33]  In later submissions the broadcaster noted: ‘It is well understood and accepted that HRT may increase the risk of breast cancer in certain circumstances. But it is also considered a safe and appropriate treatment for many women, subject to the relevant diagnostic considerations.’

[34]  We agree with the complainant there was some ambiguity in how the statement might have been interpreted. We also agree if the statement was interpreted as suggesting the link between HRT and cancer had been discredited, it would be inaccurate.²⁸ However, even if the statement meant the link to cancer itself had been discredited, that inaccuracy (while not trivial) was immaterial in the context and would not have affected viewers’ understanding of the programme as a whole.

[35]  In reaching this finding, the Authority was influenced by the following contextual factors:

• The programme was primarily a human-interest piece about the two women featured, and its purpose was to bring to light a not often talked about issue. Any inaccuracy would not materially affect the audience’s understanding of the programme (that HRT can be safe and effective for some severe sufferers).
• The programme was not promoting the use of HRT generally. As noted above, it was focused on HRT’s benefits for those with severe menopause symptoms.
• Within this context, the statement about a study being discredited was only a few seconds long.
• As above, HRT is now broadly considered safe in certain conditions and any use would be prescribed by a medical practitioner, and include appropriate warnings as to breast cancer risks.
• As noted at paragraph [20], audiences are likely to appreciate that most medicines carry risks.

[36]  In addition, as outlined further in paragraphs [9]–[13] above, there is high public interest and value in this broadcast. Any potential harm arising from the comment suggesting there is no link between breast cancer and HRT is safeguarded against as information on risk must be provided to a patient by their doctor, before they are prescribed HRT. Accordingly, we do not consider any potential harm sufficient to outweigh the broadcaster’s right to freedom of expression.

[37]  It is noted that in the full 60 Minutes episode²⁹ – from which sections of the Sunday broadcast was taken – the voiceover stating the study was flawed was preceded with the statement:

For a long time in the world of menopause treatment, HRT has been a dirty word, with a study from 20 years ago, linking it to a frightening increased risk of breast cancer. And so, almost overnight, women and doctors abandoned the therapy. But with nothing as effective to replace it, women have pretty much been left on their own ever since to suffer through menopause. As it turns out, for most, that suffering has been completely unnecessary.

and followed the statement with:

It is rarely talked about, but the truth is, while HRT may not be for all women depending on their health, it can help most. Recent studies have found, it doesn’t lead to significant increases in breast cancer in women aged 50 to 59, or in women who start treatment within 10 years of menopause.

[38]  While not changing our finding on the materiality of any inaccuracy, we note the Sunday programme would have benefited from including this more nuanced statement about the study, as it came with some acknowledgment of the existence of a risk of breast cancer, rather than simply its statement that the study linking breast cancer to HRT had been discredited as flawed.

[39]  The Authority reminds broadcasters of the need to use caution and care when editing down programmes made by other broadcasters, to ensure that nuance, and proper messaging is not lost in the editing.

Headlines

[40]  The complainant has also alleged it was inaccurate to use the headlines shown in the broadcast during the voiceover, as they were not related to the 2002 WHI study which TVNZ indicated the relevant voiceover was referencing. The headlines related to later studies including the Million Women study which had also found higher rates of breast cancer in HRT users. There was also some suggestion that the existence of multiple studies rendered the reference to ‘that study’ inaccurate (as it implied there was only one).

[41]  We consider both of these points immaterial in the context. The headlines were simply a visual tool supporting the voiceover. They were shown very quickly and without extensive knowledge of the relevant studies, a viewer would not have known what study they were referring to as the broadcast did not identify any particular study.

Balance

[42]  The complainant argued the broadcast was unbalanced as it discounted or dismissed the risks of using HRT to treat menopausal symptoms and provided no countervailing response or reference to any risks or to the broadcast’s assertions regarding 2002 WHI study.

[43]  This balance standard requires broadcasters to make reasonable efforts, or give reasonable opportunities to present significant points of view when ‘controversial issues of public importance’ are discussed in news and current affairs programmes.

[44]  There is some question as to whether this broadcast discussed a controversial issue of public importance (in particular, whether the use of HRT to treat menopausal symptoms remains ‘controversial’ given the current state of medical research). However, we do not consider it necessary to determine this point given our views as to the range of perspectives required in a programme of this nature.

[45]  In assessing whether a reasonable range of perspectives has been presented for the purposes of this standard, the following factors will be considered:³⁰

• the programme’s introduction and the way in which the programme is presented
• the type of programme
• the nature of the issue and of the discussion
• whether the programme approaches a topic from a particular perspective
• whether the programme acknowledges the existence of other views
• whether the audience could reasonably be expected to be aware of other views, including in other media sources
• the platform on which the programme is broadcast.

[46]  A key consideration is what an audience expects from a programme, and the way in which the programme was presented (ie did it purport to be a balanced examination of an issue or was it clearly signalled as approaching the topic from a particular perspective).³¹

[47]  We consider this programme was clearly focussed on the experience of the two women suffering debilitating symptoms of menopause, and the message that new treatments for those symptoms are safe and effective. The item signalled this perspective from the start: ‘along with the mood swings and hot flushes there is also laughter and light, and even better, new and safe treatments’, while images of HRT prescriptions were shown in the background. Though it briefly touched on past controversy around HRT (providing relevant context), it did not purport to be a detailed assessment of the history of relevant studies into HRT, nor a detailed discussion of the risks potentially relevant in individual cases. It was a human-interest piece which viewers would not expect to include the sort of expert analysis and alternative views mentioned by the complainant.

[48]  Further, the balance standard allows for balance to be achieved over time. It does not require every possible view on complex issues be contained within one item. The topic of HRT use for menopausal symptoms, while now generally accepted as an effective and appropriate treatment for most people with severe symptoms, is an ongoing and regularly discussed issue.³² Viewers of Sunday could reasonably be expected to have a level of awareness of significant alternative viewpoints as well as an appreciation that HRT (like most medical treatments) will carry risks for some people and in some circumstances.

[49]  We are also conscious that viewers were invited to join the host, Miriama Kamo, for a Facebook Live question and answer session where more time was provided to discuss the topic. During the Facebook Live session, Kamo encouraged viewers to make their own mind up about whether HRT treatment was right for them, and encouraged them to speak with their doctor. The host repeatedly told viewers to do their own research, learn more about the issue and different treatment options, and pointed viewers in the direction of multiple different resources where they could access more information about menopause and HRT. This session was another way in which balance was achieved over time.

[50]  For the above reasons, the Authority finds no breach of the balance standard.

For the above reasons the Authority does not uphold the complaint.
Signed for and on behalf of the Authority

Susie Staley
Chair
7 December 2022   

Appendix

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

1  Sandra Coney QSO’s email to TVNZ – 12 April 2022

2  TVNZ's response to email – 13 April 2022

3  Coney's formal complaint to TVNZ – 21 April 2022

4  TVNZ decision on complaint – 20 May 2022

5  Coney's referral to the BSA (including attachments and references) – 16 June 2022

6  TVNZ's further comments – 7 July 2022

7  Coney's further comments – 28 July 2022

8  TVNZ's final comments – 5 August 2022

9  Coney confirming no further comment – 12 August 2022

¹ Sunday TVNZ “Let’s talk menopause” Facebook <Facebook.com>
² Medsafe “Hormone replacement therapy (HRT) reminder (March 2020)” <medsafe.govt.nz>
³ Collaborative Group on Hormonal Factors in Breast Cancer “Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence” (2019) 394 Lancet 1159; Rowan Chlebowski and others “Conduct of the Women's Health Initiative randomised trial evaluating estrogen plus progestin: implications for breast cancer findings” (2013) 39 The journal of family planning and reproductive health care  226; Joanne Kotsopoulos “Menopausal hormones: definitive evidence for breast cancer” (2019) 394 Lancet 1116
⁴ Standard 9 of the Free-to-Air Television Code of Broadcasting Practice
⁵ Commentary: Accuracy, Broadcasting Standards in New Zealand Codebook, page 18
⁶ Standard 8 of the Free-to-Air Television Code of Broadcasting Practice
⁷ Commentary: Balance, Broadcasting Standards in New Zealand Codebook, page 18
⁸ As above
⁹ Freedom of Expression: Broadcasting Standards in New Zealand Codebook, page 6
¹⁰ Guideline 9a
¹¹ See NZDSOS Inc and Television New Zealand Ltd, Decision No 2022-005, at [12]
¹² See Carapiet and Radio New Zealand Ltd, Decision No 2022-033 for a similar finding
¹³ See NZDSOS Inc and Television New Zealand Ltd, Decision No 2022-005, at [16]
¹⁴ Guideline 9d
¹⁵ Medsafe “Adverse reactions to Medicines” (22 May 2022) <medsafe.govt.nz>
¹⁶NZDSOS Inc and Television New Zealand Ltd, Decision No 2022-005, at [21]
¹⁷ Health Direct “Hormone replacement theory” (accessed 3 October 2022) <healthdirect.govt.au>
¹⁸ National Health Service “Treatment – Menopause” (accessed 20 October 2022) <nhs.uk>
¹⁹ Medsafe “Evaluation and Approval Process” (12 September 2019) <medsafe.govt.nz>, at “How is the safety of a medicine established before it is approved for use in New Zealand?”
²⁰ BPAC “Menopausal hormone therapy: where are we now” (16 December 2019) <bpac.org.nz>, at “Menopausal hormone therapy (MHT): still an effective treatment for menopausal symptoms”
²¹NZDSOS Inc and Television New Zealand Ltd, Decision No 2022-005, at [21]
²² Health Direct “Hormone replacement theory” (accessed 3 October 2022) <healthdirect.govt.au>
²³ BPAC “Menopausal hormone therapy: where are we now” (16 December 2019) <bpac.org.nz>, at “What are the current recommendations for prescribing MHT?”
²⁴ Ute Seeland and others “Evidence for treatment with estradiol for women with SARS-CoV-2 infection” (2020) 18 BMC Med 369; Yu Jin Kim and Roberta Brinton “Precision hormone therapy: identification of positive responders” (2021) 24 Climacteric 350; Emily Mahoney and others “Menopausal hormone therapy has beneficial effects on cognitive trajectories among homozygous carriers of the APOE-ε4 allele” (2020) 16 Alzheimer's & Dementia e041482; Victor Henderson “Alzheimer's disease: review of hormone therapy trials and implications for treatment and prevention after menopause” (2014) 142 The Journal of steroid biochemistry and molecular biology 99; Petra Stute and others “Cognitive health after menopause: Does menopausal hormone therapy affect it?” (2021) 35 Best practice & research. Clinical endocrinology & metabolism  101565
²⁵ Guideline 9b
²⁶ See Australasian Menopause Society <menopause.org.au>: “Dr Kelly Teagle is the Founder and Principal Clinician of WellFemme, a Telehealth-only menopause clinic that offers treatment, information and support to people in the menopausal transition Australia-wide”
²⁷ Jacques Rossouw and others “Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women: Principal Results From the Women's Health Initiative Randomized Controlled Trial” (2002) 288 JAMA 321 
²⁸ Valerie Beral and Million Women Study Collaborators “Breast cancer and hormone-replacement therapy in the Million Women Study” (2003) 362 The Lancet 419; Joanne Kotsopoulos “Menopausal hormones: definitive evidence for breast cancer” (2019) 394 The Lancet 1116; Medsafe “Hormone replacement therapy (HRT) reminder (March 2020)” <medsafe.govt.nz>
²⁹ 60 Minutes Australia “The medical breakthrough helping women regain their lives back from menopause” (1 August 2021) YouTube <youtube.com>
³⁰ Guideline 8c
³¹ Guideline 8c
³² See, for example: Cathy Woulfe “Bloody menopause” Stuff (online ed, 11 January 2022); Nicky Pellegrino “Menopause: The latest debate over hormone replacement” New Zealand Herald (online ed, 24 July 2022); Lauren Libbet “I suddenly felt so old and tired: How to stop menopause ruining your sleep” New Zealand Herald (online ed, 29 September 2022); Catherine Hubbard “Knowledge is power when it comes to menopause” Stuff (online ed, 18 September 2022); Fleur Guthrie “Broadcaster Kate Rodger opens up about menopause: ‘I feared I was losing my mind’” New Zealand Herald (online ed, 21 November 2021)