Archive | September, 2013

Fertility and the media – unravelling the hype

30 Sep

1428046_21921388Each week in the UK, news and feature pieces on fertility, pregnancy and childbirth proliferate in the mainstream media, in tabloids and broadsheets alike. Stories based on results of clinical studies on topics such as advances in fertility treatment, practices to ensure a healthy pregnancy and so on appear on a regular basis. But how accurately is the science being interpreted, how much is being omitted and how misleading are some of the headlines?

Headlines such as ‘1 in 3 will be infertile in 10 years’ (Daily Mirror, June 2005) and ‘Babies given Calpol and other forms of paracetamol are more likely to develop asthma’ (Mail Online, November 2012) certainly grab readers’ attention, but they also cause fear and anxiety in parents and prospective parents, who may not have the relevant medical knowledge to be able to look objectively at the evidence presented. (For those who are aware of it, the NHS does a valiant job of combating some of the inaccuracy and misinterpretation of clinical evidence in these stories with its Behind the Headlines section of the NHS Choices website.)

The commodification of fertility and childbirth  

It is a sad fact that there is a high level of commercialisation around women’s health, which has undeniably increased in recent years, as health services become privatised. The areas of maternal health and fertility treatment are particularly affected. Vicky Garner wrote recently of seeing sales reps from a commercial ‘parenting club’ lurking on maternity wards handing out child benefit forms. Under the guise of offering support to complete the form, they were taking down the details of new mothers with a view to contacting them to market their services. She argues that the reps exploit women who are at their most vulnerable and anxious to give their newborns the best start in life; an anxiety that is heightened by the scare-mongering headlines we see every day.

When it comes to fertility treatment, it is easier to see where there are opportunities for profit to be made by private companies, given that fertility treatment is not universally available on the NHS (eligibility depends on where you live and other criteria). It therefore falls to private clinics to offer IVF treatment, and they can market and advertise their services as they wish.  However, as Miriam Zoll wrote in an op-ed in the New York Times, ‘marketing and advertisements’ play their part in selling hope to ‘customers who are at their wits’ end, desperate and vulnerable’. Zoll speaks of the ‘debilitating trauma’ associated with failed IVF cycles and treatments, highlighting that, though fertility clinics offer, advertise and market services to paying customers as if they were any other for-profit company, when treatment fails it takes a significant psychological and emotional toll.

Hype and hope

A recent event at City University, London, looked at the intersection between science, the media and public engagement, in reporting advances in fertility treatment. The meeting, entitled ‘Hype, Hope and Headlines: How Should Breakthroughs in Fertility Treatment be Reported?’ questioned where responsibility should lie for accurately reporting advances in fertility treatment. Speakers Prof Simon Fishel, Managing Director of the CARE Fertility Group, who was part of the original team whose work produced the world’s first IVF baby in 1978; Prof Nick Macklon, Professor of Obstetrics and Gynaecology at the University of Southampton, and Director of the Complete Fertility Centre; and Dr Hannah Devlin, Science Editor at The Times, discussed the issues around this controversial topic.

Ahead of the meeting, Profs Fishel and Macklon and event organiser Connie St Louis spoke on BBC Radio 4’s Woman’s Hour. St Louis said that PR teams at IVF clinics often put out ‘overblown’ press releases, and she cautioned science journalists to be wary when producing stories based on clinical trials, particularly when a study is being publicised by the organisation that funded it. She also pointed to the lack of balanced argument in healthcare stories, and said that journalists should seek out a range of expert opinions in order to include different voices in stories on IVF.

On the other side of the argument, Fishel, though he agreed with the need for robust reporting of results and for peer review, cautioned that the best must be done to push the science of the field forward via mainstream media.

The City University event following the Woman’s Hour discussion was organised by the Progress Educational Trust (PET), an independent charity that aims to raise awareness of embryo and stem cell research, genetics and assisted conception and to engage with policymakers and medical professionals to inform debate. Fiona Fox, Founder and Director of the Science Media Centre – a charity that improves public trust in science by persuading scientists to engage more effectively with controversial science stories in the media – chaired the meeting.

Media engagement

Fishel stated his position on the debate topic, saying that information on developments in reproductive technology must be accessible to patients as and when it becomes available. As the pace of reproductive medicine moves so quickly, he said, it takes time for cutting-edge technology to filter through the medical profession, meaning that GPs and even some specialists do not understand or appreciate the breadth of the work done in fertility research. He pointed out that even the National Institute for Health and Clinical Excellence (NICE) can be too slow to issue guidance when seen from the perspective of a couple seeking new, improved therapies. When looking for clinical evidence to recommend a fertility treatment procedure, it is problematic to consider randomised, double-blinded, controlled trials to be the ‘gold standard’, he said. Because of their lengthy duration (15 years), by the time the results are available it will be too late for many couples, he argued, suggesting that other types of trials, such as cohort observational studies should be considered.

It is not always easy for journalists or the public to grasp that all scientific knowledge is provisional, he said. In other words, science is progressive, with improvement and advances being made all the time; however, the time in which a couple want and are able to have a baby is limited and they should be able to be access information on all current treatment options. The key lies in responsible communication to the media, he argued, so it is up to trial investigators, clinics and press officers to accurately communicate their evidence to the media and it is up to the media to look at the evidence before reporting.

False hope

Presenting a contrasting view, Macklon argued that when a couple see a headline proclaiming breakthroughs in fertility research, there is a danger of giving false hope that they will not only be able to access this new treatment, and that it will be successful. A relationship with the media is necessary to raise awareness and encourage funding of potential new treatments, he acknowledged, but if the relationship between clinics and the media is ‘too cosy’, this can lead to false hopes being raised. Macklon, in his argument, reminds us that there is a third party, the potential patient, who stands to lose out financially and emotionally, when ‘unproven technology’ is being offered in IVF clinics for profit. The patients are the ones paying the price for uncertainty, he said.

Devlin countered Macklon’s argument by accusing him of being ‘patronising’ to potential patients. She acknowledged that, as a journalist, IVF stories are always welcomed as the science is ‘easy to follow’ and is relevant to everyday life, encapsulating controversy, morality, life-changing events and they can be illustrated with ‘cute baby pictures’. Agreeing with Fishel, she posited that it is the job of journalists to filter out anything that might give false hope to patients, but that all developments, no matter what stage they are at, should be reported. She also highlighted that there is pressure from editors to cover stories reported by the majority of most national papers, to maintain competitiveness.

Considering responsibility

In the discussion following the speakers’ presentations, there was clearly a split in the audience between where it was felt that ultimate responsibility should lie for the accurate communication of clinical results to the public. One commenter suggested that patients seeking fertility treatment would not go to a medical journal to seek out the original research, thereby placing emphasis on the newspaper/journalist to offer balanced and accurate information. Another questioned the role of the PR or press officer in drafting a press release free of language and phrasing that might appear to sensationalise the facts. Concern was also raised over not withholding or omitting information and the need for the wider debate to move forward.

It was also emphasised that other expert opinions should be presented in a story and this would be the journalist’s responsibility to present alternative viewpoints. Macklon pointed out, however, that some doctors may have a vested interest in recommending a particular treatment (or, conversely, in not recommending it).

Does knowledge empower?

Fertility treatment is unlike any other area of medicine in many respects. Being largely provided in private practice, there is the market and, therefore, the finance available to plough into technological development; however, this means that the availability of evidence from (the so-called ‘gold standard’) randomised, controlled trials cannot keep up with the pace of development or the demands of the consumer/patient.

From the speakers’ presentations at the City University event and the discussion that followed, it seems clear that a collaborative approach is needed in order to responsibly and accurately communicate developments in the field of fertility treatment. Perhaps, as one commenter highlighted, this all points to the need for better-quality are more accessible patient information in the UK. But in lieu of this it would seem that it is the responsibility of all involved – press officers, journalists, and clinicians to communicate accurately and put in context any available information. Mutual trust, it would seem, is crucial when communicating science to the public.

Conclusions

The argument that knowledge is empowering for the patient certainly has merit, but it is important to bear in mind that both the media and the clinic stand to make commercial gain from the publishing of fertility stories. And as long as treatment remains in the private sector, there will remain a ‘cosy’ relationship between the media and the provider, however well hidden; the danger is that the patient, who should be at the centre of the discussion, will be open to exploitation.

Women’s health: the patriarchal paradox

18 Sep

‘Health – bounding saucy health – is the fountain from which all true beauty springs.’1

This quote, from The Girl’s Own Book of Health and Beauty, sums up the perception of girls’ and women’s health in the late 19th and early 20th centuries. A woman’s health was never just about her physical condition, but was related to her mental health and, most importantly, her appearance.

The commonly held view, propagated by ‘experts’ such as Dr. Henry Maudsley, was that girls had a finite store of energy, which needed to be reserved for the processes of pregnancy and childbirth. Any woman who was too active before marriage would exhaust this supply of energy, making for a weak, frigid and mentally deficient adult.

Some medical professionals and social commentators used this popular belief as an argument to petition against women’s education, for example, Maudsley, who wrote of the ‘excessive mental drain as well as the natural physical drain’ caused by school or college study.2 For women to reach the ideal of motherhood, therefore, and produce many strong and healthy children, the safest and most healthy pre-marriage lifestyle involved remaining in the home, inactive except when engaging in sedentary, non-intellectual pastimes.

The ‘New Girl’

In the post-First World War era, however, the ideal image of female health and beauty underwent a radical revision and the ‘New Girl’ emerged. Sport and outdoor activity were encouraged and beauty was linked with physical strength and the shapeliness that comes from regular exercise. Bodily beauty was linked with sexual attractiveness, and the role of the wife as a sexual partner, rather than as a mother, was emphasised, placing value on youth and women’s responsibility for their own lives and winning a husband.

The link between health and sexual attraction persists in our current popular culture. Newspapers and magazines promote diet and exercise, primarily in order to achieve a desirable body.  Even in supposedly health-focussed publications, physical shape and appearance, not intrinsic health, is the real subject of the advice, as a recent blog piece on the magazine, Women’s Health, points out.

Despite the more than 100 years that have passed since Gordon Stables published The Girl’s Own Book of Health and Beauty, we are still transfixed by the idea that health is linked with appearance. In the media, women promote health products to other women through their appearance; we should be attractive, active, always striving for self-improvement and always, always thin (yet still constantly engaged in an on-going effort to lose weight). Furthermore, we are also responsible for each member of our family’s health. Possibly the only indulgent product women are ever seen to promote is chocolate, which is represented as a guilty, sexualised pleasure to indulge in secretly (see every Galaxy ad ever made).

However, while women are placed as instigators and protectors of their own and their family’s healthy eating habits, advertising aimed at men encourages indulgence in laziness and greed through the consumption of unhealthy drinks, snacks and junk food.  But despite the preoccupation with women’s health in the media, it is the bad eating habits in men promoted by such gender-specific marketing that have been blamed for a far greater cancer risk in men than women. Yet the stereotyped images persist.

Doctor knows best

The late 19th century saw the development of obstetrics and gynaecology as discrete specialisms, opening a new market in the medical landscape. The effect of this was that doctors now had even greater control of women’s bodies, administering questionable and barbaric treatments for disorders such as epilepsy and ‘hysteria’. For example,  genital massage and the development of the vibrator for the treatment of hysteria, or Dr. Isaac Brown Baker, who claimed success in treating epilepsy and other nervous disorders in female patients by excising the clitoris. In the case of the development of the vibrator, as Rachel P. Maines highlights, ‘Doctors were a male elite with control of their working lives and instrumentation, and efficiency gains in the medical production of orgasm for payment could increase income.’

At this time, the female anatomy was shrouded in mystery. As Maines points out, Thomas Laqueur says that physicians writing of anatomy ‘saw no need to develop a precise vocabulary of genital anatomy because if the female body was a less hot, less perfect, and hence less patent version of the canonical body, the distinct organic, much less genital, landmarks mattered far less than the metaphysical hierarchies they illustrated.’ Therefore, treatment for women was much more fluid, experimental and ambiguous; for the female patient it all came down to trust in the physician’s knowledge and methods.

The image of the doctor as profit-focussed businessman, who capitalises on the lack of knowledge of his patients is reflected in the recent case in Bluegrass Women’s Healthcare Centre, where the owner pleaded guilty to misbranding non-FDA approved forms of birth control. In addition to the immorality and illegality of this action, the fact that these were intrauterine devices adds an extra level of violation. Women, against their will had had a potentially dangerous object placed inside them by someone they should be able to trust.

The paradox

Women’s health, therefore, has always been a strong preoccupation for patriarchal society. The womb is seen as public property and the health of its owner crucial to the that of the society as a whole. Though we are now somewhat more scientifically informed, many of the beliefs around women’s health of the late 19th and early 20th centuries persist today. We still equate women’s health with sexuality, and place the responsibility for the wellbeing of the family, and therefore society as a whole, on women’s shoulders.

Yet, ironically, it is often women that suffer the most when it comes to cuts in health services. Take this open letter from a resident of Ravalli county in the US, in which commissioners voted to eliminate funding to women’s healthcare. To these commissioners, the woman writes, ‘somewhere down the road you may meet a woman who has no hair and less hope due to an advanced breast cancer that, if you had voted differently, could have been caught earlier’. And elsewhere in the US, politicians have been accused of backing policies that are anti-women’s health.

In the UK, a discussion on the BBC’s Woman’s Hour on NHS funding for IVF revealed that 50% of those polled believed that, as a non-emergency treatment, the NHS should not fund IVF at all. Of course, access to IVF is not something that solely affects women but this is another area in which women can be attacked and made to feel guilty about their health. By taking away the universal right to fertility treatment (even just by raising the question in discussion), the message is sent that if you cannot conceive naturally your health must be at fault and you must live with the consequences. The technology that has been developed that could help you can only be accessed by the elite.

This shows that, when it comes to women’s health, there has really been very little progress made since Victorian times. Evidence shows that, when and where there are resources and a market in which to make a profit, women are made to feel their health is imperative, and that there is something inherently unstable in being a woman that makes her mind and body vulnerable to disease, which must be remedied with medicine without question. However, when resources are scarce, it is women’s healthcare that is the most dispensable.

References

  1. Gordon Stables, The Girl’s Own Book of Health and Beauty, London: Jarrold and Sons, 1891.
  2. Henry Maudsley, ‘Sex in Mind and in Education’, Fortnightly Review, 15, 1874, 466–83.
Aside

I can dream …

12 Sep

So much has has happened in the world of gender inequality (that is, the actual world) during this blog’s lengthy hiatus, it would be foolish to attempt to cover everything.

I long to say how glad I am that, since I last posted, we now live in a culture where women who have campaigned to get a female face on an English banknote aren’t systematically targeted with death and rape threats, and that when they are, they are taken seriously by the police; or that female prime ministers are not publicly attacked with sexist abuse; or that it is regarded as just plain weird that magazines full of near-naked women would sit on supermarket shelves next to Peppa Pig magazine and the New Scientist; or that topless women were not compared with vegetables by tabloid newspapers in a sad attempt at wit. I wish I could be glad that statistics were not manufactured and misattributed by lazy journalists attempting to victim-blame and underplay the impact of a serious crime (as journalist Peter Lloyd did in a recent Daily Mail article, attributing a statistic to UK charity Rape Crisis that ‘almost 1 in 10 rape allegations are fake’ – a completely incorrect statement for which Rape Crisis has demanded a retraction and apology). I wish I could be happy that we live in a country where council cuts haven’t caused the destruction of essential services, meaning that the lives of women and children are put in danger.

But sadly I can’t.

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