The Guardian: Why health stories make you anxious

The spin doctors: Why do health news stories make us so anxious? Because of the huge gulf between science and media. By David Rowan


IT CAN be an unhealthy business these days to follow the news too closely. The least you are likely to suffer is stress and sudden behavioural changes. And that is just from the reports of medical warnings and breakthroughs.

Take yesterday's two prominent items of medical research, both geared to set blood-pressure levels rising and anxiety taking hold. Women who drink more than three glasses of wine a day are 41 per cent more likely to get breast cancer than teetotallers, according to reports sourced to the Journal of the American Medical Association. Not all newspapers chose to add the qualifications that the risk seemed to fall after a certain amount. Then there was the warning that 'sunscreens may increase the risk of getting skin cancer'. This worry was based on research presented to the American Association for the Advancement of Science. The qualification 'may' did not prevent the findings making alarmist headlines.

Astute viewers and readers may have recalled earlier stories, again based on respectable medical sources, suggesting that a certain amount of red wine could protect the cardiovascular system - and that sunscreen was an obligatory defence against skin cancer. Were sunscreen and wine, then, good or bad? The trouble is, scientific research does not look for 'good' or 'bad'. The mainstream media, on the other hand, like to present certainties and breakthroughs, and quickly and concisely at that. And it is through the media that the public gets much of its scientific knowledge.

'It's an irreconcilable gulf,' says Dr Tom Wilkie, who for 10 years was the Independent's science editor and now works in the Medicine In Society project at the Wellcome Trust, the medical research charity. 'Newspapers give you medical research as if it was Wagner with the sublime moments, but the long boring half-hours left out. How then do you show people the half-hours?' The result, Wilkie says, is that news coverage can present research findings as an unrealistic and misleading series of self-contained certainties. 'The number of people who stand up on the lab bench and shout Eureka! is severely limited. Science is not a series of breakthroughs, where suddenly people discover that the Earth goes round the Sun. It's actually a slow process of information unfolding. It may take a long time, and some findings may be contradictory. Yet newspapers need to be about 'now', about specific events and 'discoveries'.'

While each new scientific study may tease out fresh information about the complex, bio-chemical reactions triggered by our lifestyle choices, researchers' theorising and qualifications are often smoothed aside during translation into summarised news reports. Reports about wine, for instance, undermine the simplistic notion that doctor always knows best - or that everything can be reduced to being solely 'good' or 'bad' for our bodies.

It was an American study comparing heart-attack victims to healthy individuals in the early 1990s which first suggested that alcohol might protect against coronary disease. Those who consumed one to three drinks daily had half the heart-attack risk of those who never drank, the Boston doctors concluded.

At the same time a team from Sofia identified enoviton, a pigment found in cabernet sauvignon grapes, as helpful to the body in excreting radioactive substances. The World Health Organisation remained unconvinced by what it viewed as commercial self-interest. 'There is no minimum threshold below which alcohol can be consumed without any risk,' Hans Emblad, director of the organisation's programme on substance abuse, warned in 1994.

Those arguing for more discriminating guidelines, however, found backing in a Danish study which proposed that wine, as opposed to beer and spirits, helped protect against heart disease and cancer because it contained useful anti-oxidants and flavonoids. The hunt for wine's benevolent properties intensified as a means of solving the so-called 'French paradox' - why the country has surprisingly low rates of heart disease and cancer. Last year the US journal Science carried a report on resveratrol, a substance found in grapes and wine, showing that it acts as an antioxidant and antimutagen, blocking other cell-changing agents from starting cancer.

Since then researchers from Northwestern University Medical School have found that resveratrol is a form of oestrogen which has a benevolent effect on cholesterol. And then came yesterday's report from the US (which did not distinguish between wine and other forms of alcohol) warning that heavy drinking might increase the risk of breast cancer. Oestrogen, it said, might be triggering the disease. Readers, understandably, may have been left slightly perplexed about how many glasses a day constitute a safe intake.

PROFESSOR Dorothy Nelkin, a sociologist at New York University, explored the mismatch between science and media in her book Selling Science: How the Press Covers Science and Technology (WH Freeman). She sees the reporting of the new
alcohol research this week as par for the course. 'The alcohol study was confusing even to a well-educated reader - you're told one minute that a few glasses of red wine a day are good for your heart, and the next that they're bad in terms of cancer.

'The press have to educate the public to be a bit sceptical, to understand the process of science. The public is now given no perspective - there's a front-page news story of a 'breakthrough', and then a later retraction is hidden away on page 14 if covered at all. And that word, 'breakthrough' - it's just a media word, that the scientists are now using.' Nelkin identifies
a problem not only with the way research is reported, but with the way scientists themselves and their institutions deal with the media. 'The institutions have become very adept at packaging press releases. Scientists these days feel that media coverage is very important in helping them gain funds, so they're prone to exaggerate the importance of their results, and
make definitive claims when they cannot be justified.'

David Pendlebury, research analyst at the Institute for Scientific Information, in Philadelphia, also puts some of the responsibility at the learned journals' door. 'The leading journals are not total innocents in the way they deal with journalists. They're lucrative enterprises, they like having their papers featured, and they're highly competitive: if they're cited in the press it's a signal to other researchers that that's where they ought to send their papers . . .

'The long-term effect (of the reporting) is to undermine confidence in the reliability of science: when you're told you can eat as many cheeseburgers as you want, and then that you mustn't eat cheeseburgers, you're going to ask what these people in the lab are up to.' It is not as if the mainstream news media are limited in their choice of scientific research to cover.

The Wellcome Trust runs a Research Outputs Database of biomedical findings, which monitors 'articles, notes and reviews' published in the UK. It records about 30,000 papers published a year. The UK excels in such research, with about 9 per cent of all world biomedical publications, second only to the US (43 per cent)(1). So why do so few of them make it to the mainstream media? Partly it is because of daily pressures on journalists to turn stories around quickly. 'British newspapers are less well-staffed and have tighter deadlines than their US counterparts,' says Tom Wilkie, 'so having access to information
that's easy to turn around quickly is at a premium.' The journals do all they can to help: some in the US have even begun producing video-clip press releases for the TV news.

The temptation, naturally, for journal and journalist, is to focus on the research that 'makes a noise'. 'The results which claim an effect will be published; the results which report a null effect, with no consequences, tend not to be,' says Wilkie. 'It's easier to write a story that says there is a gay gene. Yet subsequent studies that did not find such an effect have not been published in high-profile journals, or picked up by journalists like the 'gay gene' story did when it first appeared in Science.'

Then there are the benefits publicity can bring to those commissioning the research. Cancer charities, for instance, need to raise awareness (and, indeed, funds), which news coverage can deliver. Yet they also need to assure their own scientists that their work will not be misrepresented in media releases. Professor Gordon McVie, director-general of the Cancer Research Campaign, talks of a 'balance' that must be struck. Too much publicity can raise expectations too far, he says. The campaign's communications department considers the 'translatability' of research, and the concerns of the 150 scientists who work for it, before releasing any of it.

The lesson seems to be that it may not always prove entirely wise to reconstruct one's life on the basis of one or two research papers reported in the mainstream media. Knowledge keeps moving, in its backwards-and-forwards way, and all we do know for certain is that life, eventually, is bound to be fatal.

In the meantime, take some final heed from Tom Wilkie's carefully worded message: 'It may not necessarily always be inaccurate to convey to the public the idea that scientists don't have the answers. A lot of it is asking questions and getting partial answers. Not providing a definite statement - 'red wine is good for you' - may actually be an accurate way of conveying their knowledge.'

David Rowan is editor of the Analysis page

[PANEL]
How to make the news
The Lancet receives about 500 full research papers each month, not counting letters and responses to earlier papers. It prints about 50. This is how the screening process works.

The review process takes at least three months, usually more

1 The initial screen
Editors begin shortlisting papers according to various criteria: the clinical and public health impact the findings may have, the novelty of the findings, the strength and size of the research, the journal's readership (which is generally medical rather than specialist). They choose about a third.

2 The first review
Each paper is sent confidentially to two or three experts in the field (sometimes more). They have two or three weeks to fill in a standardised form rating the paper. Their concerns include: the issue's importance; the originality of the findings; the impact on clinical practice and public health; the design of the medical trials; the appropriateness of treatment; whether dosages are suitable, and whether death, for instance, is the best way of assessing the outcome.

3 The weekly editorial meeting
Those papers which have been panned are separated. Other papers, plus the advisers' comments, are summarised and put into a basket for Lancet editors to read. Their deadline is the weekly two-hour meeting on Thursday, which continues on Friday morning. About 10 people decide which papers to take to the next stage.

4 The statistician's panel
Chosen papers are sent to a member of a statisticians' panel, who assesses technical aspects of the study, logic, methodology, etc.

5 The editorial assessment
Lancet editors now discuss the reviews and decide whether to reject the paper or invite a revision in the light of the reviewers' (and editors') points.

6 Back to the Author

7 The editorial assessment
The revised paper is discussed at a weekly meeting; a decision is taken to accept, reject or for the paper to be reassessed by the advisers. If the advisers are external (and sometimes even when the decision is made in-house), another round of revision may be necessary.

8 Editing
Accepted manuscripts are then edited. Only when authors have seen the proofs are they printed: about 50 appear each month.

(The Guardian, February 19 1998)

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The Guardian: Analysis - the Multilateral Agreement on Investment

Corporations v states: Meet the new world government: Multinationals will be able to take governments to court, under a worrying new agreement to be finalised next week. What happened to democracy? By David Rowan

YOU may not have heard of a new international accord called the Multilateral Agreement on Investment. There's no reason why you should have: the MAI has been debated over the past three years in extraordinary secrecy, and none of the parties to it has been keen to publicise the process (indeed, it has been mentioned barely two dozen times in the British broadsheets over the last year).

But if you have ever reflected on the growing power of the trans-national corporations, and feared that at some stage national governments might finally be forced to bow to their chief executives' demands, you ought to inform yourself rather sharply. Next week that moment will arrive: we may have been busily conducting a loud public debate over Brussels' infringements on our national sovereignty, but we are about to ceding to international investors some of our more fundamental democratic rights.

Over the weekend, representatives from the world's 29 richest countries will gather in Paris to put the final touches to an agreement that will give multinationals power like never before. It will let them sue national governments for any profits lost through laws which discriminate against them. It will put at risk international UN treaties on climate change and over-fishing, and will threaten workplace and environmental legislation we have elected politicians to enact. More crucially, it will acknowledge for the first time that corporate capital now has more authority and freedom to act than mere national and local governments.

The MAI is a comprehensive accord being finalised by the Organisation for Economic Cooperation and Development (OECD) designed to give international investors a 'level playing field'. It amounts to a new set of investment rules that would grant corporations the right to buy, sell and move their operations wherever they wish around the world, without government regulation. This new investor freedom, the OECD says, will give a new impetus to growth, employment and higher living standards.

The agreement, being prepared in Paris next week for signature by OECD ministers in April, is a logical extension of existing international trade treaties such as the General Agreement on Tariffs and Trade (Gatt) and the North American Free Trade Agreement (Nafta). But more than them, it seeks finally to create a world where capital can move entirely free of restriction. As Renato Ruggerio, director-general of the World Trade Organisation, put it: 'We are writing the constitution of a single global economy.'

The trouble, according to the increasing numbers of groups campaigning against the accord, is that this constitution's bill of rights extends only as far as the investors. It was initiated by business organisations - 477 of the Fortune Global 500 companies are based in OECD countries - in order to make international investment easier. More than 85 per cent of the world's foreign direct investment (known as FDI) flows out from OECD nations, increasingly to developing countries. And the amount is rising rapidly (see panel, left): as business grows more global, FDI is growing faster than trade flows.

Currently, investors are concerned that they cannot compete on equal terms with nationals of a host country. So the MAI was designed according to three key principles: non-discrimination (foreign investors cannot be treated worse than domestic companies); no entry restrictions (signatories cannot refuse any form of foreign investment, including the purchase of privatised companies, in any sector apart from defence); and an absence of special conditions (such as to ensure local employment or control currency speculation). 'Investment' is defined broadly, to extend to intellectual property, real estate and shares. Once a country signs, it cannot withdraw for 5 years and will be bound by the agreement for 15 years. In the case of any breach, a multinational can take the offending national or local government to an international tribunal. There it can sue for past and potential future damages.

Non-governmental organisations - and so far more than 600 from 67 countries have united to oppose it - warn that the MAI will make your vote irrelevant. They talk of 'supercitizens', corporations freed from the normal citizens' obligations to the environment or to workers. They point to an early concrete example of the anti-democratic legal actions likely to result. Last April, the Canadian government banned a petrol additive called MMT, which Canada considers to be a dangerous toxin. The additive's sole manufacturer in Canada is Ethyl Corporation, which responded by filing a $251 million lawsuit against the government to cover losses resulting from the 'expropriation' of its MMT production plant and its 'good reputation'.

The case, brought under clauses in Nafta, is still in progress, but even now it is not an isolated one. Two Mexican local
authorities are also being sued under Nafta clauses by US companies prevented from establishing toxic-waste dumps in their jurisdictions. Signatories to the MAI will also face such actions, held in special international courts, should corporate lawyers identify breaches.

'The MAI creates a precedent that elevates the rights of companies over the democratic rights of citizens,' according to the World Development Movement. The group is warning that UK local authorities, for instance, would be prevented from campaigning against South African wine, as many did during the anti-apartheid boycotts of the 1980s. The South African vintners would simply sue for compensation. Those local battles to stop McDonald's opening a branch - such as is now being given some official backing in Bermuda - would stand no chance.

And what of a national government that decided to prevent an international press baron from pricing his newspapers below cost? Mr Murdoch's lawyers may well claim that such a strategy sought to discriminate against the multinational News Corporation. A government cheque may eventually have to be forthcoming.

Even the OECD's own guide to the MAI admits that, 'as with all binding international agreements, this will moderate the exercise of national authority to some degree'. It then offers this not entirely reassuring concession: 'Governments will remain free to regulate in most fields provided the non-discrimination rule is respected.'

Then there are the environmental implications. MAI would, according to Friends of the Earth, let companies oppose the Kyoto agreement, under which industrial countries gave developing countries 'climate friendly' technology in return for pollution rights: for such rights would be an anti-competitive subsidy. Similarly, the MAI could challenge the UN Convention on Biological Diversity, designed to protect developing countries' genetic resources, as foreign multinationals demand equal access to such resources.

The greatest concern comes from those who represent developing countries. They will be invited to sign the agreement when completed, but without having influenced its content. And they will find it hard to resist signing if they want the investment that many consider vital: of the Dollars 112 billion invested in developing countries in 1995, more than 80 per cent ended up in just 12 countries. The 48 least developed (with 10 per cent of world population) attracted just 0.5 per cent of global investment. Yet being 'in' will open them up as unlimited new markets for cigarette companies, infant-formula marketers, and those seeking to exploit forests and minerals.

There are, however, indications that the growing opposition to the MAI may still be in time to postpone its signing. NGOs have made the issue a priority: according to Nick Mabey, economic policy officer for WWF, 'this is bigger now than global warming. Type in 'MAI' on the Web, and you'll get more than 1,000 sites - virtually none in favour, apart from the OECD sites.'

There are also increasing concerns among the signatories themselves. The US, in particular, has sought many exemptions to protect federal and state governments. Organised labour, too, is concerned that the agreement will override workers' rights. As a result, the final text is facing heated debate. Further, French filmmakers and musicians plan a protest on Monday amid fears that France and the EU would have to offer the same creative subsidies to Hollywood under the deal.

Herman van Karnebeek, deputy chairman of the Dutch chemicals group Akzo Nobel, who heads the OECD business and industry advisory committee, said last month: 'We now hear of disturbing signs that many of the elements we were hoping for may not be possible. What, then, we are beginning to ask ourselves, is in the MAI for us?'

The NGOs believe they can now exploit the growing divisions. 'There's a lot of tension in every European government between the environment and development people and the trade people,' says Nick Mabey of WWF. He believes concerned citizens should lobby MPs and ministers to urge a delay in negotiations. 'The decision to rush it through was taken in 1995, but most of those ministers are not around now, so there's no political faith to be lost in delaying,' he says. 'And faced with the problems of a hostile Congress, even the Americans are smiling on the idea of a delay. . .'

[PANEL]
Ultra vires
Many nations have laws which will run into direct conflict with the MAI's requirements. As drafted, the agreement will override the following states' laws:

Australia
Requires foreign investors taking a substantial stake in an existing Australian business worth A$5 million, or establishing a new one worth A$10 million, to submit to a screening based upon a 'national interest' test.

Taiwan
Forbids foreign investment in 'highly polluting industries'.

US
Some states restrict non-residents' use of public land for grazing and for mineral, oil and gas extraction.

Mexico
Bars foreign ownership of development-banking institutions and credit unions.

Canada
Requires a 'benefits plan' to encourage the employment of Canadians, and offer opportunities for Canadian contractors, before approving foreign investment in the oil and gas sectors.

Venezuela
Limits the number of foreign employees in companies with more than 10 workers to 10 per cent, with a 20 per cent payroll limit for foreign employees.

Colombia
Bars foreign investment in the processing or disposal of toxic or radioactive waste not produced in Colombia.

New Zealand
Requires aproval for foreign direct invesment that results in control of 'significant' assets, such as businesses worth more than NZD 10 million.

Chile
Bars the repatriation of capital until one year after a foreign investment is made.

David Rowan is editor of the Analysis page;


(The Guardian, February 13 1998)

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