Balancing controversy and intelligent debate in the media

The speaker at a recent seminar at McMaster University, which focused on ways to publish controversial evidence and stimulate an intelligent public debate while avoiding a media circus, was perfect. After all, Lancet editor Richard Horton is no stranger to controversial articles.

The most recent article involves the merits of breast cancer screening. He recounted that in early January, The Lancet published a paper concerning the analysis of randomized trials that investigated breast cancer screening. It revealed that the benefit of screening was only significant in those trials which were poorly randomized. "We felt this was a very technical inquiry into the details of randomization in these 8 trials, and that there needed to be some open debate about this, particularly because the Danish government had tried to suppress it," he said. Recognizing that the evidence was contrary to a decade of health policy, a commentary accompanied the paper; it noted that the trials were old and that the screening technologies were out of date.

Horton said media response in the UK was swift, with headlines declaring that breast cancer screening was a waste of time and that screening programs should be reconsidered. The hope of an intelligent debate was quickly lost: within days, media outlets determined that they couldn't decide one way or the other on the issue, and then ignored the report. In essence, Horton said, "2 days of debate and move on to the next scare story."

He experienced the same frustration with new variant Creutzfeldt-Jakob disease and beef consumption. While the media focused on the death of a new mother, the scientific debate was buried. He has come to appreciate, he said, the power the experience of an individual patient can have. The next step will be to determine "how one melds that narrative-based medicine, which fundamentally deals with the individual case, with other issues to do with more classical epidemiology."

As editor, Horton must evaluate whether instigating a public controversy is worth it. Based on his belief that medical science should aim for a refinement of debate, he continues to publish controversial evidence, although he has learned some hard-earned lessons. He says it is important to "work closely with the authors to try to get a proper and consistent message out." This may require participating in press conferences or even managing conflicts within a research team. Although not always successful, he now tries to anticipate and actively manage the spin that journalists may place on an issue.