On 19 December 2002 CISS lodged a complaint to the ABC, the latest of a series of complaints to the ABC over the previous 14 years.
The Background History
CISS first acquainted the staff at ABC Radio in about 1987 with information showing that most orthodox cancer therapies had not been shown to be effective and actually caused significant harm in many cases; and that there were some alternative therapies, based on a different paradigm, that appeared to have significant benefits and were not harmful; and that we believed these therapies were being suppressed. We received no acknowledgement of this material that was provided to Dr Norman Swan.
Over the subsequent years we sent several letters to the ABC about this problem.
In July 1990 as the evidence mounted supporting our claims we wrote to the ABC’s Andrew Olly program and the ABC General Manager raising the same issue again. In August 1990 we also wrote to the ABC program “The Investigators” pointing out this situation.
When Don Benjamin’s first paper, “The Efficacy of Surgical Treatment of Cancer”, was published in early 1993 we again drew Norman Swan’s attention to the situation and sent a News Release to the ABC on the issue . This paper showed that there was no evidence from any randomised trials that surgery affected survival in any type of cancer. No media outlets aired the Release.
We raised the issue again with ABC Radio in November 1996 when Don’s second paper, “The Efficacy of Surgical Treatment of Breast Cancer”, was published and sent a News Release to ABC radio and TV. (This paper showed that all the randomised trials evaluating mammograms were flawed and that early detection of breast cancer with mammograms had not produced any increased survival; so the conclusions from Don’s earlier paper were still valid. The paper also identified one of the major sources of the errors: the results had ignored several “confounding variables” because post-screening treatment differed between the two matched groups.)
In August 1998 the ABC’s Health Report covered the mammography screening issue, in particular the information provided to women to help them make a choice. Although it was a very useful program in that it highlighted the shortcomings in current information supplied to women, it included comments such as “Clinical treatments these days are very effective. We know that five out of those seven women will survive their breast cancer.”
There is no reliable evidence from randomised trials that survival is affected by clinical treatment; rather it appears that survival figures reflect what would have happened without treatment. So it is not good for people developing information booklets to be misinformed about efficacy and passing this on to women who rely on such booklets for accurate information.
The program also repeated the invalid claim that mammography screening reduces mortality from breast cancer by 30%. These invalid claims were also made by Associate Professor Jeanette Ward who runs the Needs Assessment and Health Outcomes Unit at Central Sydney Area Health Service.
In January 1999 ABC Life Matters had another biased program on the treatment of late-stage breast cancer in that it failed to mention the benefits of psychotherapy that had been shown in two randomised trials not only to have a dramatic effect on survival with late stage breast cancer patients but also to improve their quality of life. We again wrote to Life Matters expressing our concern with continued bias on this Program.
In May 1999 ABC Health Report/Life Matters had another biased program on breast cancer that failed to mention the role of the mind/emotions in the treatment of cancer. We again wrote to the ABC expressing concern at the two programs’ bias.
We received a reply from Dr Norman Swan dated 9 June in which he stated that “he” believed that psychotherapy is not a proven treatment for breast cancer because “there is not enough research in that area to make a solid recommendation”. His understanding was that “the main evidence relates to the survival rates for women who receive good support from each other and from their families” thus ignoring the results of two well-run randomised trials by Spiegel and Eysenck published in 1989 and 1991 respectively, both of which he must have been aware of as he had mentioned them in passing on earlier programs.
In June 1999 we again wrote to the ABC summarising our complaints over the years and referring to the ABC relying on Norman Swan deciding what its listeners would hear. We received a reply from Andrew Lloyd James, then Head ABC National Networks essentially admitting bias by stating that “the [Health Report] program is constrained by medical orthodoxy – it would be irresponsible if it were not….” and stating that the Program would not air views suggesting that Psychotherapy could help people with breast cancer because “the program’s producers believe medical orthodoxy is clear that psychotherapy is not an effective treatment for cancer. Surgery, chemotherapy and radiotherapy can all be effective…”
In other words no other viewpoints would be considered by the Health Report or Life Matters that questioned the current orthodox paradigm, irrespective of the latest evidence.
In July 1999 we wrote to the ABC General Manager citing the ABC’s recent response as an confirmation of a conflict of interest on the part of the ABC, contrasting it with the more objective ABC TV program “Too Much Medicine”.
In January 2000 the Lancet published a paper by the Nordic Cochrane Group whose findings confirmed those of this Society that had been published in 1996, viz mammograms have not been shown to save lives. The trials claiming reduced mortality were all biased and failed to correct for several variables (as Don had pointed out). Their conclusions were widely criticised by the cancer establishment.
We again wrote to the General Manager, ABC pointing out that Norman Swan was still claiming on air that “mammograms save lives” despite this evidence to the contrary recently published in the Lancet and that such comments were misleading its listeners.
In October 2000 we wrote to the new CEO Jonathon Shier complaining about continued bias by ABC Radio.
In December 2000 we raised the issue of bias on ABC Radio with the Senate ECITA Reference Committee, S1.57.
In July 2001 the ABC issued a Health Minute reporting that early detection using breast self examination did not produce benefits and caused harm. For years the Health Report had claimed that breast self-examination was a useful technique for early detection. The ABC had changed tack only because the cancer establishment had been forced to admit they had been wrong.
In October 2001 the Nordic Cochrane Group republished its paper in the Lancet reconfirming what our Society had been saying and adding that (like breast self-examination) mammographic screening not only produced no benefits but also produced harm, including more aggressive treatment. ABC Radio continued its biased presentation by airing views from only one side of the debate, those criticizing the Cochrane Group’s findings.
For example the ABC issued a News Item “Cancer Council encourages women to ignore Danish research and the ABC issued an item as Health News on the debate over evidence for breast screening in which two people were interviewed, both of whom rejected the findings of the Nordic Cochrane Group. No other opinion was aired to answer their criticisms in either ABC news report. So we wrote to the Manager, ABC Radio pointing this out.
In November 2001 Norman Swan issued a Health Minute pointing out that “proponents of breast screening point to falling death rates from breast cancer in the population at a time when the incidence of breast cancer is rising as a positive indication that it’s working”. He then cited results from a report that he said provided “encouragement for women to be screened”. He said the report showed that breast screening discovered tumours that were “significantly smaller with fewer involved lymph nodes” which he said should translate to better outcomes” thus again reflecting only one side of the debate. He did not mention that the review of the breast cancer screening trials showed that although these effects were found in the screening trials they had not translated into better outcomes.
Nor did he mention that mortality rates had fallen and risen again several times in Australia and the current mortality rates are no better than those of 30 years ago, well before screening was introduced. He also did not mention that all screening programs result in an increasing incidence of the particular cancer, so comparisons of changes in incidence and mortality are fraught with problems of interpretation. Nor did he mention that such comparisons are much less reliable than randomized trials.
In effect Norman Swan took sides in the debate, ignoring evidence from reviews of randomised trials and accepting far less reliable evidence. In supporting him in doing so the ABC management effectively stifled all opposing views in the debate.
In April 2002 Norman Swan again presented only one side of the debate by quoting from a paper by Nystrom et al who had reviewed several of the Swedish mammogram trials and ignored the adverse findings by the Nordic Cochrane Group. Nystrom had broken all the principles of interpreting randomized trials and compared a sub-group of women in one trial arm with all of those in the control arm, thus making any conclusion invalid. He had claimed that women invited for screening who had actually been screened had a 21% lower risk of dying from breast cancer than those who weren’t invited for screening. Nystrom had ignored the increased deaths from other causes that had accompanied their reduced deaths from breast cancer, one of the reasons Don had found in his 1996 paper that the mammogram trials were all invalid, a point confirmed by the Nordic Cochrane Group.
The ABC has in effect, by taking sides in this debate, decided that it knows more about randomised trials than the world’s leading specialists in assessing clinical trials in medical science, the Cochrane Collaboration. In fact it then refuses to allow anyone to outline any plausible alternative explanations for falling breast cancer mortality rates although there are several available.
Don Benjamin was the first Australian scientist to identify serious methodological flaws in all of the randomised trials evaluating the efficacy of mammographic screening in improving survival and have his results were published. Randomised controlled trials are supposed to allow only one factor to vary. He found that all the trial authors allowed up to six factors to vary and did not correct for any of these other factors. He then identified one possible explanation for the observed reduction in deaths from breast cancer after screening and this explanation has never been refuted. (This is that harm from radiotherapy or chemotherapy had resulted in more women in the screened group dying of causes other than breast cancer, so that while breast cancer deaths fell in some trials this was accompanied by similar increases in deaths from other causes. So overall death rates were not reduced by screening.) Rather this explanation has not only been confirmed in the Nordic Cochrane Review referred to above but also in
l a recent review of other randomised cancer screening trials (colorectal and lung cancer) that have found serious and similar flaws in their methodology that render their conclusions questionable;
l a review of trials evaluating the harm from radiotherapy;
l a review of apparent percentage increased survivals; and
l discovery of harm from intervention in all forms of cancer.
Earlier last year The New York Times devoted a lead editorial to the subject of the questionable conclusions from the mammogram trials in the light of the Nordic Cochrane Review. In its editorial Uncertainty Over Mammograms, it questioned the likelihood of ever getting an honest answer to the question of whether or not mammography is a worthwhile screening technique.
"It may not be easy to get a truly independent review. Mammography has been so strongly endorsed by the cancer establishment and has become such a significant source of revenue and patients for many hospitals and doctors that it may be difficult to excise without overwhelming evidence that it is dangerous."
In contrast the Australian public has heard little of this debate. The ABC has presented only one side of the debate and suppressed all opposing viewpoints.
This is the context of our recent complaints about bias in ABC Radio.
When ABC Health Report’s Rae Fry was interviewed by Norman Swan in July 2002 about the reliability of information on websites she claimed that the ABC was a trusted source because it relies in the “best available evidence”.
We therefore wrote to her to explain why we disagreed, concluding with the comment: “So the ABC presumably sees no need for Australian women to hear that the world's leading independent research collaboration whose work is based on the principles of evidence-based medicine has found that mammograms are not justified”.
Her reply missed the point. She thought we meant that the issue had not had sufficient coverage. In her response she listed five occasions when the mammogram screening issue had been covered by ABC Radio in recent times.
We had said the issue had not been covered objectively because it had only aired one side of the debate. In fact in all of the five cases she cited as fair coverage, none aired viewpoints supporting the Nordic Cochrane Group’s findings or questioning current orthodoxy about the value of mammographic screening
She had listed five recent ABC stories.
1. Two local representatives were invited to comment on Olsen’s findings published in the October 2001 Lancet. Both were critical of the Olsen findings.
2. Norman Swan had presented the findings from a recent paper by Nystrom supporting mammography screening. He did not mention that the Swedish trials covered in the Nystrom paper had been found in Olsen's paper to be flawed.
3. This item on mammogram screening was supportive of the efficacy of mammographic screening in general, questioning its efficacy in some cases only.
4. This item was also supportive of mammographic screening.
5. This item was also supportive of mammographic screening. Professor Ward repeated the invalid claim that screening reduces mortality from breast cancer by 30%.
We pointed this out in our response to her. Her evidence cited as ABC objectivity showed that the ABC had only allowed one side of the debate to be aired.
She then forwarded our response to the ABC’s Audience and Consumer Affairs Team to comment on behalf of ABC News Media and ABC Radio.
Denise Musto replied in December 2002 on behalf of the ABC. She backed up Norman Swan as “the ABC’s specialist medical broadcaster” and implied that any comments questioning his viewpoints would have to go into “the minutiae of medical research debate regarding any particular issue”.
She then went on to justify Norman’s Swans rejection of the Cochrane Group’s Review: “Norman Swan and the Health Report team have therefore discussed mammographic screening cognisant of the epidemiological evidence of falling mortality from breast cancer, alongside the increasing incidence and prevalence of breast cancer. There would appear to be few plausible alternative explanations to this dynamic other than the use of mammographic screening.”… “It would be reckless of the ABC to over-emphasise the evidence against mammographic screening you refer to unless the evidence was stronger than it is…. The ABC believes these [stories] were balanced and gave both sides”
As with earlier correspondence, the ABC has in effect stated that it must present only the prevailing orthodox view (presumably even when this runs counter to the latest evidence).
In the UK there are now calls for the $100 million a year UK Breast Screening Service to be scrapped, including a call by one of its previous main proponents, Professor Michael Baum who helped to set it up. There has been little if any reporting of this political debate in Australia.
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According to the ABC Code of practice:
4.2 Every reasonable effort must be made to ensure that
programs are balanced and impartial. The commitment to balance and impartiality
requires that editorial staff present a wide range of perspectives and not
unduly favour one over the others. But it does not require them to be
unquestioning, nor to give all sides of an issue the same amount of time.
4.3 Balance will be sought through the presentation, as
far as possible, of principal relevant viewpoints on matters of importance. This
requirement may not always be reached within a single program or news bulletin
but will be achieved as soon as possible.
Members of this Society have complained that they have been misled by the media into having unnecessary surgery and radiotherapy for breast and other cancers.
When the complaint from CISS was passed to the Independent Complaints Review Panel (ICRP) our complaint was upheld.
The ICRP commented that “this an extremely difficulty issue to adjudicate. Not that there is much doubt about bias in the ABC broadcast and online material….”. In their findings the ICRP found that “there was bias in the presentation of this issue, mitigated to some extent by the concern of the ABC that repudiation of orthodox treatment might lead to serious outcomes”.