BRITISH MEDICAL JOURNAL
29 JULY 1978
people to sort out for themselves. However great their skills, they are spectators and consumers, not practitioners. Both clinical practice and clinical science are supported by funds derived from the general public, who, ably abetted by politicians and other opinion-formers, are not going to leave us alone to conduct our professional activities as we think best. Unless we have explained ourselves and got their support we can expect, such is the mood of our society, both antagonism and interference. The importance of medicine is far too great for it to be otherwise. We have had a go at explaining our subject, and we have no idea whether our attempt will have any success. But we urge others to try it too. D R LAURENCE
and in the medical press in Modern Medicine (January 1978). I have continued to campaign for HRT but always for it to be prescribed correctly and in the light of our new knowledge with regular endometrial checks. I hope and believe that my attitude has been responsible and consistent, but like all of us I am learning all the time. (3) Finally, during the very inadequate discussion session at the end of the programme, the lady cytologist, while actually holding my book, talked about oestrogen being promoted as an "elixir" and called No Change "misleading." I would strongly point out that I have repeatedly stated that oestrogen is not an elixir, but can vastly improve the quality of life for the woman who becomes severely oestrogen-deficient. I also believe it may postpone the onset of osteoporosis and, like your writer, regret that the biased nature of Department of Clinical Pharmacology, University College Hospital Medical the programme left out all reference to this School, work. I cannot feel that Sir John Peel would London WC1 have written the introduction or recommended so warmly a book which really deserved the SIR,-As my name was mentioned in your description of misleading. review of the "World in Action" programme WENDY COOPER on hormone replacement treatment (HRT) (8 July, p 120) and, as your writer correctly Sutton Coldfield, W Midlandssurmised, a great deal of what we said was unfortunately omitted from the "edited" version of the programme, may I ask for space SIR,-In your new feature "Medicine and the Media" (8 July, p 121) you mention my to make the following three points ? (1) At no time have I been pressured by any contribution to what you considered a muddled drug company, nor has any such attempt been feature on the hazards of jogging in Tonight made. My initial commission to investigate (BBC 1, 28 June). Perhaps the inside story HRT back in 1971 came from a national news- may be of help to some of your readers as an paper and my subsequent sustained campaign example of what happens to the naive clinician was based solely on my deep personal con- when faced with the media. I am tending now viction, reinforced by continuing research, very strongly to the view that the producer that this treatment was effective and should be approaches the subject with a pre-set idea more widely available. and then selects little bits of what the experts (2) My book followed in response to the say that fit in with his own view. Certainly the constant flow of letters from women which treatment of the topic and the selective editing clearly indicated they wanted to know more involved in my interview, in which only part about the menopause and about HRT and of an answer to a question was incorporated felt that this was at the time a neglected area without the question itself being posed, lead of medicine. It advocated and gave consider- me to this view of television journalism. My contact with the media started as a able space to the need for the "combined" therapy and the use of a progestogen at a time result of a paper I gave during the course of a when this was not popular with the drug meeting organised by the British Association companies. I was, however, well advised on of Sport and Medicine on "Exercise-a the rationale for this by pioneers of HRT such prescription for health ?" I had given a paper as Dr Robert Wilson and Dr Greenblatt in on sudden death associated with exercise and the United States and by Sir John Peel in this this paper was picked up in a headline in The country, all of whom I quoted in the book. Times as "Exercise no guarantee of avoiding They insisted from the start that any woman heart attack." This short article, which with an intact uterus on prolonged HRT should dramatised my contribution to the symposium have a secretory endometrium and a regular and gave far less space to the benefits of withdrawal bleed. After publication of the exercise, was probably what gave the TV American series of retrospective studies from producers my name. I was first approached by ITN News and December 1975 onwards, which suggested that this hypothetical risk might be an actual thoroughly enjoyed a four-minute interview one, I ensured that later editions of No with Peter Sissons, which was spontaneous, Change carried an additional appendix covering unscripted, and unedited. The questions on the new situation and adding additional the benefits and dangers of jogging, the emphasis to the need this implied for regular longevity of athletes, etc, gave me an ample courses of progestogen. (I also rang Dr Smith opportunity to give what I felt was a balanced in Seattle, securing for the first time the actual view of the subject and I stressed that jogging cancer category and distribution in his larger was only dangerous for those with heart study. This showed that 95% of cancers in his disease. I was able to get some health educaoestrogen-treated women actually fell into tion propaganda over on the dangers of categories 0 or 1. The subsequent 5-year smoking and sitting watching too much mortality rate for these women has proved to television. I was subsequently approached by the be 7% against 37% for the non-oestrogen group.) British prospective studies, however, Tonight team, who were producing a proat the King's and Chelsea clinics confirmed a gramme on what they claimed was "The distinct risk of hyperplasia in relation to risks and rewards of jogging." My eightunopposed oestrogen, and I was first into minute interview, which was squeezed in print with these adverse findings in the lay rather hurriedly at my home in the middle of press in the Guardian (28 September 1977) the day, was cut to 40 seconds. Since I tape-
351
recorded this interview I have been able to analyse what the editor preferred to leave out as not supporting his case that jogging was dangerous and what he put in, which was my rather badly worded answer to a question that was never posed on screen. The programme itself consisted of the apposition of Health Education Council advertisements for exercise and an interview with Mr Mackie of the HEC with, on the other side, a non-medically qualified exercise physiologist advocating commercial progressive exercise testing for virtually everybody considering any form of exercise because, in his view, unsupervised exercise was dangerous. After discussing mass jog-ins the question was asked to the viewer, "Could some of these people be killing themselves by taking part ?" I was then shown saying, "While you are actually exercising your chances of having a heart attack are increased five times." At no time during the programme, which lasted about eight minutes, was it stated that people with normal hearts ran no risk of having a heart attack or suffering collapse as a result of jogging, despite the fact that I had made the point on five separate occasions during the course of my eight-minute interview. To quote my answers incorporating this point: "If you have a large number of people jogging there is a risk of heart attacks being precipitated in those who already had coronary artery disease. Now this is a small risk . . ." "For the vast majority of people who have a very low risk of coronary artery disease I am all for them taking as much exercise as they can . . "It is dangerous in the small group who have coronary artery disease . . ." "The evidence is that somebody who has a normal heart cannot damage themselves with exercise
"World wide there is a very small but definite incidence of sudden death among athletes who at post mortem are found to have fairly minor abnormalities of the heart, but I do not want to exaggerate this because the chances of them being struck by lightning are about the same . . ."
Having talked on the subject of dangers to people with heart disease for most of the interview and repeatedly made these points I was then asked, "Are the dangers increased while people are at that moment taking exercise ?" My answer was, "There are some statistics, and these statistics are very difficult to get, that suggest that while you are actually exercising your chances of having a heart attack are increased by about five times over what would have happened if you spent the same amount of time sitting quietly." I then mentioned the increased risk of taking hot showers immediately after exercise. Never for one moment did I think that this answer would be presented out of the blue as though it applied to everyone going for a run on their local common. The way the programme was presented suggests either extremely poor editing by an unintelligent layman or a desire to produce dramatic television with little respect for the truth or for the equanimity of the viewer. As you mentioned, the Sunday Times (2 July) enabled me to point out that my comments about the risks of a heart attack applied only to people with heart disease, and the journalist concerned, having spoken to me on the telephone, had the courtesy to telephone me and check his copy with me before it was printed. If television continues to treat medical interviews in the way that I was treated I think our only defence is either to insist on
29 JULY 1978
people to sort out for themselves. However great their skills, they are spectators and consumers, not practitioners. Both clinical practice and clinical science are supported by funds derived from the general public, who, ably abetted by politicians and other opinion-formers, are not going to leave us alone to conduct our professional activities as we think best. Unless we have explained ourselves and got their support we can expect, such is the mood of our society, both antagonism and interference. The importance of medicine is far too great for it to be otherwise. We have had a go at explaining our subject, and we have no idea whether our attempt will have any success. But we urge others to try it too. D R LAURENCE
and in the medical press in Modern Medicine (January 1978). I have continued to campaign for HRT but always for it to be prescribed correctly and in the light of our new knowledge with regular endometrial checks. I hope and believe that my attitude has been responsible and consistent, but like all of us I am learning all the time. (3) Finally, during the very inadequate discussion session at the end of the programme, the lady cytologist, while actually holding my book, talked about oestrogen being promoted as an "elixir" and called No Change "misleading." I would strongly point out that I have repeatedly stated that oestrogen is not an elixir, but can vastly improve the quality of life for the woman who becomes severely oestrogen-deficient. I also believe it may postpone the onset of osteoporosis and, like your writer, regret that the biased nature of Department of Clinical Pharmacology, University College Hospital Medical the programme left out all reference to this School, work. I cannot feel that Sir John Peel would London WC1 have written the introduction or recommended so warmly a book which really deserved the SIR,-As my name was mentioned in your description of misleading. review of the "World in Action" programme WENDY COOPER on hormone replacement treatment (HRT) (8 July, p 120) and, as your writer correctly Sutton Coldfield, W Midlandssurmised, a great deal of what we said was unfortunately omitted from the "edited" version of the programme, may I ask for space SIR,-In your new feature "Medicine and the Media" (8 July, p 121) you mention my to make the following three points ? (1) At no time have I been pressured by any contribution to what you considered a muddled drug company, nor has any such attempt been feature on the hazards of jogging in Tonight made. My initial commission to investigate (BBC 1, 28 June). Perhaps the inside story HRT back in 1971 came from a national news- may be of help to some of your readers as an paper and my subsequent sustained campaign example of what happens to the naive clinician was based solely on my deep personal con- when faced with the media. I am tending now viction, reinforced by continuing research, very strongly to the view that the producer that this treatment was effective and should be approaches the subject with a pre-set idea more widely available. and then selects little bits of what the experts (2) My book followed in response to the say that fit in with his own view. Certainly the constant flow of letters from women which treatment of the topic and the selective editing clearly indicated they wanted to know more involved in my interview, in which only part about the menopause and about HRT and of an answer to a question was incorporated felt that this was at the time a neglected area without the question itself being posed, lead of medicine. It advocated and gave consider- me to this view of television journalism. My contact with the media started as a able space to the need for the "combined" therapy and the use of a progestogen at a time result of a paper I gave during the course of a when this was not popular with the drug meeting organised by the British Association companies. I was, however, well advised on of Sport and Medicine on "Exercise-a the rationale for this by pioneers of HRT such prescription for health ?" I had given a paper as Dr Robert Wilson and Dr Greenblatt in on sudden death associated with exercise and the United States and by Sir John Peel in this this paper was picked up in a headline in The country, all of whom I quoted in the book. Times as "Exercise no guarantee of avoiding They insisted from the start that any woman heart attack." This short article, which with an intact uterus on prolonged HRT should dramatised my contribution to the symposium have a secretory endometrium and a regular and gave far less space to the benefits of withdrawal bleed. After publication of the exercise, was probably what gave the TV American series of retrospective studies from producers my name. I was first approached by ITN News and December 1975 onwards, which suggested that this hypothetical risk might be an actual thoroughly enjoyed a four-minute interview one, I ensured that later editions of No with Peter Sissons, which was spontaneous, Change carried an additional appendix covering unscripted, and unedited. The questions on the new situation and adding additional the benefits and dangers of jogging, the emphasis to the need this implied for regular longevity of athletes, etc, gave me an ample courses of progestogen. (I also rang Dr Smith opportunity to give what I felt was a balanced in Seattle, securing for the first time the actual view of the subject and I stressed that jogging cancer category and distribution in his larger was only dangerous for those with heart study. This showed that 95% of cancers in his disease. I was able to get some health educaoestrogen-treated women actually fell into tion propaganda over on the dangers of categories 0 or 1. The subsequent 5-year smoking and sitting watching too much mortality rate for these women has proved to television. I was subsequently approached by the be 7% against 37% for the non-oestrogen group.) British prospective studies, however, Tonight team, who were producing a proat the King's and Chelsea clinics confirmed a gramme on what they claimed was "The distinct risk of hyperplasia in relation to risks and rewards of jogging." My eightunopposed oestrogen, and I was first into minute interview, which was squeezed in print with these adverse findings in the lay rather hurriedly at my home in the middle of press in the Guardian (28 September 1977) the day, was cut to 40 seconds. Since I tape-
351
recorded this interview I have been able to analyse what the editor preferred to leave out as not supporting his case that jogging was dangerous and what he put in, which was my rather badly worded answer to a question that was never posed on screen. The programme itself consisted of the apposition of Health Education Council advertisements for exercise and an interview with Mr Mackie of the HEC with, on the other side, a non-medically qualified exercise physiologist advocating commercial progressive exercise testing for virtually everybody considering any form of exercise because, in his view, unsupervised exercise was dangerous. After discussing mass jog-ins the question was asked to the viewer, "Could some of these people be killing themselves by taking part ?" I was then shown saying, "While you are actually exercising your chances of having a heart attack are increased five times." At no time during the programme, which lasted about eight minutes, was it stated that people with normal hearts ran no risk of having a heart attack or suffering collapse as a result of jogging, despite the fact that I had made the point on five separate occasions during the course of my eight-minute interview. To quote my answers incorporating this point: "If you have a large number of people jogging there is a risk of heart attacks being precipitated in those who already had coronary artery disease. Now this is a small risk . . ." "For the vast majority of people who have a very low risk of coronary artery disease I am all for them taking as much exercise as they can . . "It is dangerous in the small group who have coronary artery disease . . ." "The evidence is that somebody who has a normal heart cannot damage themselves with exercise
"World wide there is a very small but definite incidence of sudden death among athletes who at post mortem are found to have fairly minor abnormalities of the heart, but I do not want to exaggerate this because the chances of them being struck by lightning are about the same . . ."
Having talked on the subject of dangers to people with heart disease for most of the interview and repeatedly made these points I was then asked, "Are the dangers increased while people are at that moment taking exercise ?" My answer was, "There are some statistics, and these statistics are very difficult to get, that suggest that while you are actually exercising your chances of having a heart attack are increased by about five times over what would have happened if you spent the same amount of time sitting quietly." I then mentioned the increased risk of taking hot showers immediately after exercise. Never for one moment did I think that this answer would be presented out of the blue as though it applied to everyone going for a run on their local common. The way the programme was presented suggests either extremely poor editing by an unintelligent layman or a desire to produce dramatic television with little respect for the truth or for the equanimity of the viewer. As you mentioned, the Sunday Times (2 July) enabled me to point out that my comments about the risks of a heart attack applied only to people with heart disease, and the journalist concerned, having spoken to me on the telephone, had the courtesy to telephone me and check his copy with me before it was printed. If television continues to treat medical interviews in the way that I was treated I think our only defence is either to insist on
