Select Committee on Science and Technology Minutes of Evidence


  Examination of Witnesses (Questions 360-368)

TUESDAY 28 JANUARY 2003

DR GERRY BRYANT, SIR KENNETH CALMAN AND MR PALLAB GHOSH

360. Someone, for example, with a fellowship at the London School of Tropical Medicine could take in tropical diseases including malaria.

(Mr Ghosh) I think there would be a great take-up for such a thing. I do think it would be a take-up not of the kind of national news correspondent level, but someone who works in the New Scientist who wanted to deepen their understanding of a particular area.

(Dr Bryant) Just a very simple comment, it would be wonderful if people knew that viruses and bacteria were different.

Lord Lewis of Newham

361. Is it possible to be honest about programmes where individuals are asked to take risks for the good of the public?

(Sir Kenneth Calman) I presume the answer to that is yes, and the evidence comes from clinical trials. In a clinical trial setting an individual who may not get any response or any benefit whatsoever from a drug or indeed not a drug, or a treatment or not a treatment says, I will do this because somebody else might benefit from it", they do that knowing that there might be side effects, there might be problems but they do it for a particular reason. That is how vaccines have been developed. It is possible tobe honest but to recognise that there is some uncertainty. It is slightly easier, I think, because it is usually on a one-to-one basis between the doctor and the patient or the nurse and the patient. It is much more difficult when you are talking to 50 million people to get that kind of trust over.

(Mr Ghosh) I did not hear anyone during the MMR crisis saying, actually the safest thing of all is for you not to have your child vaccinated but for everyone else to and carry that argument through. The argument was that MMR is safe. I think that was half the problem, as I see it. I think it is not a question of, is it possible, I think it is essential.

(Dr Bryant) If I can extend this further, it is not so much a matter of taking risks but if we look at the CJD incidents and how that area of work is going to develop then we have a situation where people may or may not be at risk themselves being asked to take action to protect other members of the public from any potential risk they may themselves pose. It is a very complicated situation. Yes, we have to be utterly honest about why we are expecting, hoping, asking and wishing individuals to behave in an altruistic manner for the good of the greater society.


Chairman: Again when we were in the States last week we came across an interesting situation in a Harlem hospital where they treated TB, multi-drug resistant TB, that is a prolonged treatment and not very enjoyable. The attitude of the patients was that not only would they undertake this treatment but they saw it as a benefit for the community too. There was a double expectation there that they were doing something for their population, which is the poor and the down and outs, and it was quite remarkable to see that developing. You might imagine they would be interested solely in themselves getting better but they saw it as a double benefit. I am not sure that the New York press got hold of that but we were quite impressed by it.

Baroness Finlay of Llandaff

362. How do you think the marginal views should be represented, both by the science community and by the media?

(Sir Kenneth Calman) My own view is that they should be represented, that is the first thing. Once they are represented the press, the media and the scientific community really have to put that in perspective. The analogy, if I may express a Biblical analogy, is the distinction between the true and the false prophet. When I asked my theology colleagues to try and answer that question you only get an answer on the outcome, in other words you cannot make that distinction. If somebody says maybe this is the cause of it then I think maybe we need to sit up and think seriously about that. If you think seriously, if you get to the stage where all of the evidence is stacking up the other way you then have to say that has now to become marginalised rather than a marginal view. It is that process, round the time of somebody saying something might be different, that you must take very seriously. Having taken it seriously you might then put it aside because it is not worth it.

(Dr Bryant) I would agree. I have no further comment on that. There is another angle to this, and that is the views of the marginalised in presentation to the media. If we look at communications relating to a whole host of medical things and our ability to communicate with more marginalised groups, that is another area this question has just sparked up in my mind, which we will perhaps move on to later.

(Mr Ghosh) Marginal views should not be ignored because in science and in medicine sometimes marginal views can take over and become the mainstream. In journalism the marginal view might be a whistle-blower giving us information about something. For my part the process is to actually scrutinise it to see if it stands up, if in my own mind it does not then you do not, especially if you have 40 seconds on a piece in the morning, use it at all. There is no point in saying, this is a marginal view but it is not true or to put in its proper context. The original Wakefield paper is a case in point, it was published in a peer review journal but if you do report you have to say that it is at odds with the bulk of scientific evidence. I think is about putting it in context and sometimes deciding not to run with it at all, particularly in the broadcast media where the main news bulletins have the same threshold as the front page or the second page of a broadsheet.

363. Is the time frame the problem? The marginalised view may show itself as emerging as being reasonable or weighing but within the time frame of the media presenting it that has gone off the headline and out of people's consciousness, so you never get back, you never have a second bite of the cherry to have that reasonable representation, not very often anyway, apart from an independent programme?

(Sir Kenneth Calman) If I was an individual involved and felt marginalised or I had disease or something happened to me and somebody said that it is not related to that it is something else I would still have great difficulty getting rid of that from my mind. It is that bit that continues to go on and it is very understandable for individuals who are looking for a way of explaining something that has happened which is very difficult to them. I think we have got to recognise that that will happen. What I think the media needs to do is to move that discussion back to the mainstream while recognising that individuals may have a particular problem.

(Dr Bryant) It is almost a displacement phenomenon: that argument will remain in the mind until the next best argument presents itself and dislodges the first one.

(Mr Ghosh) There are two things. You can keep a watching brief on something to see how it develops but, equally, I do get marginal views across my desk all the time and what I try and do within the time frame is carry out my own peer review process and just ask around, find out what people think, and then form a judgment as to whether it should be in or not and, if it is in, the way in which it is covered. I think that is the way a lot of us operate.

Chairman

364. Any further points on this? If we can go on to question ten. Do we know enough about how people make risk analyses or should there be an increase in research into this area and should we communicate that increase in research to the public?

(Sir Kenneth Calman) Yes, yes and yes. I havesome relationship with the National Radiological Protection Board and because it has got a remarkable database of people phoning in and asking questions you can analyse that and you can begin to use that. PHLS has the same kind of database. So you can begin to look at people's concerns and try and deal with them. The fundamental question is that you and I as individuals have beliefs and values and things that we are concerned about that are not only dictated by the scientific evidence but by lots of other things, that is what influences us, which is why the media is quite important to this. I think we need better research in terms of how that can be developed further. There are a lot of organisations, including the research councils, who have got a particular interest in this at the moment.

(Dr Bryant) However good our research and knowledge is now it will be different tomorrow because people change. We, as a society, continually change. I hark back again to the fact that how we perceived risk 20, 30 years ago was very different and the things that we use within our personal being, as it were, to assess risk are different now. That will continually evolve and change. We need to be up-to-date with what the situation is now always.


Chairman: Any other points?

Lord Lewis of Newnham

365. Can I just ask how far do you consider yourself to do risk analysis and risk management? It does seem to me that the management is really the end of the line and is what is of concern to us. It seems to me that this is the area in which more research is going to be needed.

(Sir Kenneth Calman) If I may respond to that, my Lord Chairman. I think it is part of the whole process. Identification of what the issue is is what I call the anticipatory phase when you are not quite sure there is one, how do you identify that, and that is the risk definition and analysis. Then you get into the management of that. The trouble is that most of the major risks that I have been involved with and the ones which you read about in the press do not happen as cleanly as that, they happen very rapidly and Mr Ghosh has to make some decisions quite quickly. What I think those of us at the other end have to do is to help him with that process rather than hinder it. I think that might make life a lot easier for everyone.

(Mr Ghosh) I think risk management is a necessary part of the work that Sir Kenneth and Dr Bryant carry out, but when it comes to dealing with the media, particularly the broadcast media, what is more important than anything else is people who are trusted and winning back trust has got to be the number one priority and for those people to express their views clearly and honestly. I think the public are very good at judging day-to-day risk, as a species our evolutionary survival ensures that, but when complex scientific issues are concerned what they rely on is what other people think. They used to trust messages from government, the public information films and whatever, but somewhere along the line that trust was lost. It is a case of winning that back so that when government scientists go on the television or radio their views are taken into account and acted upon accordingly.

Chairman

366. A final question more or less directed to Sir Kenneth. Do you think that the new Health Protection Agency which is being developed should have significant independence from the Department of Health in order to ensure that its advice is more trusted than the Department of Health's advice?

(Sir Kenneth Calman) Just one preliminary remark. There is a nice phrase that says trust comes on foot and goes on horseback" and I think that is precisely what Mr Ghosh has demonstrated. I must preface what I say by saying that I am not in the Department of Health any more and I have no links, apart from a small link with NRPB, no real links and nor was I involved in the publication of the document around the Health Protection Agency. My understanding is that the parts of the agency, such as chemicals and environment, the radiological protection and the infectious disease one, will wish to continue to present directly to the public. They will, as always, have to communicate with the Department of Health, that has been a good thing to do, and there will be some areas which will have a national significance, others which will have a more local significance. That balance is one which has always been an important one and I would hope that the individual organisations and the Health Protection Agency itself will continue to be ableto provide advice for the public on whatever, as they do at the moment, linked to the Department of Health.

Lord Rea

367. At the beginning of our discussion the need for a hotline both for journalists but also for professionals was discussed and I wonder whether the Health Protection Agency should provide that hotline and whether it should be adequately staffed in order to do so? It might be a very valuable function I think.

(Sir Kenneth Calman) The answer is I am sure it could but it would not provide an overall coverage. For example, it would not cover drug-related risks, for example, or maybe even vaccine-related risks depending on where they come in the organisation. There is a need, I think, for something perhaps even more central to be able to do all of that together so you have got the one way in rather than six different phone calls or six different websites. The technology is there but if it gets overcrowded it is quite difficult to get into, as we have seen.

(Mr Ghosh) There is a lot of expertise and goodwill, I think what is lacking is co-ordination. If there was a central body able to know who to contact and to bring those people very quickly in contact with the relevant journalists that would be fantastic.

Baroness Finlay of Llandaff

368. Going back to your request which came at the beginning as to whether the mechanism needs to be there very centrally but whoever is called in is inevitably going to have to vary. I am just thinking of when you have a major disaster, there is a hotline set up, people are called in rapidly from lots of places to man this information line and you are asking for the same but really closed between the science and the media we are talking about now and not open to the general public.

(Mr Ghosh) It was just illustrative of what my specific request was for in the event of a bio-terrorist attack, a hotline for a number of journalists to contact. That is quite straightforward because there are a limited number of potential weapons and so forth. I think a wider hotline for dealing with broader issues might be a good idea.

(Dr Bryant) Could I just comment on the last question which was addressed to Sir Kenneth but as somebody who I hope will be working at the Indian level of the Health Protection Agency I hope that I would be able to retain some autonomy in addressing the media and particularly the local public rather than being seen as an arm of government because I think that would lose the credibility of that individual.


Chairman: Well, lady and gentlemen, we have had a good morning. We have gone over a wide area. Thank you very much for attending. You will get a transcript, of course, of what has been said and an opportunity to correct factual data. If there is any other point that has not emerged in our session this morning that you feel is important then please feel free to let us know and to submit some written evidence on that. Otherwise, may I thank you again very much indeed, it has been a most useful session this morning. Thank you.


 
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