Examination of Witnesses (Questions
TUESDAY 28 JANUARY 2003
DR GERRY BRYANT, SIR KENNETH CALMAN AND MR PALLAB
360. Someone, for example, with a fellowship at the
London School of Tropical Medicine could take in tropical diseases
(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
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
(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.
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
(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.
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
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
(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.