The right to a fair trial

Abstract

Few newspaper readers can even have been aware of the need for double-blind clinical trials of new drugs, until the recent furore over the early results of such a trial.The Independent was explicit in its front page lead story on 7 April (“Drug can halve the risk of breast cancer”). The Guardian was more cautious (“Drug may halve risk of breast cancer”). Their common subject was the release of data from a trial in the US indicating that tamoxifen might be highly beneficial in women who were especially vulnerable to the disease.The contrast between these and other substantial reports in UK broadsheet newspapers and those in the tabloids was striking. The Sun, for example, ignored the news altogether, while the Mirror gave it three sentences at the bottom of page 7. So much for the women readers of these mass circulation papers.But this was no ordinary clinical trial. The US National Cancer Institute had indeed announced results (from the National Surgical Adjuvant Breast and Bowel Project) which apparently showed a 45% reduction in the risk of invasive breast cancer in those of 13,000 women who had been receiving tamoxifen as a preventative in a double-blind trial.The findings, however, were publicised 14 months before the original target date because early results suggested that the drug was proving highly effective. Abandoning the trial protocol, and thus sacrificing some of the intended clarity in the results, the organizers had taken the unusual step of breaking the double-blind.Hence the prudence of the Guardian's headline, and the cautionary comments from UK experts embedded in its account and in most other UK coverage. In general, however, journalists paid more attention to the known side-effects of tamoxifen, rather than to the possibility that its administration had simply postponed the development of breast cancer and had not prevented it altogether.It was the potential for toxicity, too, which persuaded several US newspapers to use headlines such as “Cancer breakthrough comes with big risk” (USA Today) and “Breast cancer study offers hope but no easy answers” (Los Angeles Times). Although most British accounts mentioned other on-going UK and international studies (albeit briefly in some cases), most US writers totally ignored them.The US papers reflected anxieties about the side-effects, not the incompleteness of the resultsThey continued to do so even after a press conference called in London by the Cancer Research Campaign and the Imperial Cancer Research Fund, which received extensive coverage in the British press on 8 April. In contrast to expert comments published the previous day (“This is very, very encouraging”, Dr Trevor Powles; “We are delighted”, Dr John Toy), the tone became extremely sceptical.“Doctors accuse US of wrecking cancer drug test … Researchers are angry that early announcement of results ruins other trials,” said the results ruins other trails,” said the Times. “US breast cancer claims denounced … It will take years to be sure about new drug,” said the Guardian.The Guardian's coverage at this stage was superb. In addition to a news item, health correspondent Sarah Boseley contributed a comprehensive analysis, two thirds of a page in length, accompanied by diagrams and references to source material. This was a model feature of the type often required by the public but seldom provided by the media, and which is essential to explain such a complex issue fully.The Times adopted a similar approach, with a collation of four pieces on different aspects of the story. One was an admirably succinct summary by science editor Nigel Hawkes of the problems created by the premature termination of the US study, focusing particularly on the important questions that will now never be answered.With the conspicuous exception of the New York Times, caveats concerning the “wrecked” trial were largely absent from US coverage. Reports were tempered, certainly, by warnings of side-effects, and in some instances by careful observations on the potential application of genetic tests to identify high-risk women. But few reporters highlighted the inherent uncertainties in conclusions from a study abandoned long before the end of the time originally deemed necessary for unambiguous results. And the word “breakthrough” was much used.Were UK readers, on the other hand, likely to be confused by the spectacle of one seemingly authoritative group of experts repudiating research findings reported by another? After all, this was not a clash of opinion as to what causes obesity, autism or depression, but a disagreement over the very foundations of scientific method.The question is valid. Nevertheless, Britain's newspaper readers probably learned more about the theoretical and practical dilemma inherent in double-blind studies than US readers did from their country's style of reportage. As the Los Angeles Times observed, this was a story with no easy answers. Yet the wider perspective adopted by most UK journalists did much to aid understanding.