Inaccurate, Muddled Messages Jeopardize the Public's Trust in Science

Maurie Markman, MD

Most members of the medical establishment probably are aware of Dr Andrew Wakefield and the serious damage resulting from his now completely discredited “research” attempting to link childhood vaccination with the subsequent development of autism.¹ The disclosures that Wakefield had a serious undeclared conflict of interest and his stunningly inappropriate research methodology have negated any suggestion of the validity of his claims. Unfortunately, those who wish to believe the unsubstantiated hypothesis that autism is a direct result of vaccination continue to cite these data despite their rejection by the entire scientific community.

The public’s faith in science, particularly in efforts related to health, is crucial for the successful implementation of strategies designed to improve the human condition. Consider, for a moment, where we would be today if the public refused more than 50 years ago to trust the public health community and clinical science regarding the suggested benefits of the polio vaccine versus what at that point were its unknown risks.

Prevention Communications Fall Short

Yet at times the scientific community has failed to adequately convey the essential message—or overcome even stronger but misleading or false messages—that a particular activity is terribly harmful to the individual, the family, and society as a whole. A recent commentary discussing public concern that continues to surround genetically modified foods (GMOs) despite their long-term safety record emphasizes this point.² As stated in the article, “90% of scientists believe GMOs are safe—a view endorsed by the American Medical Association, the National Academy of Sciences, the American Association for the Advancement of Science, and the World Health Organization.” Nevertheless, the commentary notes, “only slightly more than a third of consumers share this belief.”²The cancer community is not immune from these issues. One needs just to consider the massive but, unfortunately, far less than satisfactory struggle that public health officials worldwide have waged against the profoundly dangerous habit of cigarette smoking to appreciate the limits of objective, unequivocal facts in decisions made by individuals about their health.

A recent report from an international consortium sponsored by the Bill & Melinda Gates Foundation and Bloomberg Philanthropies noted that 11.5% of all deaths globally in 2015 (6.4 million people) were attributable to smoking and that more than half occurred in 4 countries, including the United States.³ Worldwide, 25% of men and 5.4% of women smoked. Although these statistics represent a reduction in smoking prevalence since 1990, they cannot be considered an overwhelming success by the public health community in communicating the dangers of smoking, an addictive habit without any remotely meaningful counterbalancing health-related benefit.

Unfortunately, events “external” to the medical community, as well as misguided actions within our own profession, can interfere with the delivery of a clear and coherent message to the public. One cannot find a better example of an external event that should leave one frustrated with how health policy is considered, implemented, and communicated than the decision by a Los Angeles Superior Court judge who declared that coffee is carcinogenic and, as a result, required businesses to state this “fact” on product labels.⁴ Evidence supporting this claim at the clinical level is essentially nonexistent. However, a California law (Proposition 65, passed in 1986) “mandates that businesses with more than 10 employees warn consumers if their products contain 1 of many chemicals that the state has ruled as carcinogenic.”⁴ As a result, this nonmedical authority made a stunning health-related determination.

The chemical in question, acrylamide, has been suggested to produce this effect just in animals, and the quantity present in coffee is far less than what is considered to be carcinogenic, but that is apparently irrelevant. Imagine the tobacco industry’s delight upon learning that the critical message of the dangers of smoking can be diffused by new concern about the dangers of that morning cup of coffee.

Finally, we come to the issue of “internal” health-related statements by the medical community that may confuse, rather than enhance, communication of critical messages regarding cancer prevention. An excellent example of this phenomenon is a recent peer-reviewed report in the Annals of Internal Medicine about drinking hot tea and the subsequent development of esophageal cancer.⁵ A survey conducted in China highlighted the relationship between alcohol and tobacco use and the habit of drinking hot tea. The investigators concluded that “drinking tea at high temperatures is associated with an increased risk for esophageal cancer when combined with excessive alcohol or tobacco use.” In fact, daily drinking of hot tea was not by itself found to be associated with an increased risk of esophageal cancer. However, combining hot tea with either tobacco use or excessive alcohol consumption or both revealed a statistically significant increase in the risk of this most difficult cancer.

Notably, the study authors did not conclude that the data provided strong support for avoiding excessive alcohol intake or ceasing tobacco use but, rather, stated the following regarding their findings: “They suggest that abstaining from hot tea might be beneficial for preventing esophageal cancer in persons who drink alcohol excessively or smoke.”

Again, imagine a delighted tobacco industry, which can now cite this peer-reviewed manuscript that declares a reasonable strategy for reducing the risk of this cancer is to not drink hot tea. What were these authors thinking when they wrote that statement, and who were the peer reviewers and journal editors who permitted this unhelpful and potentially dangerous conclusion to be included in this publication?

References

1. Wakefield AJ, Murch SH, Linnell AA, et al. Retracted: ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 1998;351(9103):637-641. doi: 10.1016/S0140-6736(97)11096-0.
2. Brody JE. The debate persists over G.M.O. foods. New York Times. April 24, 2018:D5.
3. GBD 2015 Tobacco Collaborators. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: a systematic analysis from the Global Burden of Disease Study 2015. Lancet. 2017;389(10082):1885-1906. doi: 10.1016/S0140-6736(17)30819-X.
4. Carroll AE. Cancer label on coffee has its own risks. New York Times. April 24, 2018:A14.
5. Yu C, Tang H, Guo Y, et al; China Kadoorie Biobank Collaborative Group. Hot tea consumption and its interactions with alcohol and tobacco use on the risk for esophageal cancer. Ann Intern Med. 2018;168(7):489-497. doi: 10.7326/M17-2000.