On 24 and 31 October 2013, ABC television’s Catalyst program aired a two-part series that questioned the link between blood cholesterol and heart disease, and whether current dietary advice or statin medication was effective in lowering heart disease risk. Although the first program on diet was very biased Catalyst may have got away with it as the science around diet and heart disease is considered rather ‘soft’ and is still unfolding.

However, the second program on statins, cholesterol and heart disease was on very firm scientific ground. The last time I looked there were 24 meta-analyses on statin medication and heart disease risk and all showed benefit. But rather than present this perspective Catalyst decided that the public interest would be better served by sowing seeds of doubt.

There were howls of protest. To their credit, other journalists at the ABC took aim at Catalyst. Media Watch presenter Paul Barry said … Catalyst struck us as sensationalist and grossly unbalanced; and some of their so-called ‘experts’ had questionable qualifications.

The ABC’s health guru Dr Norman Swan considered the health implications saying that People will die as a result of the Catalyst program …. It doesn’t get much stronger than that. Was Swan going over the top, or did he just have a good understanding of his subject?

New University of Sydney study

A new study led by researchers at the University of Sydney’s Faculty of Pharmacy has provided some answers. The purpose of the study was to quantify any changes in the dispensing of statins after the airing of the Catalyst program in October 2013. The researchers found significant and sustained changes in statin dispensing following the airing of the program, 60,897 Australians having been affected up to 30 June 2014.

In relation to the health implications the researchers had the following to say:

If the 60,897 individuals we estimated to have been affected continue to be non-adherent, this could result in between 1522 and 2900 preventable, and potentially fatal, major vascular events.

So, unless the situation can be reversed a couple of thousand preventable heart attacks or strokes may occur as a direct result of the Catalyst program. It’s impossible to say how many of these events will be fatal so we can’t accurately answer the question posed at the top of this post. But it would appear that Norman Swan did indeed know what he was talking about when he made the claim that People will die.

Spare a thought for the poor souls working in the ABC’s legal section. Just imagine the litigation to come.

How did the ABC let it happen?

Although current affairs programs on commercial television often present shock-horror health stories, the community expects more from the ABC, especially from its science program. No doubt the credibility of both the ABC and Catalyst led to the high ratings and high impact of the cholesterol programs – people thought it was true. Yet these two programs would have to rate as the most irresponsible and dangerous piece of health journalism ever aired in Australia. Has any other single act of journalism ever put the health and lives of so many people at risk?

What is unclear, however, is why these programs ever saw the light of day? Who pitched the idea to Catalyst? Why would any producer of a reputable science program take it on? Why was the program’s research so bad and so one-sided? Who chose the dodgy ‘experts’ to mount the non-science argument? Why didn’t the ABC’s internal systems start flashing red lights before the program went to air?

The offending Catalyst programs have been removed from the internet so no more damage can be done. How the producer of the cholesterol programs managed to keep her job at Catalyst is a mystery? Wasn’t the casualty rate high enough?

In the meantime the next chapter in the cholesterol story is about to unfold. I’ll cover it in my next post.

The media doesn’t manage nutrition very well. Apparently, fundamental concepts of good nutrition such as variety, balance and moderation just aren’t very sexy so the media is forever souping things up a bit as it attempts to meet the general public’s insatiable appetite for articles about food, nutrition and diets. Instead of old nutrition truism like ‘There are no good and bad foods, only good and bad diets’ we read that some foods are ‘toxic’ while others are superfoods. All quite over the top.

Fortunately, every now and then a health journalist will examine a nutrition topic in depth, potentially providing the general public with an opportunity to gain some real understanding of nutrition and to hear the views of leading experts.

But with the opportunity there is also a threat – false balance.

What is false balance?

Wikipedia defines false balance as … a real or perceived media bias, where journalists present an issue as being more balanced between opposing viewpoints than the evidence actually supports. Journalists may present evidence and arguments out of proportion to the actual evidence for each side, or may censor information which would establish one side’s claims as baseless.

A good example of false balance in recent times was the ABC’s Catalyst program about saturated fat, cholesterol and heart disease. The views of two Australian experts were contrasted with those of several gentlemen from the United States. To the viewer the differing perspectives would have appeared as a legitimate debate among equally qualified experts. However, a quick check of the credentials and publication history of the US speakers showed that they had little expertise in the field. The perceived balance in the program was not real – false balance.

Image: source

Motives behind false balance

One possible motive for false balance in health journalism is the desire for sensationalism. While an accurate assessment of the links between diet, cholesterol and heart disease may be a bit dry and therefore unlikely to generate big ratings, a contentious debate in which a longstanding tenet of modern nutrition is challenged is likely to draw an audience.

Some argue that false balance can be an unintended consequence of a journalist just trying to do a good job by providing alternative views. But this comes unstuck if there is ‘false equivalence’. For example, in a discussion on fluoridation and dental health, is it right for the views of an eminent Professor of Preventive Dentistry to be given equal weight to those of a concerned member of the general public with no background or knowledge in the health sciences? Journalists can’t be expected to have deep knowledge of everything they write about and their false balance may be inadvertent. But if a journalist knows that the views of the concerned citizen are based on false information, is the journalist providing balance by broadcasting their views or knowingly distorting the facts?

One issue here may be the postmodern contempt for facts. Whereas science is based around generating and testing hypotheses as a means of developing an objective and reliable foundation for knowledge, those journalists schooled in postmodernism eschew the very idea of universal truths. If this philosophy is at play the role of the journalist can stray from reporter to activist.

Unfortunately, commerce also plays a part as some nutrition articles are paid editorial, but this is not the journalist’s fault.

Image: source

Catalyst on low carb diets

Towards the end of last year ABC television broadcast ‘Low Carb Diet fact or fiction’, the Catalyst program’s first real foray into diet and health since its infamous cholesterol programs, which were eventually withdrawn. Were lessons learned? Yes and no. Certainly the moderate views provided by Associate Professor Tim Crowe and dietitian Melanie McGrice were welcome and the tone was less sensational than previously. But was this a case of balance or false balance? Was the evidence presented out of proportion to the actual evidence for each side of the argument?

There were certainly many more speakers advocating low carbohydrate diets than there were recommending more moderate approaches. Of more concern, seven of these speakers (eight if the Catalyst presenter is included) have been associated with Low Carb Downunder, an organisation whose funding source is undeclared. Rather than representing a range of independent views these speakers were in lockstep with one another, though viewers would have been unaware of this. The airing of the Catalyst program actually coincided with the commencement of a nationwide seminar series by Low Carb Downunder, providing an ideal advertisement. A happy coincidence I am sure.

In a science program that interviewed three people with professor in their title and five medical doctors or PhDs, we can only wonder why celebrity chef Pete Evans was interviewed. His contribution was to extol the virtues of animal fats and coconut oil – at one point he shoved a spoonful of coconut oil in his mouth stating ‘you can eat it by the spoonful’.

Maybe he was just there to boost the ratings. But given that Pete Evans is associated with Low Carb Downunder, and given that the invited speaker at the recent Low Carb Downunder events has a coconut tree in his logo, it’s not hard to imagine a commercial motive.

False balance?

So yes, false balance on display again. But why? As new scientific evidence on the role of carbohydrates in the diet emerges expert views are in a state of flux, providing health journalists with a rich vein of nutrition controversy to mine. The general public deserves to hear the real debate and the views of the experts who are engaged in it.

Message to all dietitian-nutritionists: Feel free to send examples of biased articles about nutrition to The Sceptical Nutritionist.

Image: source