Richard Smith: My vain search for a pro-mammography speaker

Richard SmithFor the past two months I have been trying to find somebody to speak in in favour of mammography in a debate, but I have failed. Some six people have turned me down. Why, I wonder?

The debate will take place in Edinburgh as part of a meeting on “Controversies in Breast Cancer.” It’s a small, long standing meeting of scientists and clinicians from all over the world interested in breast cancer. The atmosphere is friendly but challenging. My impression is that most of those who attend believe in the benefits of mammography. In other words, they are no rabble.

I’m charged with organising a session on how we disseminate information on complicated scientific stories, including through the media. We want as well to stay away from the standard structure of Powerpoint presentation plus questions. I chose mammography as a good example of a topic in breast cancer where the public are presented with extremely confusing information.

The BBC website reported a study from the BMJ with the headline and standfirst of “Breast screening benefits queried; Screening has not had a significant impact on the fall in deaths from breast cancer, a study claims.”  Three months ago another BBC website story said “Breast screening does more good than harm with any over-treatment justified by the number of lives saved.”
These ping pong reports have been going on ever since mammography was introduced, which is why some countries have adopted screening programmes and others have not.

I have devised a session in Edinburgh whereby we hope to see two high quality researchers with opposing views debate the value of mammography with some 15 minutes each. Before the debate we will have filmed a short Newsnight style interview with both of them. In addition, I will interview them and write a story from each in two styles, one tabloid and one in the style of a “quality daily.” We will give these to our panel and the audience to read in advance together with a collection of conflicting stories from the media. Finally, a panel discussion chaired by Sheena McDonald, a well known professional television and radio presenter, will try and draw some general lessons. The panel will include a patient with breast cancer, a woman citizen, a GP, and the two protagonists. The audience will do most of the talking.

So why can’t I find a scientist or leader of a mammography programme to take part? Most of those who turned me down didn’t give a reason, but one said “We’re tried of this debate. We’ve been through it again and again.”

This strikes me as appalling. While women are bombarded with conflicting and hard to understand information those who favour mammography—and have persuaded governments to spend millions on programmes and hundreds of thousands of women to undergo an uncomfortable procedure with many receiving a false positive diagnosis—are unwilling to discuss the issue. I think of myself as a neutral, but if one side won’t debate—the essence of science and democracy—inevitably I begin to turn against it.

Competing interest: RS is organising the session at the meeting in Edinburgh and will have his expenses paid, including a first class return to Edinburgh bought well in advance so that it’s cheaper than a standard return. He’s not being paid a fee—despite his wife saying “Why do you do all these things for nothing?”

Richard Smith was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.