June 6, 2013

pregnancy advice: trying to be helpful

This is a guest post by Tom Sheldon, Senior Press Officer at the SMC.

As a society we look to experts for information and guidance.  Need legal advice?  Talk to a lawyer.  Knocking a wall through?  Ask a builder.  We likewise look to scientists and health professionals when we need to know what’s safe and what’s not.  When you’re pregnant and worrying for two, that advice matters.

On issues like diet and folic acid the evidence is very clear, and advice is provided to pregnant women accordingly.  But there are some things we can’t yet say for certain.  Are the levels of bisphenol-A in food packaging, or vitamin A in moisturisers, really harmful to health?

The trouble is, sometimes scientists don’t have the answers.  Do mobile phones cause cancer?  On balance, probably not; but we can’t say for sure.  How to give good advice when there is no strong evidence of harm, but when ‘more research is needed’ (as that scientific catch-all so detested by journalists goes), is a dilemma for scientists.

At the Science Media Centre we are used to dealing with science being misrepresented, distorted or hyped, and it is usually a matter of ensuring journalists have access to scientists who can help separate fact from fiction.  But that’s where this story is a little strange, as it’s not really a scientific argument at all.  The authors of a new report from the Royal College of Obstetricians and Gynaecologists (RCOG) are themselves excellent, responsible scientists who pay great heed to the evidence; they readily agree, for example, that evidence of harm of plastic-wrapped food or moisturiser to an unborn child is weak.  But it’s so weak, some of their critics argue, that no meaningful advice can – or should – be given.

The RCOG report has done just that, and – it must be said – with the noblest of intentions.  They quite rightly note the rash of rumours about chemicals and pregnancy, and have sought to plug a gap in proper advice to expectant mothers that is otherwise a minefield of anecdote and speculation.  The report re-emphasises much good advice on known risks and benefits, as well as highlighting some other less-known dangers – such as the common assumption that natural or herbal remedies are benign, despite such products being relatively unregulated.

When it comes to plastics, cosmetics and furniture, however, things get murkier.  Faced with questions like ‘should I avoid using non-stick pans when pregnant?’ RCOG have wrestled with how to answer it.  Their report recommends “a ‘safety first’ approach, which is to assume there is risk present even when it may be minimal or eventually unfounded” – and here is where the quarrel begins.

As Prof David Spiegelhalter says, “these precautionary ‘better safe than sorry’ recommendations are not necessarily cost-free.”  First, the report has the potential to raise the very alarms it seeks to dampen – and in a vulnerable group who really don’t need any additional unnecessary stress.  Second, as Tracey Brown from Sense About Science puts it, you end up mixing together a huge number of unproven, speculative risks with the really big important ones like smoking and drinking; such a barrage of messages gambles with the power of scientific advice and risks a weary public cynicism.  And third, following every piece of precautionary guidance would be simply impossible in the modern world; as such the advice loses its practical worth.

The most troubling thing for me is that the report, to quote The Times’ (original) headline, ‘passes the buck to mothers’.  I don’t believe it set out to do that intentionally.  But I know from my own experience that when you are expecting a child your precautionary senses are razor sharp.  More than ever, new parents look to experts for advice on dangers to their child.  This report advises women to avoid a huge range of common products “if they are concerned about this issue and wish to ‘play safe’ in order to minimise their baby’s exposure”.  But what parent isn’t concerned?  Who doesn’t want to play safe?  We ask questions of authoritative groups such as RCOG for a reason.  When those questions are turned back on us it’s unsettling.

Let’s be clear: I’m not suggesting we should be told all these products are completely safe.  We don’t know that and it would be irresponsible to claim otherwise.  But we must get it in perspective.  As one developmental biologist put it: “if there really was a significant problem we would be seeing a clear trend of childhood abnormalities – and we’re not”.

If we adopted the precautionary principle in all walks of life, life itself would grind to a halt.  We crucially need scientific evidence to make informed choices about our risk taking.  If a risk is big, small or non-existent, we need to know – and we look to scientists for that assessment.  But as long as we are being given honest answers, we are also remarkably good at putting up with unknowns.  If there is no clear evidence of a risk, tell us that and let us make up our own minds.

As soon as the press release was issued, media coverage was inevitable.  How did the media deal with this?  Pretty well, on the whole.  The BBC’s extensive coverage was exemplary.  And as I write I am working with the Mail to prepare – on their request – a point by point assessment of the evidence of each product and category of chemical highlighted.  Above all, this was yet another defining example of why news outlets need their specialist science and health reporters.  Contrary to the views of some critics, these are not docile creatures spoon-fed canned quotes by the SMC.  They are highly intelligent, well-briefed professionals with a canny eye for good science and – with good scientists and press officers at their disposal – an ability to critically appraise the science behind their stories.

This blog contains the thoughts of the author rather than representing the work or policy of the Science Media Centre.