UK: How a newspaper can help to misrepresent expert views

In a 30 October 2016 article pretending to be a news report, a UK newspaper reported that the Royal College of Obstetricians & Gynaecologists (RCOG) had been accused of calling for abortion of all fetuses diagnosed with Down’s syndrome antenatally because, according to their headline, “it costs too much to care for them”. This is not the RCOG’s position. But the newspaper got itself a juicy story and made the RCOG, who never said any such thing, look like a villian. The newspaper wrote: “The row erupted following a consultation over a new, more accurate prenatal blood test for Down’s [syndrome] that the [UK] National Health Service is expected to approve.”Here is some history: In 2009, the RCOG published a statement regarding the effects of the changes in maternal age [in the UK] and advances in screening on the incidence of live births with Down’s syndrome and on the number of antenatal diagnoses”. The statement supported “increased access to non-invasive testing to improve antenatal screening for Down’s syndrome” in line with the UK National Screening Committee’s own policy, in place since 2001.The crux of their statement was: Antenatal screening for Down’s syndrome provides important information for pregnant women and their families. The RCOG fully supports women’s informed choice in relation to antenatal screening, regardless of how they choose to proceed. Quality information and counselling are also important prior to antenatal screening and related interventions, in order to prepare women for possible results, explain options, and enable families to access support when required.”As seemed likely in 2009, the new antenatal screening test for Down’s syndrome is now ready for use, and was recently approved by the UK government. However, a recent BBC2 TV programme by the actress Sally Phillips, called “A World Without Down’s Syndrome?“. In it, she says that the number of people terminating for Down’s syndrome has gone up 40% and that 90% of British women terminate their pregnancies when they receive a positive diagnosis. Having a child with Down’s herself, she asks: “What’s so dreadful about Down’s syndrome?” She interviews a teacher whose view is that Down’s should not be a legal reason for termination. At several moments in the film, doctors are criticised for not understanding Down’s and challenged as to why they should want to give women prenatal screening information. She expresses the fear that the new test would lead to an increase in terminations for Down’s syndrome. She defends the right of children with Down’s to be born, which she implies is not shared by others, and perceives the existence of testing as a condemnation of people with Down’s. She interviews a doctor in Iceland who tells her that 100% of pregnancies diagnosed with Down’s are terminated. But while he thinks that may not be a good thing, he does defend the right to knowledge so that the individual woman/couple can make an informed decision. She says she agrees with him, but as the film goes on, she clearly doesn’t and can’t accept that women decide they would not be able to cope and act accordingly.Offering a different perspective, obstetrician-gynaecologist Brenda Kelly defends the new test as much more accurate than existing screening tests – over 99 out of 100 pregnancies with a Down’s syndrome baby will be picked up earlier in pregnancy, and there is no risk of miscarriage with the test, as there is with previously existing tests – amniocentesis and chorionic villus sampling. With the new test, far fewer women will need to undergo one of these more invasive tests later in pregnancy, which in turn means less risk of miscarriage due to these tests, as well as less uncertainty about the accuracy of the results for the woman/couple. Perhaps there will be more cases of Down’s syndrome identified, she said, and perhaps more terminations. But women who don’t want testing need not have it, and those who are tested and learn that the baby will have Down’s need not decide for abortion. In essence, this is what the RCOG says too.The RCOG’s concern was that if the government refused to approve the use of the new test in the National Health Service, it would be because of its cost. Instead of simply arguing that cost should be no object because of the value of the new test, they argued that if cost was an issue, a different kind of cost analysis should be done that took into account not only the cost of the test itself but also the costs to the state of caring for children and adults with Down’s syndrome. This led to a storm of protest because it was misinterpreted to mean that the cost of caring for children and adults with Down’s was too high, with the implication that abortion was the only solution following a diagnosis of Down’s. The newspaper capitalised on the misinterpretation of the RCOG’s point and used inflammatory language (the headline read: “Doctors’ anger over medical body’s call to ‘abort Down’s babies’ because it costs too much to care for them”) for the scandal value, and managed to get a few jabs in against abortion as well.Language and meaning are important and are open to, in the case of the newspaper, wilful misinterpretation. Scientists and medical professionals communicate in particular ways. Positions expressed in a public forum have to be carefully worded because anti-choice groups and media are waiting to pounce on any excuse to twist your views to suit their means.SOURCES: Daily Mail, by Jonathan Petre, 30 October 2016 ; inews, by Dr Brenda Kelly, 5 October 2016 ; Letter to the RCOG, undated ; VISUAL