A tale of two colleges: is it really controversial to advise mothers about potential health effects of chemical exposures?

October 24, 2013 at 6:32 pm | Posted in Feature Articles | 1 Comment

Image by Madlyn / Morguefile

This month (October 2013), the American College of Obstetricians and Gynecologists (ACOG) published a Committee Opinion about exposure to toxic environmental agents. It describes “reducing exposure to toxic environmental agents” as a “critical area of intervention” for reproductive health care professionals because of “robust” evidence linking exposure to environmental agents to a range of adverse reproductive and development health outcomes. The Opinion goes on to state that while reproductive health professionals should provide in-clinic counselling on reducing chemical exposure, they also have a role to play beyond the clinical setting, in advocate “timely action to identify and reduce exposure to toxic environmental agents”.

A similar paper was published on the same theme in the United Kingdom in June this year, when the UK equivalent of ACOG, the Royal College of Obstetricians and Gynaecologists (RCOG), issued a Scientific Impact Paper titled “Chemical Exposures During Pregnancy”. As did ACOG, the paper recommended a “safety-first approach” for dealing with the problem of being “exposed to a complex mixture of hundreds of chemicals at low levels” for which “methods for assessing the full risk of exposure are not yet developed”. A list of things which women can do to reduce their exposure was given, and it was suggested that this information be conveyed to women by reproductive health professionals.

Reaction in the UK

For a short paper intended for internal use by members of RCOG, the publication brought on a storm of criticism and press interest, with almost all major printed media outlets picking up on the story.

The BBC led the way with almost exclusively negative media coverage with an article titles “Pregnancy safety advice prompts criticism”, with a brief outline of the main points of the Paper, followed by criticisms from “many expert organisations”, some of whom were quoted as critical when they more-or-less repeated what the report said (that there “needs to be more scientific and evidence-based research into the issues”), another who made claims in direct contradiction of the RCOG paper which the story made no attempt to verify (that “there is no evidence to suggest that chemicals in items such as personal care products are a risk to public health”) and closing with a quote from a spokesman for the Cosmetic, Toiletry and Perfumery Association saying there was “no need for anyone – pregnant or otherwise – to worry”.

Other papers similarly ran with the controversy. The Daily Telegraph ran a story “Top toxicology professor condemns ‘unhelpful’ advice for expectant mothers”, while the Guardian led the story with the RCOG advice being “criticised as confusing”.  The Daily Mail ran a comprehensive article “Pregnant women told to avoid painting the nursery, buying new furniture or going near non-stick frying pans as they may expose their unborn baby to dangerous chemicals” quoting apparent criticism from the Royal College of Midwives, Mumsnet and Sense About Science – the same organisations as quoted by the BBC.

The Independent was the only major national paper to cover the story without putting controversy front-and-centre, even offering a rare example of an organisation welcoming the report by identifying the UK National Childbirth Trust as having “praised” the report because “‘practical guidance’ on chemical risks” is “sorely lacking in the UK”, and even putting a different slant on the comments by the Royal College of Midwives, quoting them as saying that women should not be “unnecessarily alarmed” and that more research is needed to get clear on potential harm – which puts the oppositional slant as presented by other media outlets in a different light.

Overall however, the media reaction combined with a comment piece in the Financial Times titled “The Mother of all Scare Stories” and two comment pieces in the Guardian (one bemoaning another “list that doesn’t help”, another that pregnant women deserve more than “infantile advice”) leaves a sense that RCOG produced a needlessly controversial, ill-informed and unnecessary report about an at-best minor if not outright speculative problem during pregnancy.

Reaction in the US

In comparison, the response in the US to the ACOG paper could not have been much more muted.

PR Newswire ran a press release from the American Chemistry Council, ACOG Opinion Creates Confusion For Pregnant Women, which presents the Opinion as being scientifically limited because it “includes references to specific chemicals, which are based on a limited number of flawed studies, and ignores thorough scientific assessments that demonstrate safe use of these substances.”

The ACC also expressed concern that women “rely on their physicians for sound medical advice and access to reliable information” and that “creating confusion and alarm among expectant mothers will distract from the well-established steps doctors recommend to support a healthy pregnancy and a healthy baby.” The ACC is the principal representative of chemicals industry interests in the US.

The theme that such advice is a problem because it is alarmist was only significantly echoed in an opinion piece in Guampdn.com, an electronic newspaper for the US-administered Micronesian island of Guam. The piece complained that the ACOG advice would discourage women from having children when Western birth rates are already too low “to sustain the population”, the possibility that such advice will make “women needlessly worried about canned vegetables” so they “may well end up consuming less vitamin-packed vegetables overall” and that “these warnings make pregnancy more stressful”.

The piece was written by Carrie Lukas, author of several studies for the Cato Institute and formerly a senior policy analyst for the House Republican Policy Committee, and currently managing director of the Independent Women’s Forum, a politically conservative non-profit.

Otherwise, the limited coverage was positive. RH Reality Check published an opinion piece describing ACOG as grappling with the problem that we “can’t completely eliminate exposure to chemicals that are harming our health and that of our families”, and that the problem is most likely to affect women in low-income jobs – supporting the recommendations that obstetricians and gynaecologists should give women counselling on how to reduce exposure to potentially harmful chemicals and advocate for reforms to chemical policy. An opinion piece in the Huffington Post echoed the sentiment. Salon.com ran a short article, as did Boston.com, while US News & World Report quoted Dr Howard Frumkin, University of Washington public health dean and environmental health specialist as saying the report was “a very balanced, reasonable and evidence-based contribution.”

And that was more-or-less it.

Concluding remarks

The difference in reaction to two similar papers in the US and UK media should be surprising, given that in the US coverage of chemicals issues is now an everyday occurrence, while UK outlets (outside the confines of the famously sensationalist Daily Mail) are much less likely to cover chemicals stories. Yet here we have a minor publication intended for reproductive health professionals having almost unprecedented impact across all the major UK papers.

Some people undoubtedly wanted there to be a controversy. It sells papers, for one thing. But it does not follow that the originating point of the controversy is itself controversial: there is a very real difference between creating a controversy through eliciting and reporting criticism, and reporting on conflicting opinions which are a direct result of intellectual controversy. In the latter case the controversy is a natural event; in the former, it is a manufactured one.

Journalists, talking heads and commentators should all be cognizant of this, and be aware that if one is going to comment on a controversy, it will not advance issues by treating a manufactured debate as if it is a genuine controversy. The fact is, only Sense About Science, a small handful of university professors and a few trade associations originally had anything at all to say about the RCOG report – and these same faces popped up in almost all the UK media coverage.

Nobody else noticed that RCOG had published their “list” for mothers, and they would not have done had this small group of experts and reporters not made such a fuss about it – just as virtually nobody in the US noticed, barring an advocacy group with a conservative reputation and the US chemical industry trade association.

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  1. […] ACOG: Exposure to Toxic Environmental Agents. The evidence that links exposure to toxic environmental agents and adverse reproductive and developmental health outcomes is sufficiently robust, and the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine join leading scientists and other clinical practitioners in calling for timely action to identify and reduce exposure to toxic environmental agents while addressing the consequences of such exposure.  (Click here for our coverage of the statement.) […]

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