Presenting the Benefits and Risks of Oral
Contraceptives: Lessons from a UK 'Pill Panic'.
Ann Furendi, Director, Birth Control Trust,
16 Mortimer Street, London, WIN 7RD, England
On 18 October 1995 the UK Committee on Safety of Medicine
sent a letter to all doctors warning that three yet-to-be published studies had
indicated that "combined oral contraceptives containing desogestrel and
gestodene ... are associated with around a two-fold increase in the risk of
thrombo-embulism". A press release issued by the Department of Health on 19
October 1995 recommended that women "should see their doctor ... to discuss
whether a change of pill is necessary".
The
information on which the CSM announcement was based could have been understood
to confirm the safety of the pill for the overwhelming majority of users. The
excess risk of venous thromboembolism to pill-users was confirmed as one per
10,000 to women using older brands of pill and as two per 10,000 to women using
the more modem 'third generation pills'. The information was, however, presented
as a 'health risk issue' by health officials and reported as such in sensational
terms by the media.
In
the two weeks following the publication of new advice the Family Planning
Association's helpline received 20 times as many enquiries from health
professionals as usual. A letter in the British Medical Journal noted that a
telephone helpline established at a family planning clinic in Glasgow too 2,348
calls on the first seven days after the CSM announcement and that attendances
rose from an expected 700 to 2029.
The
announcement seriously undermined confidence in the safety of oral
contraception. A survey published in the British Medical Journal in march 1996
suggested that 12 per cent of women on the 'higher risk' pills were so concerned
about the publicity that instead of switching to a different pill, they stopped
taking it altogether. A survey of local health authorities has found that, of
those able to supply statistics, 80 per cent recorded an increase in the rate of
abortions. It is estimated that total number abortions associated with the panic
will be approximately 3,000.
This paper will examine (i) why the pill panic
happened (ii) how information on the benefits and risks of oral contraceptives
can be presented (iii) how such announcements can be managed more effectively.
It will draw on an extensive range of interviews with key stakeholders, and on
material drawn from focus groups run to determine how women perceive risk in
relation to reproductive health.
The
author is director of Birth Control Trust -- a non-profit organisation that
organises research and provides information on reproductive health issues -- and
chair of the UK Contraceptive Alliance working group on risk issues and
contraception.
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