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Wednesday, 29 September 2010

PCC Decision Re. Dr Christian Jessen.

Now that the wheels of procedure have turned, I can let you see the letter I sent to the PCC regarding this article, and their reply, which I received today.
I have to say, it's not good news.  This is the second time the PCC has failed to protect breastfeeding from being maligned in the press this month and you can't help but wonder if the Code needs strengthening?  I am pretty stunned at their decision, especially since Dr Jessen is a medical professional, however but as I'm sure you'll be interested in how they came to their decision here is a copy of my letter to them, and their reply to me:

To whom it may concern – 


I wish to make a formal complaint about an article published in Closer magazine – dated 28th August – 3rd September 2010. The article is by Dr Christian Jessen and forms part of his ‘Ask Dr Christian’ column.

I am concerned that the article breaks the PCC editorial code (section 1) in at least two areas, i) and iii).

1:i) The Press must take care not to publish inaccurate, misleading or distorted information, including pictures.

In my opinion the information being presented is distorted:

1/ The title of this section ‘Breastfeeding can make your boobs sag – FACT!’ is very misleading. Breastfeeding does not cause breast sagging. It has been clear for some time that the breast changes (breast-ptosis) which occur in women are due to pregnancy and not breastfeeding. Many women who do not breastfeed experience the same phenomenon as they grow older.

A study presented to the American Society of Plastic Surgeons (ASPS) Plastic Surgery 2007 conference in Baltimore (and which was widely reported in the press at the time) concluded that:
‘Greater age, higher body mass index, greater number of pregnancies, larger prepregnancy bra size, and smoking were identified as significant independent risk factors for postpregnancy breast ptosis. Breastfeeding was not found to be an independent risk factor for ptosis’
In addition to this, Dr Jessen and Closer magazine stated that:
‘breastfeeding can cause changes to your breasts, including loss of fullness and even dropping, especially if you suffer a lot of mastitis’
Mastitis is most frequently caused by poor breastfeeding management and problems with the baby’s ‘latch’. Failure to mention this simple fact as an important element in prevention of this disease is irresponsible in my opinion.

Mastitis can, therefore, be prevented in the vast majority of cases by a mother having access to good breastfeeding support. Section 7.6 of the WHO Document on Mastitis (2000) states that:
Recurrent mastitis may be due to delayed or inadequate treatment of the initial condition (71) or uncorrected poor breastfeeding technique. 
The best estimates give the number of women suffering from mastitis as something in the region of 10% (WHO)
http://www.cks.nhs.uk/patient_information_leaflet/mastitis# 

Of this 10%, an estimated 3% to go on to suffer a breast absess*.

Therefore the outcome Dr Jessen referred to in his article – changes to the breasts caused by breastfeeding - can be estimated to affect 0.3% of breastfeeding women.
* ‘In approximately 3% of cases where mastitis does develop a breast absess may form’

Therefore the long term damage Dr Jessen refers to in relation to mastitis only occurs in a tiny minority of lactating mothers who develop mastitis in the first place. The disease can also occur amongst the general population – and in’ failing to mention this, the article seems to imply that breastfeeding is the sole cause of this condition.

‘Mastitis is inflammation of the breast with or without infection. Mastitis with infection may be lactational (puerperal) or non-lactational (e.g., duct ectasia). Non-infectious mastitis includes idiopathic granulomatous inflammation and other inflammatory conditions (e.g., foreign body reaction). A breast abscess is a localised area of infection with a walled-off collection of pus. It may or may not be associated with mastitis’

Key to treating mastitis is continued breastfeeding – if a mother reading this article feared she was suffering from the condition she may cease breastfeeding suddenly for fear of causing herself long term damage. This would in fact make the condition worse

By failing to mention the need for continued feeding and professional breastfeeding support in such circumstances, both Dr Jessen and Closer magazine have put their readers at risk of sudden cessation of breastfeeding and therefore further complications.

A WHO document on the illness states that:
‘With timely, appropriate and adequate treatment of mastitis and breast abscess, recovery should be complete, and normal function of the breast can usually be expected with subsequent lactations. However, delayed, inappropriate or inadequate treatment may result in relapse, more extensive lesions and even permanent tissue damage. Repeated episodes of mastitis may give rise to chronic inflammation (141) and irreversible distortion of the breast (134).’
The phrase ‘irreversible distortion of the breast’ here references a 1982 study by Qureshi F. ‘The acute breast abscess. Practical procedures’ (Australian Family Physician).
In the abstract to this study the author states that:
‘irreversible distortion can result from the chronic inflammation and persistent discharge associated with delayed or inadequate drainage of the abscess’ 

However, such a complication is highly unusual and more recent research published on the ‘Best Practice’ section of the British Medical Journal website (copyright 2010) states that:
‘Breast infection, including an abscess that is adequately treated, is unlikely to cause significant breast scarring.  Surgical intervention other than needle aspiration may cause a postoperative scar.  Recurrent infections, TB, and granulomatous mastitis* can cause significant breast deformity.’  

(*Granulomatous mastitis is an autoimmune disease and an extremely rare condition, which usually only affects women between 2 and 6 years after pregnancy.  It is therefore highly unlikely to be caused by normal breastfeeding. http://en.wikipedia.org/wiki/Granulomatous_mastitis)

The British Medical Journal article also states that the risk of long-term damage from mastitis is ‘low’ but that the likelihood of what it describes as the ‘complication’ of a woman giving up breastfeeding is ‘medium’.

‘an abrupt cessation of breastfeeding may exacerbate the symptoms of mastitis, and there is an increased risk of breast abscess.’ 
http://bestpractice.bmj.com/best-practice/monograph/1084/follow-up/complications.html

You can see from this that the possibility of long term damage to a woman from discontinuing breastfeeding is higher than if they continue.

In my opinion Dr Jessen’s article in Closer magazine has distorted the facts because it does not give an indication of the true likelihood of a woman suffering the outcome described.

ii) A significant inaccuracy, misleading statement or distortion once recognised must be corrected, promptly and with due prominence, and - where appropriate - an apology published.

I emailed the magazine (25th August 2010) to express my concerns (about what is in my opinion a ‘significant inaccuracy’) to the editor and received the following replies for your information:
‘Hello,
Thank you for your email.
I am afraid I cannot recall the April edition in which we give the answer you quote in blocks and italics – if you let me know the page and section of the magazine I will try and retrieve it.
Regarding this weeks answer, I believe Dr. Christian’s response to the question is hugely balanced and gently explains that in case of complications such as mastitis the breast shape can change but that breastfeeding doesn’t automatically lead to sagging breasts.

Kind regards,
Maggie Hitchins Editorial Assistant’

And (when link to their previous article was supplied)

‘Thanks Anne. We have asked Dr Christian to come back to us and I will get back to you then.  Kind regards, Maggie Hitchins  Editorial Assistant’

iii) The Press, whilst free to be partisan, must distinguish clearly between comment, conjecture and fact.

Nowhere in the article does it state that this is personal opinion, nor does it cite any scientific references. Doctor Jessen has written the piece to read as fact and I can see no disclaimers. In this respect I feel it contravenes section 1:iii of the code quite clearly.

I look forward to hearing from you regarding the outcome of this complaint.

Best regards,

Response email received today:


Further to our last correspondence, the Commission has now made its assessment of your complaint under the Code of Practice.
The Commission members have asked me to thank you for giving them the opportunity to consider the points you raise. However, their decision was that there was no breach of the Code and a full explanation is enclosed.
Although the Commissioners have come to this view, they have asked me to send a copy of your letter to the editor so that he is aware of your concerns.
If you are dissatisfied with the way in which your complaint has been handled - as opposed to the Commission’s decision itself - you should write within one month to the independent Charter Commissioner, whose details can be found in our How to Complain leaflet or at http://www.pcc.org.uk/complaints/process.html
Thank you for taking this matter up with us.
Yours sincerely
Elizabeth Cobbe

Commission’s decision in the case of X/Y/Z v Closer
Three complainants were concerned that the article “Fact or Fiction?” had failed to distinguish between comment, conjecture and fact. They argued that as the article had presented the statement “Breastfeeding can make your boobs sag – Fact!” as a fact when evidence exists to the contrary. The complainants said that not only was this misleading to readers but it had potential health implications for them too.
Under the terms of Clause 1 (Accuracy) of the Editors’ Code of Practice, publications must take care to distinguish clearly between comment, conjecture and fact. In this instance, the Commission noted that the article made clear that, firstly, the claims were based on the unique medical opinion of Dr Jessen, and secondly, the inclusion of the term “can” in the phrases “Breastfeeding can make your boobs sag”, “breastfeeding can make your boobs sag” and “pregnancy and complications when breastfeeding can cause changes to your breasts” did not imply that every case of breastfeeding resulted in sagging.

The Commission was satisfied that readers would recognise that the impact of breastfeeding is different for every woman and the article was reporting matters of conjecture, rather than statements of fact. On this occasion, the Commission could not establish a breach of Clause 1 (Accuracy) of the Code.

The Commission acknowledged the complainants’ further concern that the statement “breastfeeding can cause changes to your breasts, including loss of fullness and even drooping, especially if you suffer a lot of mastitis” should have been further substantiated, particularly as one of the complainants indicated that mastitis was a preventable condition. However, the Commission considered that the newspaper was entitled to present Dr Jessen’s view in the manner which it had. Furthermore, the omission of exhaustive detail regarding the wider research that had been conducted on the subject of breastfeeding and the prevention of mastitis was not a matter that rendered the article misleading to any significant degree.
Finally, the Commission turned to the complainants’ concern that readers’ health may be at risk if they stop breastfeeding as a result of the article. While this was not strictly a matter for consideration under the Code, it noted that the conclusion of the article clearly promoted breastfeeding. For example, the author stated that “it has important short and long term health benefits for both mum and baby”. There were no outstanding matters to pursue under Clause 1 (Accuracy).'


I look forward to hearing your thoughts, and regret that Dr Jessen will probably think this gives him a license to continue to denegrate breastfeeding and breastfeeding mums.  It's still possible that he'll be more considered in his public statements from now on, since clearly, we'll be watching him very closely!

8 comments:

  1. "The Commission was satisfied that readers would recognise that the impact of breastfeeding is different for every woman and the article was reporting matters of conjecture, rather than statements of fact"

    Really? Even when the title of the article had the word 'FACT!' in it?

    Pah.

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  2. Quite... There were a few holes in their response!

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  3. I'm really shocked that this happened again. Are you thinking of complaining? I don't know what the complaints procedure is like an I have spent hours ammassing evidence that has just been ignored with the Mother and Baby complaint so I am a bit demoralised about the whole thing.

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  4. I'm not sure where we go from here - the Press are self-regulating, which seems to mean that if there's enough public feeling about an issue they do something about it (Clare Blading) but if not, they respond with a fudge. This leads me to believe that the only way to encourage a serious response is to use the press themselves to do it. This is something we can look into. They have recently undertaken to tighten their rules (special guidelines) relating to mental health issues, I wonder if we could provide pressure to have breastfeeding-related issues treated in a similar manner?
    'The PCC from time to time issues special guidelines to editors which are designed to add even further to this protection. In 1997, for instance, the Commission issued guidelines on the portrayal in the media of persons suffering from mental illness. Other specific areas the PCC has tackled include the identification, against their wishes, of lottery winners. In 2001, the Commission produced practical advice to help people suffering from press harassment and acted to emphasise the need for care in the reporting of matters involving race and religion. In 2009, the Commission published briefing notes on the reporting of suicide; and on the payment to parents for material about their children, in the wake of the Alfie Patten case.'

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  5. Worth a read:
    http://www.pcc.org.uk/external/dialogue/index.html

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  6. Can someone remind me what the purpose of the PCC is???

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  7. @Sam - still trying to figure that one out! ;)

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