Friday, November 4, 2011

Injectable Depo Provera: Scientists Blame Media for their Own Indecisiveness

When scientists shout with joy, wave their hands in the air and slap each other vigorously on the back because they have decided that mass male circumcision is great, that concurrent relationships drive generalized HIV epidemics or that one of the latest offerings from the pharmaceutical industry will stop the HIV pandemic in its tracks, the mainstream media report accordingly. That's just how they are; they don't generally report critically, unless some particular flavor of the month is replaced with a new one.

So James Shelton's plea for scientists and the media to give a balanced view about the possible role of injectable hormonal contraceptives (HC) in increasing the transmission of HIV, from males to females and from females to males, seems a little pointless. The media doesn't tell scientists how to report their findings, thankfully. But scientists can't expect to be able to control how the media report theirs. The point of writing a scientific paper is to inform people about research findings. What they do with that information is up to them.

The disagreement about possible undesirable effects of Depo Provera and other injected HCs is not just a disagreement between science and the media. It is also, like a lot of disagreements, between scientists and other scientists. But the people who wrote the recent article in question, Heffron, et al, published in a peer reviewed journal, The Lancet. Although the media refuses to regulate itself and academica has no authority over the media, academia is regulated by other academics. You may not agree with the system, but there is a system.

What Shelton appears to be saying is that Heffron et al's findings don't conform to the mainstream stance that WHO, UNAIDS, USAID, CDC and various others have adopted. He doesn't like what they have reported so he tries to pick holes in the findings. I wouldn't mind if the findings were earth-shatteringly different from many earlier findings, but they are not. The only earth-shattering thing is how long various institutions have delayed issuing decisive guidelines for the use of injectable HC.

Shelton applies (some of) the criteria of Austin Bradford Hill for assessing evidence of causation and his point is clear enough; causation has not been demonstrated. But causation has not been demonstrated in the cases of mass male circumcision, concurrent relationships or the use of various highly lucrative drug programs (such as pre-exposure prophylaxis, treatment as prevention, etc). Yet these attract massive amounts of funding and publicity.

Shelton asks why the media applies so little critical thinking, but surely that's the job of academia, not the media? By the time the media get the press release, or however they are informed of what academia wishes them to know, the critical thinking should have been completed. The media have their own commercial and political interests to consider and these may or may not converge with the commercial and political interests of academia.

But one could ask Shelton and other HIV experts why it has taken so long for them to issue coherent guidance. Doubts about the safety of injectable HC have been around for a long time. Why haven't the various kinds of research Shelton mentions been carried out yet? The sheer volume of denial from academia being directed at what started with one article in the New York Times does not constitute guidance on whether to continue with this birth control method, or to switch to a different method until the safety of Depo Provera and others drugs can be assured.

The tone of those opposed to the findings of Heffron, et al, and others who have questioned the safety of injectable HC suggests that the orthodoxy is not going to change its collective mind on this issue. WHO will meet in January, but they have discussed this on and off for years without ever giving a convincing response to evidence that Depo Provera and similar products may be unsafe.

As with the possible role of unsafe healthcare and cosmetic services in HIV transmission, the HIV industry seems unwilling to scrutinize Depo Provera too closely. They say they are worried about people's sexual and reproductive health, but injectable HC is just one birth control method of many. Perhaps there is something else they are worried about?


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