Professor Nelkin finds journalists to be, if reluctantly, subject to influence and describes their uneasy relationship with scientists in filling a difficult role

Nelkin, Dorothy

English

University of New Hampshire

RISK: Health, Safety & Environment (1990-2002)
Volume 5
Number 3 Symposium on Technical Risk in the Mass
Media
Article 8
June 1994
Reporting Risk: The Case of Silicone Breast
Implants
Dorothy Nelkin
Follow this and additional works at: https://scholars.unh.edu/risk
Part of the Biomedical and Dental Materials Commons, Communication Commons, and the
Science and Technology Studies Commons
This Article is brought to you for free and open access by the University of New Hampshire – School of Law at University of New Hampshire Scholars'
Repository. It has been accepted for inclusion in RISK: Health, Safety & Environment (1990-2002) by an authorized editor of University of New
Hampshire Scholars' Repository. For more information, please contact ellen.phillips@law.unh.edu.
Repository Citation
Dorothy Nelkin, Reporting Risk: The Case of Silicone Breast Implants, 5 RISK 233 (1994).
Reporting Risk:
The Case of Silicone Breast Implants
Dorothy Nelkin*
The media coverage of the 1992 dispute over regulation of silicone
breast implants, devices suspected of causing autoimmune disorders
and neurological diseases, became in itself a part of this bitter
controversy. Many physicians were angry at the coverage, accusing
journalists of projecting their personal opinion, of irresponsible
sensationalism, of jumping to conclusions without listening to experts.
They blamed the media for creating unnecessary fear. A review of this
case suggests some of the dilemmas involved in risk communication.
Media reports on the breast implant controversy were influenced by
several factors that more broadly characterize risk events. First, despite
Food and Drug Administration (FDA) mandates requiring that the
device be systematically tested, no adequate data were available. The
Advisory Panel, meeting in 1992 to assess the risk had to make
decisions about regulating the implants mainly on the basis of anecdotal
evidence and individual testimony. The media also had to rely on these
anecdotes.
Second, many dimensions of the risk from implants were complex,
controversial, and poorly understood. Scientists themselves did not
fully agree about the nature and extent of risk. Were the cases of
leaking silicone aberrant or inevitable? Were the damaged implants
defective or would all implants eventually fail? What was the effect of
silicone on the body? Were the reported cases simply anecdotes from
women seeking money from malpractice suits, or were there significant
patterns? In light of the debates over these questions, who were
reporters to believe?
* Dorothy Nelkin is University Professor at New York University, teaching in the
Department of Sociology and the School of Law.
5 Risk Health, Safety & Environment 233 [Summer 1994]
Third, like so many questions of risk, this issue was socially and
politically controversial. In the deregulatory climate of the Bush
Administration, David Kessler as an activist FDA commissioner, was an
anomaly, and, in an election year, a publicized risk controversy was
threatening. Moreover, the issue became a media event at a time when
the American medical profession was under attack for its neglect of the
diseases of women. A National Institutes of Health initiative to remedy
the situation had called public attention to the history of this neglect,
creating awareness of the problems of using a device, on women that
had never been adequately tested. The case also followed the much
publicized dispute over the Dalkon Shield. The risk of silicone breast
implants, then, became one more issue in a parade of uncomfortable
incidents.
Finally, the reporting of the risk of silicone breast implants, was
bound to have a direct and immediate effect on the behavior of
women. Some use implants for breast augmentation - that is, for
cosmetic surgery that some regard as frivolous, but others as essential.
Implants are also used as reconstruction after mastectomy, and are
considered essential for the psychological and even physical recovery of
cancer patients.
Like so many risk disputes, the reporting of the silicone breast
implant controversy took place in a context of technical uncertainty and
political controversy about social and clinical implications. The
complaints of physicians about overblown media reports resembled
those of a chemist some years ago who accused the press of reporting
that modern technology is poisoning America. "If there is any
poisoning of America going on, it is not chemicals that are the culprit, it
is the media which seem intent on burying us in purple prose - a sort
of verbal poison. Journalists have helped to create crises where none
exist (the cancer epidemic), have blown out of proportion legitimate
stories (Three Mile Island) and avidly hunted for crises to come (acid
rain)."
The physicians' irritation with the media reports reflected the
controversial implications of risk reporting. By their selection of news,
Nelldm Reportingan Silcone Breast lmplants 235
journalists set the agenda for public policy. They can point the finger of
blame - in the implant case towards the product manufacturer - and
imply responsibility for remedial action. They can define an issue as an
urgent problem or reduce it to an aberration. By creating public issues
out of particular events, the media can force regulatory agencies to
action simply out of concern for public image. The media interest in
the drama of the silicone breast implant controversy was important in
encouraging the appointment of a commission to decide on regulation.
Through their disclosure of new discoveries the press can also affect
consumer behavior. We know this from many cases. After extensive
media reports on the dietary studies relating cholesterol-producing
foods with heart disease, consumption of beef, eggs and fatty milk
products declined. Similarly, the media attention to the risks of the
silicone implants have greatly increased the use of saline implants
though this is a far more complex and costly procedure.
Given the impact of reporting, control over the information and
images, the values and views, the signs and symbols conveyed to the
public are understandably a sensitive issue. Industries, political
institutions, professional groups and aspiring individuals all want to
manage the messages that enter the cultural arena. Public relations
efforts are a growing aspect of every field of science, technology and
medicine, but they are most elaborate in the promotion of dramatic
medical interventions, promising new discoveries or therapeutic
techniques. Recall the extraordinary publicity over the artificial heart,
promoted as a "revolutionary development," a miraculously effective
solution for heart patients, a medical milestone.
Sometimes firms try to market products by defining them as
newsworthy discoveries. Silicone breast implants had been widely
promoted by the company and by some private physicians as a panacea
for women who, for reasons of vanity, or for post operative
reconstruction, were extremely vulnerable to such sell. This, however,
was hardly the first instance of such promotion. In the 1970's physicians
and drug firms promoted estrogen replacement therapy by claiming it
5 Rislk Health, Safety & Environment 233 [Summer 1994]
would reduce the biological effect of aging. Promotional materials on
estrogen were designed to attract the press, which was, of course,
attracted in any case to stories on a therapy that promised eternal
youth. Thus news articles on estrogen replacement therapy were
headlined: "Science Paints Bright Picture for Older Women." Eager for
copy, journalists uncritically accepted the claims of interested experts
who debunked the growing set of studies that suggested a relationship
between estrogen and endometrial cancer, well after the FDA issued
warnings to that effect. The press uncritically cited estrogen proponents
who dismissed the concern about risk: "When we drive down the
freeways, we take a risk."
Drug companies use "science-based press agentry" to market their
products, in effect pushing products as newsworthy discoveries. Lilly's
arthritis drug, Oraflex, was initially marketed this way as the firm's
public relations office sent out press kits promoting the drug as a
scientifically proven way to relieve arthritis. When the media covered
the product as science news, in prescriptions increased from 2,000 to
55,000 a week. Twelve weeks later, a report showed its harmful side
effects and it was withdrawn from the market. Similarly, silicone breast
implants had been marketed for many years without significant testing
despite uncertainty about long term risks. In the course of investigation,
Dow-Corning admitted misleading the FDA and the public about its
data on the possible problems of implants, and other companies had
not collected data at all. Meanwhile, the media encouraged the use of
implants by playing up to women's concerns about image and
capitalizing on the belief that large breasts mean sex appeal.
Just as the media have been used as a tool to market new products
by defining them as scientific discoveries, so there are efforts to manage
the media's reporting of risk from technologies. Efforts to control the
communication of risk was evident in the nuclear industry's use of the
media to project positive images of nuclear power to allay public fear.
The chemical industry employs similar strategies, using scientific
expertise in their public relations as a means of damage control in risk
disputes. So too in the silicone implant controversy, both the industry
Nelkln: Reporting on Silicone Breast Implants 237
and the women who suffered disorders from the implants engaged
both scientific experts and public relations practitioners to support their
conflicting claims.
Journalists are vulnerable to such public relations strategies, for they
are constrained by intense competition, tight deadlines, limited
budgets and the need to cover complex and often technical material
within limited space and time. Pressed for time, they are inclined to
rely uncritically on material that is conveniently packaged by public
relations staffs. This gives an unusual degree of power to those sources
best organized to provide facts in a manageable and efficient form.
Thus institutions skilled in organizing timely and lucid material have
considerable influence on the media. Though ambivalent about public
relations and aware of efforts to subordinate journalism to private
interests, journalists are still influenced by it - a fact which prompted
Upton Sinclair to define journalism as "a business in the practice of
presenting the news of the day in the interest of economic privilege."
By now, with 20 years of experience in risk reporting, reporters
approach the subject with greater independence and, indeed, a certain
cynicism about corporate behavior. The silicone implant fiasco followed
on the heels of a series of cases in which companies have been found to
obfuscate known risks - for example, the risks of asbestos, of dioxin
and of cigarette smoking. Investigations, sometimes by journalists, had
uncovered many cases of products that were marketed even when
known to be harmful.
Reporters are especially skeptical of the increasing pressures from
science-based institutions: "I get calls from Dr. Knowledge, the world's
leading authority on X disease or Y technology, who is also president of
Z society." They refer to "pesky PR types," or "the flacks." Irritation is
not limited to corporate public relations. "They're all grinding the same
axe, from breakthrough university to wonder pharmaceuticals to the
National Institute of Nearly Cured Diseases."
The physicians' anger at the media coverage of the risks of silicone
breast implants reflect less the actual content of the media coverage
5 Risk Health, Safety & Environment 233 [Summer 1994]
than the broader tensions between the medical and journalist
"communities. These groups hold fundamentally different views on the
appropriate behavior and role of journalism. First, there are differences
in judgments about what is news. In the medical community, research
results become reliable and therefore newsworthy through the
endorsement of professional colleagues. Research findings are
provisional - and therefore not newsworthy - until certified by peers
to fit into the existing framework of knowledge. The physicians could
not see this issue as newsworthy because there were no adequate data,
and without such data they felt that no public judgments should be
made about risks and how they should be balanced against the benefits
to their patients. They did not regard the testimony of individual
women who had been harmed by the devices as news. As one critic put
it starkly: "Distraught women are not news."
A related source of tensions concerns when to release information to
the public. In the case of suspected risk, how much evidence is necessary
before informing the public? How certain must the evidence be? How
much scientific consensus must there be before problems or potential
problems are widely disclosed? Are there situations when reporting risk
may cause unnecessary panic or counterproductive behavior when
nondisclosure of risks would be desirable? Most journalists believe that
risk data should be promptly available to the public. But the doctors,
facing patients who were even reluctant to have mammograms if they
thought they might be disfigured, believed that releasing information
before risks were well understood was irresponsible. While their desire
for definitive knowledge is understandable, if certainty was a condition
for disclosure there would be no public information at all.
A further set of conflicts follows from different assumptions about
how to communicate risk. Journalistic conventions may violate the
norms of the scientific and medical community. To create a human
interest angle, journalists will focus on conflict and create polarities;
technologies are either risky or they are safe. Their quest for simplicity,
drama, and brevity preclude the nuanced and complex positions that
scientists prefer. Moreover, journalists follow the principle that verity in
Nelldn: Reporting on Silicone Breast Implants 239
reporting disputes can be established by balancing conflicting claims.
This clearly contradicts the scientists' view that claims can be verified
only by empirical evidence.
A related source of tension lies in the conflict between the
professional practices of journalism and scientific expectations about
appropriate styles of communication. Constrained by the interests of
their readers, journalists must select and simplify technical information.
This often precludes the precautionary qualifications that scientists feel
are necessary to accurately present their work. Readability in the eyes of
the journalist may be oversimplification to the scientist. Indeed, many
accusations of inaccuracy follow less from actual errors than from
efforts to present complex material about risk in a readable and
appealing style.
Differences in the use of language contribute to strain. The
language of science is precise and instrumental. Information is
communicated for a purpose - to indicate regularities and aggregate
patterns, and to provide technical data. In contrast, journalistic
language is often chosen for richness of reference and suggestiveness.
Scientists or, in this case, physicians are used to directing their
professional communication to an audience trained in their discipline.
They often forget that some words with special meanings in a scientific
context may be interpreted quite differently by the lay reader. Take,
for example, the word "evidence." Biostatisticians use the word
"evidence" as a statistical concept. For biomedical researchers, the
critical experiment is also defined as evidence. Most laypersons accept
as evidence anecdotal information or individual cases. Thus the media
considered the experience of the individual women as news. While
physicians wanted aggregate data, reporters wrote of the immediate
concerns of their readers.
Finally, an important source of strain between scientists and
journalists lies in the ambiguity about the appropriate role for the press.
Many professionals talk about the press as a conduit or pipeline,
responsible for converting technical information into a form where it
may be easily transported to the public. Regarding the press as a
5 Risk Health, Safety & Environment 233 [Summer 1994]
240
technique to further technical or medical goals, they expect to control
the flow of information to the public just as they do within their own
domain, and feel betrayed when their views are challenged. Physicians
are especially aggrieved when the issue has immediate policy or clinical
relevance.
The silicone breast implant controversy was marked by such strains.
The tensions over the coverage of this dispute illustrate the important
role of the media in risk disputes and the difficulties that are intrinsic to
this role.


Reporting Risk: The Case of Silicone Breast Implants

UNH Scholars' Repository

RISK: Health, Safety & Environment (1990-2002)Volume 5Number 3 Symposium on Technical Risk in the MassMediaArticle 8June 1994Reporting Risk: The Case of Silicone BreastImplantsDorothy NelkinFollow this and additional works at: https://scholars.unh.edu/riskPart of the Biomedical and Dental Materials Commons, Communication Commons, and theScience and Technology Studies CommonsThis Article is brought to you for free and open access by the University of New Hampshire – School of Law at University of New Hampshire Scholars'Repository. It has been accepted for inclusion in RISK: Health, Safety & Environment (1990-2002) by an authorized editor of University of NewHampshire Scholars' Repository. For more information, please contact ellen.phillips@law.unh.edu.Repository CitationDorothy Nelkin, Reporting Risk: The Case of Silicone Breast Implants, 5 RISK 233 (1994).Reporting Risk:The Case of Silicone Breast ImplantsDorothy Nelkin*The media coverage of the 1992 dispute over regulation of siliconebreast implants, devices suspected of causing autoimmune disordersand neurological diseases, became in itself a part of this bittercontroversy. Many physicians were angry at the coverage, accusingjournalists of projecting their personal opinion, of irresponsiblesensationalism, of jumping to conclusions without listening to experts.They blamed the media for creating unnecessary fear. A review of thiscase suggests some of the dilemmas involved in risk communication.Media reports on the breast implant controversy were influenced byseveral factors that more broadly characterize risk events. First, despiteFood and Drug Administration (FDA) mandates requiring that thedevice be systematically tested, no adequate data were available. TheAdvisory Panel, meeting in 1992 to assess the risk had to makedecisions about regulating the implants mainly on the basis of anecdotalevidence and individual testimony. The media also had to rely on theseanecdotes.Second, many dimensions of the risk from implants were complex,controversial, and poorly understood. Scientists themselves did notfully agree about the nature and extent of risk. Were the cases ofleaking silicone aberrant or inevitable? Were the damaged implantsdefective or would all implants eventually fail? What was the effect ofsilicone on the body? Were the reported cases simply anecdotes fromwomen seeking money from malpractice suits, or were there significantpatterns? In light of the debates over these questions, who werereporters to believe?* Dorothy Nelkin is University Professor at New York University, teaching in theDepartment of Sociology and the School of Law.5 Risk Health, Safety & Environment 233 [Summer 1994]Third, like so many questions of risk, this issue was socially andpolitically controversial. In the deregulatory climate of the BushAdministration, David Kessler as an activist FDA commissioner, was ananomaly, and, in an election year, a publicized risk controversy wasthreatening. Moreover, the issue became a media event at a time whenthe American medical profession was under attack for its neglect of thediseases of women. A National Institutes of Health initiative to remedythe situation had called public attention to the history of this neglect,creating awareness of the problems of using a device, on women thathad never been adequately tested. The case also followed the muchpublicized dispute over the Dalkon Shield. The risk of silicone breastimplants, then, became one more issue in a parade of uncomfortableincidents.Finally, the reporting of the risk of silicone breast implants, wasbound to have a direct and immediate effect on the behavior ofwomen. Some use implants for breast augmentation - that is, forcosmetic surgery that some regard as frivolous, but others as essential.Implants are also used as reconstruction after mastectomy, and areconsidered essential for the psychological and even physical recovery ofcancer patients.Like so many risk disputes, the reporting of the silicone breastimplant controversy took place in a context of technical uncertainty andpolitical controversy about social and clinical implications. Thecomplaints of physicians about overblown media reports resembledthose of a chemist some years ago who accused the press of reportingthat modern technology is poisoning America. "If there is anypoisoning of America going on, it is not chemicals that are the culprit, itis the media which seem intent on burying us in purple prose - a sortof verbal poison. Journalists have helped to create crises where noneexist (the cancer epidemic), have blown out of proportion legitimatestories (Three Mile Island) and avidly hunted for crises to come (acidrain)."The physicians' irritation with the media reports reflected thecontroversial implications of risk reporting. By their selection of news,Nelldm Reportingan Silcone Breast lmplants 235journalists set the agenda for public policy. They can point the finger ofblame - in the implant case towards the product manufacturer - andimply responsibility for remedial action. They can define an issue as anurgent problem or reduce it to an aberration. By creating public issuesout of particular events, the media can force regulatory agencies toaction simply out of concern for public image. The media interest inthe drama of the silicone breast implant controversy was important inencouraging the appointment of a commission to decide on regulation.Through their disclosure of new discoveries the press can also affectconsumer behavior. We know this from many cases. After extensivemedia reports on the dietary studies relating cholesterol-producingfoods with heart disease, consumption of beef, eggs and fatty milkproducts declined. Similarly, the media attention to the risks of thesilicone implants have greatly increased the use of saline implantsthough this is a far more complex and costly procedure.Given the impact of reporting, control over the information andimages, the values and views, the signs and symbols conveyed to thepublic are understandably a sensitive issue. Industries, politicalinstitutions, professional groups and aspiring individuals all want tomanage the messages that enter the cultural arena. Public relationsefforts are a growing aspect of every field of science, technology andmedicine, but they are most elaborate in the promotion of dramaticmedical interventions, promising new discoveries or therapeutictechniques. Recall the extraordinary publicity over the artificial heart,promoted as a "revolutionary development," a miraculously effectivesolution for heart patients, a medical milestone.Sometimes firms try to market products by defining them asnewsworthy discoveries. Silicone breast implants had been widelypromoted by the company and by some private physicians as a panaceafor women who, for reasons of vanity, or for post operativereconstruction, were extremely vulnerable to such sell. This, however,was hardly the first instance of such promotion. In the 1970's physiciansand drug firms promoted estrogen replacement therapy by claiming it5 Rislk Health, Safety & Environment 233 [Summer 1994]would reduce the biological effect of aging. Promotional materials onestrogen were designed to attract the press, which was, of course,attracted in any case to stories on a therapy that promised eternalyouth. Thus news articles on estrogen replacement therapy wereheadlined: "Science Paints Bright Picture for Older Women." Eager forcopy, journalists uncritically accepted the claims of interested expertswho debunked the growing set of studies that suggested a relationshipbetween estrogen and endometrial cancer, well after the FDA issuedwarnings to that effect. The press uncritically cited estrogen proponentswho dismissed the concern about risk: "When we drive down thefreeways, we take a risk."Drug companies use "science-based press agentry" to market theirproducts, in effect pushing products as newsworthy discoveries. Lilly'sarthritis drug, Oraflex, was initially marketed this way as the firm'spublic relations office sent out press kits promoting the drug as ascientifically proven way to relieve arthritis. When the media coveredthe product as science news, in prescriptions increased from 2,000 to55,000 a week. Twelve weeks later, a report showed its harmful sideeffects and it was withdrawn from the market. Similarly, silicone breastimplants had been marketed for many years without significant testingdespite uncertainty about long term risks. In the course of investigation,Dow-Corning admitted misleading the FDA and the public about itsdata on the possible problems of implants, and other companies hadnot collected data at all. Meanwhile, the media encouraged the use ofimplants by playing up to women's concerns about image andcapitalizing on the belief that large breasts mean sex appeal.Just as the media have been used as a tool to market new productsby defining them as scientific discoveries, so there are efforts to managethe media's reporting of risk from technologies. Efforts to control thecommunication of risk was evident in the nuclear industry's use of themedia to project positive images of nuclear power to allay public fear.The chemical industry employs similar strategies, using scientificexpertise in their public relations as a means of damage control in riskdisputes. So too in the silicone implant controversy, both the industryNelkln: Reporting on Silicone Breast Implants 237and the women who suffered disorders from the implants engagedboth scientific experts and public relations practitioners to support theirconflicting claims.Journalists are vulnerable to such public relations strategies, for theyare constrained by intense competition, tight deadlines, limitedbudgets and the need to cover complex and often technical materialwithin limited space and time. Pressed for time, they are inclined torely uncritically on material that is conveniently packaged by publicrelations staffs. This gives an unusual degree of power to those sourcesbest organized to provide facts in a manageable and efficient form.Thus institutions skilled in organizing timely and lucid material haveconsiderable influence on the media. Though ambivalent about publicrelations and aware of efforts to subordinate journalism to privateinterests, journalists are still influenced by it - a fact which promptedUpton Sinclair to define journalism as "a business in the practice ofpresenting the news of the day in the interest of economic privilege."By now, with 20 years of experience in risk reporting, reportersapproach the subject with greater independence and, indeed, a certaincynicism about corporate behavior. The silicone implant fiasco followedon the heels of a series of cases in which companies have been found toobfuscate known risks - for example, the risks of asbestos, of dioxinand of cigarette smoking. Investigations, sometimes by journalists, haduncovered many cases of products that were marketed even whenknown to be harmful.Reporters are especially skeptical of the increasing pressures fromscience-based institutions: "I get calls from Dr. Knowledge, the world'sleading authority on X disease or Y technology, who is also president ofZ society." They refer to "pesky PR types," or "the flacks." Irritation isnot limited to corporate public relations. "They're all grinding the sameaxe, from breakthrough university to wonder pharmaceuticals to theNational Institute of Nearly Cured Diseases."The physicians' anger at the media coverage of the risks of siliconebreast implants reflect less the actual content of the media coverage5 Risk Health, Safety & Environment 233 [Summer 1994]than the broader tensions between the medical and journalist"communities. These groups hold fundamentally different views on theappropriate behavior and role of journalism. First, there are differencesin judgments about what is news. In the medical community, researchresults become reliable and therefore newsworthy through theendorsement of professional colleagues. Research findings areprovisional - and therefore not newsworthy - until certified by peersto fit into the existing framework of knowledge. The physicians couldnot see this issue as newsworthy because there were no adequate data,and without such data they felt that no public judgments should bemade about risks and how they should be balanced against the benefitsto their patients. They did not regard the testimony of individualwomen who had been harmed by the devices as news. As one critic putit starkly: "Distraught women are not news."A related source of tensions concerns when to release information tothe public. In the case of suspected risk, how much evidence is necessarybefore informing the public? How certain must the evidence be? Howmuch scientific consensus must there be before problems or potentialproblems are widely disclosed? Are there situations when reporting riskmay cause unnecessary panic or counterproductive behavior whennondisclosure of risks would be desirable? Most journalists believe thatrisk data should be promptly available to the public. But the doctors,facing patients who were even reluctant to have mammograms if theythought they might be disfigured, believed that releasing informationbefore risks were well understood was irresponsible. While their desirefor definitive knowledge is understandable, if certainty was a conditionfor disclosure there would be no public information at all.A further set of conflicts follows from different assumptions abouthow to communicate risk. Journalistic conventions may violate thenorms of the scientific and medical community. To create a humaninterest angle, journalists will focus on conflict and create polarities;technologies are either risky or they are safe. Their quest for simplicity,drama, and brevity preclude the nuanced and complex positions thatscientists prefer. Moreover, journalists follow the principle that verity inNelldn: Reporting on Silicone Breast Implants 239reporting disputes can be established by balancing conflicting claims.This clearly contradicts the scientists' view that claims can be verifiedonly by empirical evidence.A related source of tension lies in the conflict between theprofessional practices of journalism and scientific expectations aboutappropriate styles of communication. Constrained by the interests oftheir readers, journalists must select and simplify technical information.This often precludes the precautionary qualifications that scientists feelare necessary to accurately present their work. Readability in the eyes ofthe journalist may be oversimplification to the scientist. Indeed, manyaccusations of inaccuracy follow less from actual errors than fromefforts to present complex material about risk in a readable andappealing style.Differences in the use of language contribute to strain. Thelanguage of science is precise and instrumental. Information iscommunicated for a purpose - to indicate regularities and aggregatepatterns, and to provide technical data. In contrast, journalisticlanguage is often chosen for richness of reference and suggestiveness.Scientists or, in this case, physicians are used to directing theirprofessional communication to an audience trained in their discipline.They often forget that some words with special meanings in a scientificcontext may be interpreted quite differently by the lay reader. Take,for example, the word "evidence." Biostatisticians use the word"evidence" as a statistical concept. For biomedical researchers, thecritical experiment is also defined as evidence. Most laypersons acceptas evidence anecdotal information or individual cases. Thus the mediaconsidered the experience of the individual women as news. Whilephysicians wanted aggregate data, reporters wrote of the immediateconcerns of their readers.Finally, an important source of strain between scientists andjournalists lies in the ambiguity about the appropriate role for the press.Many professionals talk about the press as a conduit or pipeline,responsible for converting technical information into a form where itmay be easily transported to the public. Regarding the press as a5 Risk Health, Safety & Environment 233 [Summer 1994]240technique to further technical or medical goals, they expect to controlthe flow of information to the public just as they do within their owndomain, and feel betrayed when their views are challenged. Physiciansare especially aggrieved when the issue has immediate policy or clinicalrelevance.The silicone breast implant controversy was marked by such strains.The tensions over the coverage of this dispute illustrate the importantrole of the media in risk disputes and the difficulties that are intrinsic tothis role.

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