Horizon Programme

Letter from John Warren to the BBC

Dear Sir Christopher,

I wish to make a complaint about the content of the Horizon programme broadcast on Thursday 16 November 2000 on BBC2 at 9pm, which dealt with the role of circumcision in the prevention of HIV infection in Africa. I write as Chairman of NORM-UK, a registered charity involved in education about the foreskin and offering support to circumcised men who find themselves regretting the loss of this body part.

In my view the programme was unbalanced, unfair and irresponsible. My reasoning for such a view is as follows:

Balance:

I would suggest that the programme lacked balance in that it was devoted to demonstrating that the presence of the foreskin played a major part in the transmission of the HIV virus, without mentioning the harmful effects of removal of the foreskin from healthy males, or doubts that circumcision is effective in HIV prevention. The section of the BBC’s own code of ethics dealing specifically with impartiality and accuracy includes the following:

"Due impartiality lies at the heart of the BBC. It is a core value and no area of programming is exempt from it. All BBC programmes should show open-mindedness, fairness and a respect for truth."

2.1 "... [A programme] may choose to test or report one side of a particular argument. However, it must do so with fairness and integrity. It should ensure that opposing views are not misrepresented."

".....Sometimes it will be necessary to ensure that all main viewpoints are reflected in a programme or in linked programmes, for example, when the issues involved are highly controversial and a defining or decisive moment in the controversy is imminent."

2.9 ".....There remains an obligation to ensure that a proper range of views and perspectives is aired over a reasonable time. This calls for systematic review and continuing discussion so that the output builds into a complete mosaic."

The introduction to the programme accepted that the subject matter was controversial. NORM-UK fully accepts that it is legitimate, perhaps even unavoidable, for programme makers to reach a view on the subject matter and seek to persuade viewers to that view.

Yet the programme started with the position that it had been proved beyond any doubt that circumcision has a major role in the HIV pandemic. It continued with a highly slanted and selective stance; took bits uncritically from some studies to bolster this; failed, except very briefly and in a dismissive way, to discuss that there was a lack of consensus as to this position and indeed considerable scepticism; and failed to reflect that the African studies showing a protective effect have suffered not only from major flaws, and indeed from bias to the point that they could be described as dishonest.

No researcher from the opposing side of this debate was shown, or even his work discussed, let alone discussed in any detail. The viewer was not told that circumcised USA has the highest HIV rates among Western nations, and that uncircumcised Europe has rates a fraction of the American ones; yet if the hypothesis were correct, one would expect the figures to be reversed, given that living standards, behaviour patterns and so on are similar.

Nor did the programme mention that some of the studies relied on had not been published in peer-reviewed journals and were therefore not available for scrutiny by the rest of the scientific community.

Thus, Short (an obstetrician) had failed to find a journal to publish his studies of a small number of penises from elderly men. His finding that the glans was equally keratinised in circumcised and uncircumcised men was not, despite being presented as such, novel or startling (except perhaps for someone who was not acquainted with the basic structure and available literature).

Patterson’s work is also unpublished.

Hayes’ paper on his revisions was, we understand, refused publication in a peer-review journal, and has been strongly criticised as having serious biases by someone who has read it; it is now awaiting publication in the journal ‘AIDS’, but it is not currently available for general scrutiny.

Unfairness:

Those interviewed who supported the programme’s stance were identified by name and, where appropriate, by institution. Even the Nairobi prostitute was given her first name of Salome. But not one of the ‘members of NOCIRC’ (and it is doubtful if all were members of NOCIRC) was identified by name, nor was the viewer told that the group included a former Professor of psychology, a paediatrician, a lawyer and two nurses. So the viewer was given the academic qualifications of only one side, and the other side were thereby made to look like unqualified simpletons.

The Code says:

13.8 "...An interviewee who is being asked to reply to detailed criticism, should be given an opportunity to respond to each of the main points aired in the programme. Care should be taken to reflect in the edited programme the points of substance made by the interviewee in the full recording. Choosing only the weaker responses of an interviewee in preference to effective rebuttal is unfair. Overall, a reasonable person, seeing or hearing an interview both in full and in edited form, should conclude that it has been edited fairly. .... Using only brief extracts from long and unfocused interviews can cause justified ill-feeling."

The very brief (timed at about 1 minute 45 seconds out of a total of 50 minutes) segment started with a disparaging comment:

"For organisations like NOCIRC even if the science was absolutely convincing circumcision is seen as mutilation and a violation of human rights."

There followed a far too brief comment (from the Professor of psychology); then some carefully selected quotations (more like one-liners/soundbites) which really did nothing to raise or discuss the various concerns - scientific, ethical and legal. The segment was interrupted by a 30-second slot in which Plummer was able to make disparaging comments about emotion, irrationality and lack of scientific evidence.

The segment then concluded with some very emotive language, clearly wrenched (as all the selected NOCIRC comments were) out of context. Plummer’s comments would have been inaccurate wherever placed in the programme. Since not one NOCIRC member was shown as discussing any of the science, and given that no other person was shown as discussing the science of the opposing position, the careful juxtaposition with NOCIRC in the middle of the only segment purportedly putting forward the case of the other side, made the unfairness to those arguments and to NOCIRC even more blatantly unacceptable.

NORM-UK does not accept that the opposing view of the controversy could fairly, responsibly and properly be covered in some 75 seconds.

Irresponsibility:

Auvert’s comment as quoted in the transcript that;

"In South Africa they are making in some places among women aged 24 which 67 percent today. I really think that if all males were circumcised in Africa the epidemic couldn’t go much higher than 10-15%"

was echoed very strong terms by Bailey and Carael. Indeed, the whole message of the programme was that being circumcised can prevent HIV infection without condom use. Thus Tom Onyango says in the film;

"Well, I think because of the rumours about condoms people believe some condoms are laced with the HIV virus, some have got holes, they easily burst and they’ve been talking to them against these rumours, but people change slowly, but we believe male circumcision is one of the strategies we can sell to our people."

I accept that the programme did contain comment from Bailley and Carmael at the end that condoms should still be used by circumcised men to prevent HIV transmission. But that message was drowned out by the whole emphasis of the programme on circumcision as a preventive method.

Equally clearly, an impression has been created among some Africans that circumcision can replace condom use. Advocacy of circumcision therefore is irresponsible as it risks losing the vital messages about safe sex as the major method of preventing virus transmission, and thereby might exacerbate the already serious situation in Africa.

Given the programme’s very slanted bias and given the misleading message it imparted to the viewing public, at the very least I believe it would be appropriate for your organisation to broadcast some sort of retraction. And it would be equally appropriate to allow the counterbalancing arguments an airing in a programme of their own, to which NORM-UK would be pleased to contribute.

I am also posting a copy of this letter on the NORM-UK website (www.NORM-UK.org). This will at least allow those members of the public who access the site a better opportunity to form a more reasoned opinion of the programme, given a greater awareness of the underlying facts which make up the substance of my letter.

Yours sincerely,


John Warren, MB. BChir. DCH. FRCP.
Chairman of NORM-UK

CC: Greg Dyke, Director General.