Hormonal Contraceptives: Communication for Risk Awareness and Informed Choice, or a Public Scare?

This chapter discusses oral contraceptives as a special case in risk communication on medicines, as they are provided to large populations of young, healthy people and the tolerance for risks is therefore low. All combined oestrogen–progestin containing oral contraceptives have similar effectiveness in preventing pregnancy, but carry different risks for rare but serious venous thromboembolism (VTE), i.e. blood clots that are potentially fatal if they travel to the lungs. In 1995, large-scale studies indicated a higher VTE frequency with newer “third-generation” contraceptives, and in 2009, with drospirenone-containing contraceptives. This chapter describes the challenges and outcomes of the related communication events and discusses the media representation of the “pill scare” in the United Kingdom in 1995. This had an immediate impact, leading to worldwide recognition of the need for effective communication of risks of medicines as a crucial task, with a profound effect on regulatory risk communication that is still haunting us today. The chapter further examines the role of financial conflicts of interests of medical journal authors in the interpretation and wider dissemination of research evidence.