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8
Communication of Study Results
There are many factors to evaluate in the
communication planning and practice related to the release of the
HTDS Draft Final Report. Some aspects of the communication
strategies were well carried out, particularly the ones that kept the
public informed about the study protocols, design, and progress
over the years. However, in the fall of 199S, problems-some
controllable and some not arose that had substantial and
unfortunate effects on the communication efforts that finally were
made in late January 1999 for the release of the HTDS findings.
The release of the Draft Final Report led to unhappiness and
dismay among some citizens in the Hanford area, not only because
of the main message, but also because of how the message was
delivered.
BACKGROUND
The communication of risk information to the public is
an important issue that has been addressed by many individuals
and groups. Numerous journal articles, manuals (Swanson and
others, June 1991), and reports including one by the National
Research Council (1989) have discussed how to convey
information about health and environmental risks to the public. But
there is no sure prescription to follow for providing such
information effectively. One piece of advice that appears in most
nsk-communication publications is to ensure that the information
~4
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~5
source is credible and trustworthy in the minds of the public to
which it is communicating.
Risk communication as a field has evolved over the last
15-20 years from a simple linear top-down communication mode}
(experts translated technical information and dispensed it to the
public) to a more sophisticated series of models that view risk
communication as a "tangled web" of interactions that move in
many directions and involve many players local, state, and
federal governments; special-interest groups; citizen groups,
industries; unions; and so on (Krimsky and Plough, 1988~.
The communication that occurred about the HTDS is as
tangled a set of risk-communication webs as one comes across. It
includes not only a federal agency and a private contractor, but
also health agencies in three state governments and representatives
of nine American Indian nations, numerous citizen groups in the
region, national and regional journalists, a class-action lawsuit
involving many litigants, various consultants and potential expert
witnesses, and a number of private individuals in the region who
have suffered or whose family members have suffered from some
type of thyroid disease. The public and private messages traded
back and forth by these groups and individuals over the years have
all shaped the Hanford and HTDS communication process. For
example, it is important to remember that, according to citizen
comments reported in the mass media and elsewhere, many of the
citizens in the area had developed a distrust of government
sources, particularly the Department of Energy (DOE) and its
precursor agencies. When CDC began to evaluate the thyroid-
disease situation at Hanford, the distrust was already in place,
although not applied directly to CDC at the time, it became an
important factor when the HTDS Draft Final Report was released.
From citizen comments, it appears that the Fred Hutchinson
Cancer Research Center in Seattle enjoyed greater public trust than
the federal agencies while carrying out the HTDS.
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ORIGINAL HTDS COMMUNICATION PLAN
The HTDS was conducted over a 9-year period, and it
is not possible to evaluate all the written and oral communication
with the public that occurred about it, but apparently a number of
potentially effective communication efforts were made. As
described in section X of the HTDS Draft Final Report, public
meetings on the project began in 1990 and continued throughout
the study, written brochures and fact sheets were developed,
newsletters were sent to more than 9,000 people and organizations,
and a toll-free 800 line and a Web site were available. In March
1991, the first meeting of the federally appointed public HTDS
Advisory Committee was held, and this committee and several
other groups approved the study protocol. The advisory committee
continued to meet throughout the life of the study. Special
arrangements were made to keep study participants advised of the
results of their clinical evaluations of thyroid disease. The open
. .
communication seems to have continued almost up to the end of
the study, and no one who provided information to the present
subcommittee during its public meeting in Spokane or otherwise
criticized those communication efforts.
Given the earlier history of less than openness with the
public in the Hanford region on the part of DOE and its precursor
agencies, this plan for open communication was enlightened and
promising. So were the decision to establish a citizen advisory
group for the study and the apparent cooperation offered to various
other citizen groups in the region, including the Hanford Health
Information Network and the Hanford Health Effects
Subcommittee (HHES). All those efforts seemed to help to build
trust and credibility for the study and its investigators and for
CDC.
Section X of the HTDS Draft Final Report outlined a
good communication plan to deliver the final information about the
report that might have worked if it had been put into operation with
its release in March 1999. Especially admirable was the concern
shown for translating the technical information in the Draft Final
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Communication of Study Results
~7
Report into an understandable booklet for the public. The use of
focus groups to look at various presentation strategies for the
booklet was a fine approach and resulted in a readable and
understandable public summary. (More will be said about the
public summary later.)
Considering the many audiences that had to be
informed about the study findings, the communication plan
described in section X was fairly complex and involved several
types of briefings, with a suggestion that some of these be
conducted via satellite connections to remote broadcast sites
throughout the region. Although expensive, such a plan would
have probably worked far better than the telephone briefings that
were eventually used when the Draft Final Report was released.
The original communication plan was approved by the HTDS
Advisory Committee and widely disseminated in the HTDS
newsletter. According to Scott Davis, one of the principal HTDS
investigators, there was never any intent to release to the public the
draft report that was delivered to CDC at the end of September
1998. That draft report was supposed to go through internal CDC
and National Research Council closed peer review; comments
were to go to the HTDS researchers, who would then make needed
changes and release a peer-reviewed final report in March 1999.
However, three major factors interacted to bring about
the early release the Draft Final Report, which contnbuted to the
extensive communication problems encountered: public pressure to
get the document out to the public and concern that CDC's internal
review would alter the original findings of the HTDS investigators,
the National Research Council's desire for open peer review of the
draft report, and a subpoena from one party in a lawsuit that sought
immediate release of the Draft Final Report.
Concerning the first factor, in early October 199S, the
director of CDC's National Center for Environmental Health
received numerous written requests for immediate release of the
Draft Final Report. According to CDC, because the agency had
received the Draft Final Report only on September 30, the requests
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Review of the HTDS Draft Final Report
indicated that the correspondents expected the report to be made
available to the public unchanged.
As to the second factor, a communication in late
October to CDC from the National Research Council said that this
organization felt that the credibility of its review would be
compromised if the HTDS report were not publicly available when
the review process began. Given the many audiences, including
study participants who needed to be informed about the study
findings, given the extensive communication plan already
developed, and wanting to preserve the credibility of the review
process, CDC officials decided to release the Draft Final Report
before the Research Council's open review. On November 12, they
met with the HTDS investigators and decided to release the report
on January 28, 1999.
The third factor added resolve to that decision.
According to CDC, during the week of November 16, 199S, the
HTDS investigators received a subpoena that called for delivery of
the Draft Final Report to the plaintiffs' lawyers within 30 days.
The delivery date of the report had already been moved up, and the
plaintiffs' attorneys, with consent of the court, indicated that they
could wait until the January release. One of the problems
preventing an even earlier release was the need to develop
documents about the report that the public could understand
(Davis, 1999b).
Both public demands to CDC to release the report and
not change it were exemplified by the minutes of an HHES
meeting held on December 10-ll, 199S, in which a CDC official
explained that the agency had heard from many people "who
expressed a real interest in seeing if we could move the date of the
release of this report up to make it public" (HHES, 1998~.
Concerning fears that changes would be made in the draft by
CDC's internal reviewers before the report was released, one
person said, "if there are changes made between what Fred
Hutchinson delivers and what comes out the door at CDC, I'm
hoping that you have heard from this subcommittee clearly that we
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~9
want to know what those changes were and the rationale for those
changes" (Hanford Health Effects Subcommittee, 1999, p.39-40~.
Concern also was expressed at the meeting about plans
to release the report, in particular, how HHES and other citizen
groups would be briefed and the fact that the HTDS investigators
were submitting an article on the study results to a scientific
journal before citizens knew the results.
COMMUNICATION ISSUES IN THE WRITTEN MATERIALS
Besides the Draft Final Report itself, a number of
written pieces were developed for the public, including the
"Summary Final Report of the Hanford Thyroid Disease Study"
and several HTDS newsletters. One featured a summary of the
study results, another presented information on thyroid disease and
how it was diagnosed, and a third included questions and answers
about radiation and thyroid disease. There were also at least seven
fact sheets from CDC on various subjects related to the HTDS.
Most of these were included in the briefing kits for the media and
public when the report was released.
To evaluate the written materials provided by the
HTDS investigators and CDC, a number of different factors must
be considered. Among these are accuracy, appropriateness of
material, and readability or ease of understanding.
Accuracy
From a scientific perspective, the results section of the
Draft Final Report provided details on linear dose-response
analyses conducted on 13 types of thyroid disease or abnormality
and on a number of thyroid-related laboratory tests. Other analyses
were conducted, when possible, with alternative definitions of the
disease being analyzed and alternative dose-response functions.
None of the numerous tests showed a statistically significant
increase with dose.
f
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The resulting database on the absence of dose-response
relationships formed the basis for statements made in the report
that no evidence was found of a statistically significant increase in
effects associated with increased dose of its. Within the reported
framework of the data used and the analyses conducted, that is an
accurate representation of the results given in the Draft Final
Report.
Appropriateness
Although the above statement is scientifically accurate,
given the state of a draft not reviewed by outside scientists and a
number of uncertainties that were already apparent to the HTDS
researchers, some overstatements were made in the public
summary, HTDS newsletters, the news release, and the executive
summary of the Draft Final Report. In addition, there was little or
no mention in any of these documents of the uncertainty issues
involved in the study. Such uncertainties, already described in the
present report and others, included the statistical power of the
analyses, possible errors in the dosimet~y, and the reliability of some
information in the computer-assisted telephone interviews related
to possibly faulty recall about milk sources and amounts. At the
time of the Draft Final Report's release, the HTDS investigators
were trying to run an uncertainty analysis but were not succeeding
in its execution; this was not mentioned in the written materials.
Despite those problems, the results of the HTDS were
presented with unqualified certainty, and at the time of and after
the release of the report some statements attributed to the HTDS
investigators appear to have overstated the certainty of the results
in the Draft Final Report (emphasis added):
.
Thus, given that the HTDS had adequate
statistical power to detect reasonably small
effects, and the rigor of the study design, these
results provide rather strong evidence that
exposures at these levels to ]3~] do not increase
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Communication of Study Results
the risk of thyroid
hyperparathyroidism. These
disease or
results should
consequently provide a substantial degree of
reassurance to the population exposed to
Hanford radiation that the exposures are not
likely to have affected their thyroid or
parathyroid health Davis & Kopecky, 1998, p.
Ace.
Findings of the Hanford Thyroid Disease
Study are clear and unequivocal fDavis and
others, 19991.
This was a very powerful study because
it included a large number of people estimated
to have a wide range of exposures to 13~{ tDavis,
1999a].
The study had sufficient statisticalpower
to detect increases in thyroid disease risk that
were predicted based on studies in other
populations tCDC, 1999a].
The design and successful completion of
the study ensured a very high probability of
detecting relationships - between Hanford
radiation dose and diseases under study if such
relationships exist. The study was very powerful
because . . . kHTDS Newsletter, 19991.
121
The subcommittee believes that such statements were
ill-advised at a time when the Draft Final Report had not yet been
subject to external peer review. Given the many questions raised
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Review of the HTDS Draft Final Report
about dosimetry and other issues and the problems in running the
uncertainty analysis, the subcommittee feels that statements
indicating such certainty should have been modified to take
uncertainties into account and the uncertainties should have been
listed and explained. Several paragraphs and perhaps a list of
uncertainty issues should have been in the executive summary and
all public documents related to the HTDS.
The subcommittee recognizes that including such
uncertainty information would probably have diluted the strength
of the investigators' message; however, such caveats are critical to
increasing public acceptance of the results of the report. Omitting
them left the investigators open to the charge that they had
emphasized negative results.
On a related matter, the printed HTDS public summary
was titled "Summary Final Report of the Hanford Thyroid Disease
Study" (FHCRC 1999b), which was misleading, inasmuch as it
was still a draft. From the cover of the printed summary, a reader
would not have been able to tell that the report was a draft. Nor did
the text of the public summary make it clear that the report was
still under review and that some findings might be changed. The
text explained that there had been public and scientific review of
the study, but it implied that review was finished (FHCRC 1999b,
p. 8~. Those items gave too much certainty to the results and the
study itself.
In contrast, the January 1999 HTDS newsletter included
information in two places about the final stages of peer review by
both the Research Council subcommittee and a journal, and it
called the report the "Draft Final Report to the CDC". Later
versions of the public summary given out by CDC were also
stamped "Draft".
The subcommittee recommends that all uncertainty
issues be clearly noted and explained in the final report and all
public documents related to it.
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Communication of Study Results
Contextual Information
123
Both the main public documents and the executive
summary of the Draft Final Report lack comparisons with findings
in other reports on similar subjects, such as the Institute of
Medicine's report (NAS/IOM, 1999) on the nationwide fallout
study by the National Cancer Institute (NCT, 1997) and the NTS
report (Kerber and others, 1993~. It should be noted, however, that
a CDC fact sheet, "What We Know from Other Studies of
Environment Radiation Exposure and Thyroid Disease", was
available. How widely it was disseminated is unknown. The
subcommittee believes that not having at least a summary of this
contextual information in the public summary and the Draft Final
Report presented a problem because readers did not have any
background information with which to compare the HTDS results
if they did not have the CDC fact sheet. In risk issues, many
readers and journalists need to know more than just the event at
hand in this instance, the findings of only this one report. They
need to see the long-term issue in context so that they can
understand the variety of findings and judge for themselves the
validity of the current study against the others. The subcommittee
recommends that contextual information be included in both the
executive summary and the body of the final report and the public
summary.
Readability
The public summary, fact sheets, newsletters, and Web-
site information about the HTDS Draft Final Report were readable
and relatively easily understood. However, the executive summary
of the Draft Final Report was far from that. The language was
technical and often highly complex, and it did not need to be so in
most places. Scientists will not be the only people reading the
executive summary, and it should be understandable for a number
of educated groups (such as nonscientist government officials,
lawyers, journalists, and social scientists), even though it need not
be as simplified as the public summary.
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There were a number of readability problems in the
executive summary. For example, in the first part (pages 3-7), it
was difficult to keep track of the many numbers related to how
many people were in various parts of the sample. On page 4, in the
fourth paragraph, the way the numbers were presented was
confusing: 3,865 "potential participants . . . agreed on either the
first or second attempt. The remaining 3,565 . . . agreed to
participate. . . ." Those sentences should be rewritten. Throughout
this section, charts would help to clarify which numbers apply
where and help the reader to follow the discussion. The material on
the computer-assisted telephone interviews and on how people
provided names of relatives to be interviewed (pages 4-5) also
needs to be explained better.
Throughout the executive summary, abbreviations and
uncommon words were unexplained or were explained after they
had already been used. For example, finding "CIDER", "Exp.-IPl",
and "realizations" on page 5 of the executive summary would
probably confuse a reader. Those and other terms need to be
briefly explained in the text or in footnotes.
The subcommittee recommends that an effort be made
to remove excess technical language and to use consistent terms,
particularly for types of thyroid diseases, in the executive summary
of the final report. More charts should be used in the executive
summary to provide visual aids to help understand the information.
in addition, the entire final report should be edited and
should include a glossary of abbreviations and technical terms
used.
Written Materials from CDC, May 1999
After the adverse response to the release of the Draft
Final Report by members of interested citizen groups and some
other citizens in the region, as shown in letters to the editors in
several newpapers and to CDC officials, CDC prepared some new
materials that were used at two public meetings, in Spokane and
Seattle, to discuss the report in May 1999. in the "Summary of the
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of a new plan to release the final version of the report and to
provide some history of the communication efforts made for the
Draft Final Report. The new plan should include such issues as
whether the whole study or only the changes (if any) will be
released and how uncertainty will be discussed. If the changes
made to the Draf Final Report are minor, only minor planning is
needed. However, given the public dismay at the release of the
Draft Final Report, the subcommittee believes that major
communication planning will be required to ensure that the
integrity of the StUdY and the investigators is maintained in the
, do,
~ . .. .. . ~ . ~ . ~ ~ . _ . .
eyes ot both the public and the media. Some plans will also be
needed for the eventual publication of the article submitted to a
scientific journal, if it is accepted, because its publication could
attract more media attention. Additional requirements for a new
communication plan will be discussed below.
RELEASE OF THE DRAFT FINAL REPORT
With hindsight, one can often see why a reasonably
well-planned risk-communication plan was not successful.
However, during the planning of a risk-communication effort, it is
often difficult to evaluate how members of the public will respond
to messages or whether they will even pay attention to them. There
was little worry that the messages in the HTDS Draft Final Report
would reach an interested population, including national and
regional journalists. However, as described earlier, three major
unplanned factors led to an early release of the report. In addition,
at the time of the release, another unplanned factor- a leak to the
New York Times about the report put more stress on the release
situation. To evaluate the outcomes of the various briefings that
occurred with the release of the report, it is important to look at
some different aspects, if only briefly: the planning process, the
need for an information blackout, the briefings themselves, the
leak to the Times, and the selection and effect of the main
messages presented at the briefings.
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Planning Process
To release a report of great interest and magnitude, such
as the HTDS report, is not a simple task, and neither the
investigators nor the CDC appeared to take it lightly. Plans
described in section X of the Draft Final Report were ambitious
and generally well designed. With the early release of the report,
efforts had to be speeded up, and this possibly led to some
problems because many audiences had to be dealt with: HTDS
participants; the various advisory and citizen groups in the region;
state public-health officials and state, county, and local
government leaders in three states; tribal officials; Washington,
DC, officials, including those at the Department of Health and
Human Services (DHHS) and congressional delegations from the
three states involved; and, of course, the mass media. In addition,
the printed materials for the public had to be prepared as did
material that would appear on the HTDS Web site with the release
of the report. Mailings with study results had to be sent to
hundreds of people, including the study participants. That is a great
deal to accomplish in the 3 months between the decision to release
the report early and its official release date.
Nevertheless, CDC had a well-planned "rollout"
schedule, listing all the tasks, who would do them, and the
necessary deadlines. Complicating the planning and matenal-
development process was the need to procure many clearances in
CDC and DHHS that took about 2 weeks, a "fast-track" timeframe.
Some concern has been expressed that as some of the draft public
materials went through the clearance process, some of the
qualifiers on the findings were dropped and the message became
more positive. That is often the case when many messages have to
be cleared through channels, and it might have occurred here, but
no evidence to that effect was seen.
Need for an Information Blackout
Part of the planning appeared to include an information
blackout of the HTDS results until official release of the report.
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Supposedly, the blackout would let the study participants and the
public know the study results at about the same time. That was
somewhat unrealistic, given the number of groups to be briefed.
The more briefings scheduled, particularly if some are a day or so
in advance of others, the greater chance that infonnation will be
leaked as it was in this case. in addition, the blackout had an
unhappy effect on the citizen groups, including the HTDS
Advisory Committee, which had been kept informed about the
study's progress over the years. Members had come to expect to be
updated about what was happening in the study and became upset
about not being told the main findings earlier than the day of the
public release.
[n retrospect, there were reasons to keep the findings of
the study confidential, but perhaps the most important need to
communicate first and foremost with the public-was downplayed.
Trying to brief so many official parties before the public created a
substantial opportunity for information leaks. This subcommittee
believes that trying to maintain an information blackout, given the
number of briefings needed, was problematic and unrealistic.
Briefings
According to the schedule provided by CDC, briefings
about the report were to start in Washington, DC on January 22
and 26 with officials of CDC, DHHS, DOE, the National institute
for Occupational Safety and Health, and the Agency for Toxic
Substances and Disease Registry. A briefing for congressional
delegations was scheduled for January 27. On the main release
~lay, January 2S, the briefings moved to the state of Washington.
Two morning conference-call briefings were scheduled for state
health officers and the Northwest Tribal Nations and Indian Health
Service. On the 2Sth, at ~ pm, four citizen groups, including the
HTDS Advisory Committee, were to be briefed by conference call.
The media briefing was to occur at 3 pm, and the public meeting
on the report was scheduled for 7 pm in Richiand, WA. Material
concerning the study was to be posted on the Web site at 3 pm.
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129
It was an ambitious schedule, and it represented a
compromise from the earlier discussion in the Draft Final Report
of using satellite connections for remote meetings rather than
conference calls. One participant in the calls felt that they did not
work well, because they were far too impersonal and unwieldy.
Participants did not know who was on the other end; they could not
show graphs or other illustrations; they could only deliver an
abbreviated version of information that would be presented at the
media briefing and take questions.
There also was frustration for the people on the
receiving end of the conference calls, according to information
given to this subcommittee. They briefly heard a message that they
had not expected, had few details about the study, had nothing in
writing, and could only ask general questions. In addition, because
they had no written materials, they could not respond to questions
being directed at them about the report by journalists on January
28. Another problem in retrospect was that the briefings even
those for the media or the public were not taped, so they could
not be transcribed later for interested parties. Several people in the
region concluded that CDC did not take the briefings seriously
enough to record them for review.
Given that there were no transcripts, it is difficult to
evaluate how well the briefings were done. One reporter at both the
media beefing and the public meeting was surprised by "how
absolutely confident the Hutch people were." She pointed out that
subtleties and uncertainties were not discussed, nor were any
problems with statistical power. She noted that scientists usually
are not that positive about their studies and open make
"conditional statements particularly when a study is still a draft and
hasn't undergone peer review" (Steele, 19991. However, another
reporter who attended the media briefing said that even if the
uncertainties in the study had been stressed, the media probably
would not have emphasized them. She noted that the press
"wouldn't have dwelt on the uncertainties", because the media,
particularly the broadcast media, do not get into all the technical
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Review of the HTDS Draft Final Report
details, and she said that they would report only that "the bottom
line is this. That's the way the media operate" (Cary, 1999~.
Effect of the Leak to the New York Times
After the congressional briefing on January 27, the
HTDS results were leaked to a Times reporter, who quickly wrote
an article about them. The story was picked up by the Associated
Press and was on the wire to be seen by reporters in the Hanford
area about ~ pm PST that night. It was early enough, said one
reporter, that she was able to add some local reaction about the
findings to a story that she had been writing about the release of
the report the next day. Her newspaper also ran the New York
Times story on the morning of January 2S, before both the media
briefing and the public meeting (Cary, 19991.
Again, an uncontrolled situation had changed a
carefully planned risk-communication strategy. The leaked storer
sent reporters and HTDS and CDC officials scrambling. CDC
media officials starting faxing materials about the study results to
reporters at 6 am EST on January 2S, not waiting for the 3 pm
media briefing. They also began putting all the planned
information about the report on the Web site at 3 am EST.
It is hard to evaluate the impact of the article with the
leaked information on the planned risk-communication process,
but several members of citizen groups said that they were upset
because reporters were calling them for comment on the morning
of January 28 and they had not yet been briefed. Even after they
were briefed, they still had no written data and had not read
anything official about the study to which to respond. They felt
that they were put into an awkward position. There also has been
some supposition that reading the results of the study in that day's
newspapers made the people who attended the public meeting in
the evening more angry than they would have been otherwise. It is
hard to know whether that is valid. However, as one reporter said,
the Times story set the tone for most of the media coverage that
followed, and it was headlined "No Radiation Effect Found at
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131
Northwest Nuclear Site" (Wald, 19991. Many who presented
information to this subcommittee during its public meeting in June
in Spokane complained about the media coverage of the study and
its implied dismissal of thyroid problems at Hanford. That point is
exemplified by a headline found in the Salt Lake Tribune, topping
an AP story on the study: "Study Disputes Hanford Poisoned
People" (Associated Press, 19991. For a number of people in the
Hanford region, such a conclusion was unacceptable, and they
blamed the media position on the overpositive and strong message
provided in the Draft Final Report and the various briefings.
The Message and Its Effect
in evaluating the risk-communication process and the
activities that occurred around the HTDS Draft Final Report, it is
hard not to question whether the public dismay with the release of
the report would still have come about if the message had been
different. The main message no link between radiation exposure
at Hanford and prevalence of thyroid disease was not expected
by concerned members of the public in the region. Given the
findings of the NTS, Chernobyl, and other studies and the
documented radiation releases from Hanford, a positive association
was expected, according to interviews with local journalists and
some concerned citizens.
Delivering unpopular risk messages is itself risky. in
many instances, it has to be done delicately, with great thought
about how it will affect an audience expecting an opposite result.
Varied audience responses have to be forecasted and planned for.
Sensitivity to audience health concerns and fears needs to be
shown. In this particular situation, with an audience very
concerned about perceived high rates of thyroid disease in the
population an audience that had been reported to have little trust
in government agencies great care should have been taken to
deliver the results of the HTDS sensitively and tactfully.
Implications for individuals and families that have suffered from
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thyroid disease should have been not only explained, but also
highlighted.
Perhaps knowing that they faced a difficult task, the
HTDS investigators felt that they had to deliver as strong and
positive a message as they could about their findings, indicating to
people in the region that they should fee! relieved that no link had
been found. But that was not a sensitive way to proceed, given the
audience. One important error was to emphasize the statistical
group effect and not the outcome for individuals. It was only in
response to questions at the briefings that they acknowledged that
their findings did not negate the suffering of people in the region
from thyroid disease. Later, they explained that they had left the
uncertainties in the study undiscussed during the briefings and in
the written public material because the focus groups that they had
worked with on the public summary during the fall of 1998 had
told them that anything technical was not appropriate for the public
materials.
CDC's role in the message selection and delivery is
more complicated. People providing information to this
subcommittee in Spokane questioned why CDC had not intervened
to counter the overpositive message about the study given by the
HTDS investigators in the briefings and the written materials. They
said that the investigators were contractors and that CDC was
ultimately responsible for what was said about the study. They
charged that CDC had done a disservice to the people of the
region. Clearly, this is an important and complex issue. It involves
agency-contractor responsibilities and relationships, academic
freedom, and responsibilities to the public. It is even more
complicated if one remembers that in December 199S, HHES
members and other citizens urged CDC not to alter the report as it
came from the investigators and to release it as it was. Those
concerns helped to put CDC officials between a rock and a hard
place. if they asked the HTDS group to soften the tone of the
findings, they could be accused of altering the investigators'
report. It is apparent that CDC officials would have been criticized
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by various groups no matter what actions they took, because of the
numerous audience expectations about the study results.
CDC officials said that the main message was decided
by collaboration between them and the HTDS investigators on the
basis of numerous discussions. Several CDC officials noted that
they had concerns that some of the messages were too strong, such
as "this was a powerful study." Despite their concerns, after
struggling with some of the language in the report, they decided to
leave it as drafted by the HTDS investigators because of public
pressure not to alter the report.
The subcommittee recognizes and supports CDC's
sensitivity to citizens' concerns and the needs of academic freedom
for investigators, but it believes that there was a middle ground:
both the HTDS investigators and CDC officials should have
expressed their own views and interpretations about the Draft Final
Report at the briefings and in the public documents. Although
consensus might have been preferable, the differing interpretations
should have been presented to the media and the public. That is
preferable to having one point of view dominate the other
regardless of which side dominates and then backtracking to
change or soften a message. Such advice does not agree with some
generalized risk-communication guidelines, but such guidelines
must be adapted to specific situations. In this case, many members
of the public and the journalists in the Hanford region were
actively engaged in the issues and educated about them. They were
not going to accept a simplified approach and message, particularly
if it disagreed with their own experiences and points of view.
Rather than presenting a black and white picture of the results with
a positive spin, the HTDS and CDC personnel should have
emphasized the shacles of gray.
Despite its sensitivity to problems with the language in
the report and concerns over what to do about it, CDC itself
showed insensitivity to people and families with thyroid disease in
the region when it announced at the public meeting on January 28
that it would recommend a change in plans for medical monitoring.
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No matter what reasons officials gave including a report by the
Institute of Medicine questioning the value of medical
monitoring-the public linked this action to the announced results
of the HTDS. And although CDC took great pains to point out to
the public and the media that the HTDS report was a draft and
would be subject to peer review and public review, the agency
appeared to be basing policy decisions on it. Even if the decision
regarding medical monitoring was correct, announcing it at the
same time that the HTDS Draft Final Report was released was a
mistake and hurt CDC's credibility.
Recommendations about Releasing the Final Report
The subcommittee recommends that CDC continue its
open-communication policy on the HTDS and improve on it for
release of the final report. it applauds the development of materials
for the public such as the newsletters, the background fact sheets,
and the Web site-and recommends that it be continued. It is
important to remember that those efforts were well received in the
community, and they should not be overshadowed by the problems
encountered with the release of the Draft Final Report.
In writing and releasing the final report and its public
summary, steps must be taken to explain alternative interpretations
of the data and to ensure that findings are presented in an even-
handed method that does not overemphasize one point of view.
Efforts must be made both in the report and its accompanying
public documents to explain the implications of the findings for
individuals and families sensitively, indicating, for example, that a
statistical study does not necessarily negate the existence of
thyroid disease in this population and explaining why that is so.
The messages in the final report must be developed with sensitivity
to audience health experiences, concerns, and fears.
Any substantial changes made from the Draft Final
Report should be clearly outlined and explained, including why
they were made. Remaining uncertainties must be acknowledged
and explained, along with their implications and effect on the final
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conclusions. CDC and HTDS personnel should work together on
the wording and presentation of any public messages, presenting
alternative interpretations of data and conclusions as needed.
Given the controversy that already exists over this report,
presenting only one viewpoint will lead to more public distrust.
A new communication plan should be developed for the
final report. It must take into account and acknowledge the
problems encountered with the release of the Draft Final Report
and include dealing with possible lowered public trust in the HTDS
investigators and CDC in the Hanford region. Because of serious
problems encountered in trying to maintain an information
blackout, such efforts should be minimized. For the final report,
multiple briefings should be abandoned, and there should only be
an early briefing for CDC and DHHS officials followed quickly, if
possible given political realities, by one large briefing for all other
parties, using satellite transmission or other~advanced technology
to link groups in various locations. In particular, citizen groups that
have participated in the study process over the years should not be
kept out of the information flow until the last minute. All media
and public briefings should be videotaped to provide a record of
the proceedings. Journalists should receive copies of the final
report several days in advance of its official release after agreeing
not to write stories about it until the release. That practice, known
as embargo, is widely used and, particularly on complicated
subjects, allows journalists time to study a report and develop
thoughtful articles.
Given the investment of time and effort by the people
who participated in the HTDS, they should be randomly surveyed
as to their satisfaction with the communication of the draft study
findings and their own dose results, so that communication to this
group can be improved for the final report.
In light of the importance of the HTDS and future CDC
reports to the public on radiation, the subcommittee suggests that
the agency hold a workshop of selected risk-communication
experts, scientists, journalists, and members of citizen groups to
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discuss some of the important communication issues that have
been raised in this case and the complex topic of the advisability of
releasing unreviewed draft reports to the public. In particular, such
a workshop would help to focus the growing body of social-
science risk-communication research on questions about audience
response to such reports as the HTDS report and simultaneously
produce new research questions for systematic study. Such a
workshop could also investigate how the government relates to and
discusses with the public the levels of uncertainties involved in
various scientific studies, as well as alternative ways of addressing
public concerns about issues like Hanford. Much still needs to be
known about how members of the public use and respond to risk-
related messages, including the complicated roles of trust and
credibility in how audiences accept and process risk messages.
Representative terms from entire chapter:
htds draft
