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Abstract

• Emerging evidence suggests that media coverage of medicine is increasingly promotional in nature.
  
• Recent Australian examples include misleading newspaper articles on an experimental cancer vaccine and a high profile television current affairs segment on a new influenza drug, which failed to disclose the industry ties of a key expert featured in the report.
  
• There are widening concerns that this problem in medical journalism may be exacerbated by the growing commercialisation of medical and scientific research, and the increasing ties between researchers, doctors and pharmaceutical or biotechnology companies.
  
• Closer links between industry and medicine are being explicitly encouraged both in academia and the health care sector for the mutual benefits they bring. However, these partnerships are the cause of growing unease within medicine.
  
• In the United States, rigorous legislation governing research protocols is being proposed, and in Australia new ethical guidelines covering industry-profession relationships are being promulgated.
  
• If one of the media's roles is informing the community about the business of health and medicine in a fair and accurate way, a cultural change in medical journalism is required.

If one of the media's roles is to inform the community in a fair and accurate way, the reporting of medicine or medical research too often falls short of the mark. A recent study of newspaper and television coverage of medications over a five-year period found many stories tended to overstate therapy benefits, played down potential harms and failed to disclose the relevant industry ties of cited experts (Box).⁴ The misleading nature of much medical reporting requires urgent attention from both journalists and health professionals.

Concern about media reporting raising false hopes, undue anxiety or unnecessary alarm is not new.⁵ However, the increasing commercialisation of scientific research, and the expanding role of the stockmarket in medicine, are creating powerful new forces. Like many new therapeutic advances, the experimental cancer vaccine featured in the Australian media is promoted by a biotechnology company listed on the stock-exchange: for these companies positive stories may boost share prices and negative stories may send them plummeting.

Closer involvement between industry and science, which is being explicitly encouraged in a bipartisan way in Australia,⁶ may well carry the clear benefits of increased research funding or enhanced commercial opportunities for effective new treatments -- but at what cost? Within medical circles, and in the wider community, there is growing unease that overly cosy relationships may be affecting research integrity and professional independence.^7,8 It may be time for the media to offer more critical analysis of the business of medicine, and less thinly disguised promotion of the latest "breakthroughs".

Breakthroughs and boosterism

At the conference, Lars Holmgren, from the Karolinska Institute, Sweden, focused on the now-infamous front-page story in the New York Times on Sunday, 3 May 1998. It began with the paragraph: "Within a year, if all goes well, the first cancer patient will be injected with two new drugs that can eradicate any type of cancer, with no obvious side effects and no drug resistance -- in mice."¹⁰ The article referred to two agents, endostatin and angiostatin, which have shown significant promise in treating cancer in mice by blocking angiogenesis. It had an international impact, provoking widespread follow-up in other media outlets, and leading to many inquiries from anxious cancer patients about a treatment that had not yet been trialled in humans.

As Holmgren explained, the front-page story also had a dramatic impact on the shares of the company developing the agent, which increased in value severalfold the next day. An investigation by the Los Angeles Times¹¹ later showed that the shares in this and other biotechnology companies have since risen and fallen in response to continuing public relations activities and media stories, both positive and negative.¹²

In a provocative conclusion, Holmgren suggested that the trend towards researchers seeking to attract investors through publicity in the mass media -- often ahead of publication in scientific journals -- had become so prevalent that the high-tech stock index, the Nasdaq, had become a more reliable indicator of scientific developments than journals themselves!

The news business

While the television segment was extremely good news for company investors, it serves as another stark example of the malaise affecting much of medical reporting. Like many previous items about zanamivir, the drug's modest benefits were not mentioned.¹⁴ Similarly, the evidence of rare but potential serious harm associated with the new drug for those with pre-existing illnesses like asthma were ignored.¹⁵

Perhaps most importantly, the television program failed to inform its audience of the links between Glaxo Wellcome and one of the key experts who repeatedly appeared in the segment, despite the company's support for the expert's research on zanamivir being clearly disclosed in the scientific literature.¹⁶ Instead, the program chose to describe the specialist as an "independent professor" from an academic institution. This clear failure to reveal the relevant industry ties of a key source is not an isolated instance.⁴

Cosy relationships

As an example of the problem, Angell cited the difficulties in finding independent reviewers to write about the treatment of depression, because so many US psychiatrists have links to companies selling antidepressants. "The problem is by no means unique to psychiatry," she wrote. Nor is the problem unique to the United States. Two years ago a leading Australian academic complained publicly of the difficulty in finding independent specialists to sit on regulatory committees, because so many were consultants to drug companies.¹⁷

The reason for concerns about the increasingly intricate ties between researchers and industry is not simply academic. Evidence suggests that a range of physician-company interactions (like attending company-sponsored education, or accepting sponsored trips) can carry negative impacts on behaviour.¹⁸ As Angell pointed out, "there is now considerable evidence that researchers with ties to drug companies are indeed more likely to report results that are favourable to the products of those companies than researchers without such ties."⁷

An obvious concern is that corporate funding may sometimes cause bias. More subtly, according to Angell, ties may influence scientific judgements in ways that are difficult to identify. The bottom line is that companies are seen to be buying the goodwill of researchers, "which is a very valuable commodity for drug and device manufacturers".⁷

The buck stops . . . where?

Community concerns about the ties between doctors and the pharmaceutical industry led the Royal Australasian College of Physicians this year to disseminate new ethical guidelines that cover these relationships.²⁰ Largely accepting the benefits of close commercial relationships, including company funding of research, paid consultancies and sponsored travel, the guidelines recognise the possibility that these relationships may cause conflicts between physicians' responsibilities to their patients, and their own personal gain. Essentially endorsing the multiplicity of industry-professional ties, the guidelines argue that openness to public scrutiny is a sufficient safeguard.

But self-regulatory professional guidelines that carry no real penalties are not considered enough in some quarters. Responding to Angell's editorial, the United States Secretary for Health and Human Services, Donna Shalala, recently announced a list of wide-ranging measures to improve ethical conduct in research.²¹ Included is the possibility of new legislation which would impose fines of up to $US250 000 per clinical investigator and up to $1 million per research institution for violations of ethical research conduct -- such as failing to obtain proper informed consent from research participants.

Shalala argued that several recent incidents in the United States, including the much-publicised death of a subject in a gene therapy trial,²² had shaken public confidence in research ethics. One of the reasons that protection for human subjects needed to be strengthened was, according to her editorial, that academic investigators increasingly have commercial links with trial sponsors or personally hold patents over the therapies being trialled, creating potential conflicts of interest and major ethical dilemmas.

Cash for comment

In light of the revelations which emerged from the "cash for comment" inquiry,²³ a rigorous and wide-ranging investigation of the nature and extent of commercial links between the medical profession and the pharmaceutical, biotechnology and medical technology companies may now be timely in Australia. In a spirit of openness and disclosure, such an inquiry could also examine the ties between journalists and the medical companies whose products they are charged with reporting on.

Evidence-based journalism

Strategies for quality improvement will require debates within media organisations, journalist professional bodies and the wider research community. Valuable assistance in those debates may soon come from a group of researchers who are now conducting a randomised controlled trial of various educational interventions for journalists covering health and medicine.²⁵ Similarly, many researchers and journalists, as well as the Australasian Medical Writers Association, are working on educational and other resources designed to improve medical reporting.^26,27 In Sweden, for example, medical journalists are encouraged to follow a number of ethical guidelines, including do not arouse false hopes and fears; try to present risks and benefits together; emphasise the uncertain and temporal nature of knowledge.²⁸

Critical, informed and independent journalism will become even more crucial in light of increasing commercialisation, combined with the major, complex changes arising from the new biotechnologies. Media organisations currently face a fundamental choice about how they cover the issue of human health: to act as "cheer squads" for the new products, or to seek out truly independent evaluation of promotional claims in order to better inform the public about the limitations, uncertainties, dangers and costs, as well as the genuine health benefits, of new medical therapies and technologies.

References

1. Busfield W. Melanoma vaccine next year. The Daily 1Telegraph, 19 November 1999: 3.
2. The Australian Press Council. Adjudication No. 1081. Re: The Daily Telegraph, 19 November, 1999.
3. Greenblat A. Cancer drug fires up AVT. The Age 20 July 2000: B3; and The Sydney Morning Herald, 20 July 2000: 23.
4. Moynihan R, Bero L, Ross-Degnan D, et al. Coverage by the news media of the benefits and risks of medications. N Engl J Med 2000; 342: 1645-1650.
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9. Swedish Society of Medicine. Berzelius Symposium 54 -- Medicine and the Media. 31 August-1 September 2000. Stockholm.
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12. Ashraf H. British Medical Journal apologises to biotech company [news]. Lancet 2000; 355: 2139.
13. A Current Affair, June 14, 2000.
14. Summary of evidence about effectiveness of zanamivir. National Institute for Clinical Excellence, UK, 1999. <http://www.nice.org.uk/nice-web/Article.asp?a=427> Accessed 14 November 2000.
15. Relenza [US Food and Drug Administration consumer drug information]. <http://www.fda.gov/cder/ consumerinfo/druginfo/relenza.htm> Accessed 14 November 2000.
16. The MIST (Management of Influenza in the Southern Hemisphere Trialists) Study Group. Randomised trial of efficacy and safety of inhaled zanamivir in treatment of influenza A and B virus infections. Lancet 1998; 352: 1877-1881.
17. Moynihan R. Too much medicine? Sydney: ABC Books, 1998: 8.
18. Wazana A. Physicians and the pharmaceutical industry. JAMA 2000; 283: 373-380.
19. Sweet M. Medicines and the media; a journalist's view. Aust Prescriber 2000; 23: 70-71.
20. The Royal Australasian College of Physicians. Ethical guidelines in the relationship between physicians and the pharmaceutical industry. Sydney: RACP, 2000.
21. Shalala D. Protecting research subjects: what must be done? N Engl J Med 2000; 343: 808-810.
22. Greenberg DS. Stricter regulation proposed for US gene therapy trials [news]. Lancet 2000; 355: 1977.
23. Commercial Radio Inquiry. Report of the Australian Broadcasting Authority hearing into Radio 2UE Sydney Pty Limited, Sydney: ABA, 2000.
24. Sweet M. Journalist, heal thyself. Walkley Magazine, August 1999: 15.
25. Oxman A. Evidence-based medicine and medical journalism. Presentation to Berzelius Symposium 54 -- Medicine and the Media. 31 August-1 September 2000. Stockholm.
26. Irwig L. University of Sydney continuing education courses on evaluating health studies.
27. Levi R. Medical journalism: exposing fact, fiction, fraud. Studentlitteratur 2000 Stockholm. <www.studentlitteratur.se> Accessed 14 November 2000.
28. Bengtsson H. The roles of the Medical Journalist. Presentation to Berzelius Symposium 54 -- Medicine and the Media. 31 August-1 September 2000. Stockholm.

Reprints will not be available from the authors.
Correspondence: Mr R Moynihan, 76 Francis Street, Bondi, NSW 2026.
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©MJA 2000
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