IN MID-October, an email landed in my inbox that set me thinking. It was an invitation to a meeting organised by the UK Medical Journalists鈥� Association (MJA), described as 鈥渁n evening workshop with arthritis experts鈥�. Paid for by an 鈥渆ducational grant鈥� from Merck Sharp & Dohme, the UK arm of the drugs giant Merck, it included a presentation by the company about its clinical research, with comments from other experts.
Ordinarily I might have deleted the mail, but at the time I was helping to complete a report into whether drug firms are exerting undue influence on patient groups (快猫短视频, 28 October 2006, p 18). An important part of that story was the industry鈥檚 use of educational grants, so I decided to take a closer look at the MJA meeting.
Merck鈥檚 aim was to introduce journalists to the MEDAL trial, which has investigated the safety of a painkiller called etoricoxib. The drug belongs to a class called Cox-2 inhibitors, which have proved controversial. Merck faces thousands of lawsuits from patients who believe they suffered heart attacks after taking its Cox-2 inhibitor rofecoxib 鈥� better known as Vioxx 鈥� which was withdrawn in 2004.
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Merck is trying to convince the US Food and Drug Administration (FDA) that etoricoxib is a safer alternative. MEDAL was designed to compare the safety profile of etoricoxib with that of diclofenac, which belongs to a broad class of painkillers known as NSAIDs.
Some have complained that this is not an appropriate comparison, because diclofenac itself raises the risk of adverse cardiovascular events compared with other NSAIDs. David Graham, the FDA epidemiologist who blew the whistle on Vioxx, has been scathing about MEDAL. Yet at the MJA event, none of the speakers alluded to the trial鈥檚 controversy 鈥� not even the individual put forward by the association in the name of balance.
Does this matter? As an isolated incident, perhaps not too much. Unfortunately, it is just the tip of the iceberg when it comes to the influence the industry has on medical reporting. For one thing, the sheer volume of publicity material emanating from drug firms leads to a preponderance of reports on the benefits of new drugs at the expense of articles about other interventions. Furthermore, several studies have raised concern about what writers put in and what they leave out.
鈥淪everal studies have raised concerns about what writers put in their articles and what they leave out鈥�
For example, last April Steven Woloshin and Lisa Schwartz of Dartmouth Medical School in New Hampshire analysed media coverage of restless legs syndrome 鈥� currently the focus of a marketing campaign by GlaxoSmithKline, which makes a drug for the condition. They found that stories typically exaggerated the prevalence of the disease and the need for treatment, while failing to consider problems of over-diagnosis (PLoS, DOI: 10.13171/journal.pmed.0030170).
What鈥檚 more, financial conflicts are rife. Many freelance writers flit between journalism and writing publicity material for pharmaceutical companies. Media organisations 鈥� including 快猫短视频 鈥� rely heavily on income from advertisers, which include drug firms. Responsible media outlets have 鈥渇irewalls鈥� to prevent advertisers exerting influence over editorial content, but it can be a tough line to hold. As medical news migrates online, it may become tougher still. On the web, individual news items can be tagged so that they appear alongside ads that relate to the topic. Under these circumstances, we can expect companies to try harder to ensure their ads do not appear next to 鈥渘egative鈥� content.
Perhaps the biggest concern is a trend for medical news to appear in dedicated slots sponsored by drug firms. The TV network CNN led the way in the 1980s, financing a large team of medical reporters and producers through an association with Bristol-Myers. Firewalls were supposed to prevent the company exerting influence, but some who worked in the network鈥檚 medical unit say that stories dealing with adverse effects of drugs were either not pursued or had to struggle for slots outside the sponsored segment. Despite such concerns, medical sponsorship is alive and well at CNN today and the sponsorship model has spread across other media organisations.
Thankfully, some media outlets recognise that medical news tends to be more reliable if not brought to you by a major drug company. The MJA鈥檚 US counterpart, the Association of Health Care Journalists, struck a blow for independence three years ago when it decided not to accept any industry funding. The AHCJ鈥檚 website also includes a 鈥渟tatement of principles鈥� reminding medical journalists of their professional responsibilities 鈥� which include avoiding conflicts of interest.
Those conflicts are not going to disappear. Other medical journalists鈥� groups should set an example by following the AHCJ鈥檚 progressive approach. Pressure from consumers could also make a difference. If enough viewers complained that CNN鈥檚 approach to medicine belies its boast of being 鈥渢he most trusted name in news鈥�, executives might just rethink their attitude to sponsorship.
