When asked to describe the press coverage of Philippine President Corazon Aquino's administration in 1987, the noted legislator and human rights attorney Rene Saguisag replied, "media is the plural for mediocre."1 Thirteen years later, a team of investigators from Australia and the United States has reached much the same conclusions about the media's coverage of drug research and new medications.
According to a report published in a recent issue of the New England Journal of Medicine,2 the typical media coverage of drug research and new pharmaceutical products falls far short of delivering information that helps patients and providers make informed, objective decisions. The investigators found that most stories about research or medications "include inadequate or incomplete information" about benefits, risks, costs, side-effects, or financial ties between drug manufacturers and study authors.
"The public increasingly wants and needs to make informed judgments about the use of new medications on the market," said Karen Davis, president of the Commonwealth Fund, a private foundation that funded the survey. "This study shows that newspapers and television need to do a better job in reporting about both the benefits and the risks of new drugs."3
"The media are a very important source of public health information," added Dr. Stephen Soumerai, a professor at Harvard Medical School and one of the study's co-authors, "but stories on new drugs can be misleading when they fail to address potential conflicts of interest and don't discuss both relative and absolute benefits, risks and costs. We hope this study provides some focus for journalists and editors who are continually striving for greater accuracy in medical coverage."3
In the study, Soumerai and seven co-investigators studied the way the U.S. news media covered the benefits and risks of three medications used to prevent major diseases: alendronate (Fosomax), which is used for the treatment and prevention of osteoporosis; pravastatin (Pravachol), a drug used to lower cholesterol and prevent cardiovascular disease; and aspirin, which is also used to prevent cardiovascular disease.
Table I: Benefits, coverage of adverse effects and costs, and,
disclosure of ties with industry in media stories.
|
| Story Characteristic | # of Studies Meeting
Characteristic | % of Studies Meeting
Characteristic | |
| Did Not Quantify Benefits | 83/207 | 40% |
Quantified Benefits
Only relative benefits
Only absolute benefits
Relative and absolute benefits
|
103/124
3/124
18/124 |
83%
2%
15% |
Adverse Effects and Costs
Adverse effects mentioned
Costs mentioned
|
98/207
63/207 |
47%
30% |
Ties with Industry
Cited expert or study
Cited expert or study with tie to industry
Disclosed tie to industry |
170/207
85/170
33/85 |
82%
50%
39% |
Two hundred and seven news items were examined: 180 newspaper articles (60 for each drug) and 27 television reports printed or aired betweem 1994-98. The researchers looked for a number of factors in each news item, including: whether the benefits of a drug were stated, either in relative or absolute terms; potential side effects; costs for the medications; and disclosure of any ties between the researchers conducting the studies and the pharmaceutical industry.
The results surprised even the researchers:
- Eighty-three stories (40%) did not provide the numerical value of a drug's benefits, leaving people without the information necessary to measure the real value of a drug to their overall health. Of the 124 stories that did report benefits, 83 percent reported only relative benefits, an approach that the researchers said "could be viewed as potentially misleading."
- Only 47% of the news items mentioned any potential harm associated with the drugs, even though the three medications are associated with a wide range of side effects, including inflammation of the esophagus and gastrointestinal disorders.
- More than two-thirds (70%) of the stories made no mention of the cost of the drugs, a finding the researchers considered significant, because "cost effectiveness is increasingly considered an important factor in medical advances."
- Eighty-five stories cited experts or scientific studies that were either funded by companies with a financial interest in the drug or had financial ties with those drug companies. However, only 39% of those stories disclosed financial ties.
One particular series of reports highlighted the way the media skewed the results of a study to make a drug appear more effective. In May 1996, ABC, NBC and CBS all carried news items on an alendronate study, stating that it could reduce the incidence of hip fractures by 50%, a figure one reporter termed "almost miraculous."
Closer investigation, however, revealed just how much the media exaggerated the drug's effects. The reporters failed to mention that only two percent of people with untreated osteoporosis sustain hip fractures. The incidence of hip fractures was reduced by half, but the drug reduced the incidence of hip fractures in osteoporosis patients from just two percent to one percent. The media also failed to disclose that the alendronate study's investigator had received funding for the study from the drug's manufacturer.
"Patients don't have a full set of information upon which to base decisions about whether or not they want to try new drugs, especially drugs that have benefits that may not be as substantial as they are portrayed in the news coverage of the product," commented Dr. Dennis Ross-Degnan, another of the study's co-authors. "There's really a need for more in-depth reporting that doesn't just cover product launches and breaking media stories."4
Plenty of Room for ImprovementWhy is the media's coverage so incomplete? Although the question was not discussed in the article, several factors were indicated as contributors to unbalanced reporting, including a lack of time to conduct proper research and deliver information, and a general glut of health news, both of which can cloud the judgment of a reporter (or even a health care professional).
"In many ways, news coverage has the same deficiencies as advertising," remarked Sidney Wolfe, director of the Washington, D.C.-based Public Citizen Health Research Group. "Doctors read the news and watch television, too."5
While pharmaceutical companies provide a necessary service, they are still businesses that have the primary goal of making money. Millions of dollars are used in the manufacturing and marketing of drugs. The companies that make those drugs have a strong interest in recouping the money they invest and seeing that their products are portrayed in a positive light. If a trained reporter is unable to separate the science from the sales pitch, the average reader (or listener) may have an even more difficult time coming to an objective conclusion about a drug's benefits or side-effects.
To remedy the situation, the researchers did offer a number of suggestions for the media to improve their coverage of drug research and new pharmaceutical products. One option would be to provide members of the media with a guide to help them write more balanced health stories.
"An effective educational program or resource kit for journalists and editors, focusing on the reporting and interpretation of clinical findings, might be timely," they said.
The researchers also suggested that the media begin to employ "basic principles of high-quality medical reporting" based on the evidence at hand, and that before reporting on new technologies or therapies, they should first ask:
- What is the degree of the benefit (both absolute and relative)?
- What groups of patients can be helped?
- Are there any links between the sources providing the information and those that promote the therapy?
- What are the risks associated with the product?
- What are the costs associated with the product?
"Although not exhaustive," the researchers concluded, "these questions could help inform attempts to improve the quality of medical reporting."
References
- Simpson JB (ed). Simpson's Contemporary Quotations. New York: Harper Collins, 1997.
- Moynihan R, et al. Coverage by the news media of the benefits and risks of medications. NEJM 2000;342:1645-50.
- Lacey J. Medical news writing faulted in NEJM article. UniSci News, June 1, 2000.
- Media coverage of drug research is often incomplete. HealthAnswers (www.healthanswers.com), June 1, 2000.
- Vergano D. Media coverage of drugs often too rosy. USA Today, May 31, 2000.
Michael Devitt, BA
