You've heard of junk science--a term coined by corporations to describe research they don’t like--but the real danger to public health might be called "checkbook science": research intended not to expand knowledge or to benefit humanity, but instead to sell products.
Every day it seems there’s a story touting a "promising" new medical product or treatment. Unfortunately, many of those news stories are based on public relations spin machines going into overdrive on behalf of the company that sells the product--whether it’s a pharmaceutical company, a chain of diet clinics or a plastic surgery practice selling a new technique.
Do reporters know that so much medical news is actually unpaid advertising? The most effective industry influence is so well-hidden that many reporters and producers are totally unaware of it. The role of pharmaceutical companies and other health care industry interests in shaping news coverage of medical products and treatment is as invisible as it is pervasive.
The phone calls, press releases and press conferences that bring attention to new studies are the most obvious ways that companies shape medical news; but there are subtler strategies that are much more effective. For example, Excerpta Medica is a PR firm hired by pharmaceutical and other medical companies to launch new products. On their website and in other public documents, they have claimed responsibility for developing several new medical journals and other strategies to "establish a scientific base" for expanded use of their clients' offerings.
What about medical stories based on articles in prestigious medical journals? In some cases, these articles are also bought and paid for. When the stakes are high, companies hire public relations firms that hire medical writers to ghostwrite academic-style articles for medical school professors to submit to well-respected medical journals. The companies also establish speakers’ bureaus--lists of selected professors who are paid thousands of dollars in honoraria and travel expenses to speak at newsworthy national and international conferences.
It’s a win-win for the "experts" and the companies. The professors benefit because their employment status is based on being published in journals and invited to conferences. The companies benefit by having the name of a faculty member from a major university attached to an article or presentation endorsing their product. It’s a real winner when the news headline refers to the industry’s new study by its author’s affiliation--e.g., "the Harvard study"--thus ensuring that the results will be taken seriously.
Few reporters ever know that the prestigious expert speaking on behalf of a new product is, one way or another, a paid spokesperson for the product. The author can honestly say that he or she is not paid by the company--because the money comes from the PR firm (which is paid by the company or its corporate foundation).
Diet Pills: Safe or Not?
One of the most notorious examples of PR-driven medical reporting is the story of fen-phen, the combination of diet pills that was removed from the market in 1997 when Redux (or fenfluramine) was determined to be dangerous. Fen-phen was hailed by the media as a great breakthrough when it gained popularity in the mid-1990s. There was a newsworthy stampede as patients sought the prescriptions from their doctors, at weight loss clinics and over the Internet. By 1996, 7 million women and men were taking fen-phen.
When research was first published linking fen-phen to potentially fatal heart valve damage, the media took notice. Lawsuits and a settlement totaling $13 billion resulted in front-page coverage. But then a funny thing happened: New research articles were published in medical journals, indicating that fen-phen wasn’t really dangerous after all.
Again, the popular media took up the news with great enthusiasm. "Study: No Heart Damage from Diet Drug," proclaimed a front-page headline in USA Today (4/1/98). The study in question, paid for by Wyeth-Ayerst (the manufacturer of Redux) and authored by Dr. Neil Weissman, found only a small, statistically insignificant increase in heart-valve damage for women who took the diet drug compared to women who didn’t.
Let’s give credit to the reporter: He mentioned that the company paid for the study, and that the women in the study took the diet pill for only three months. He mentioned that the study was presented at a medical meeting, although he didn’t explain that such presentations are not held to the same standards as peer-reviewed medical journals. Unfortunately, those fine points were somewhat lost, because the headline and lead focused on the "news" that the drug was safe. The L.A. Times (4/6/98) and Boston Herald (4/1/98) versions of the story were even more reassuring and less questioning about the data.
When Weissman and Wyeth tried to publish the study in the New England Journal of Medicine, the editor required that they modify their data analysis. As a result, the findings were no longer so reassuring. The published article (9/10/98) was not promoted by the company, for obvious reasons, and received little press attention.
A year later (10/1/99), the New York Times’ Gina Kolata wrote about another new study, published in the Journal of the American College of Cardiology (Vol. 34/No. 4), showing that fen-phen wasn’t so bad after all. The Times did not disclose that one of the authors, Dr. George Blackburn, was paid by Wyeth-Ayerst to speak on behalf of fen-phen at medical meetings across the country. As a member of the company’s speakers’ bureau, Blackburn was paid honoraria and travel expenses when he spoke about the company's drugs.
Perhaps the New York Times reporter was also influenced by the editorial in the same issue of the Journal of the American College of Cardiology, which concluded that the story of fen-phen was just a big scare. In the fine print, the editorial stated that it was written by a consultant to American Home Products--Wyeth's parent company.
Only later did anyone learn just how active Wyeth was in making sure that medical journal articles supported their legal defense of fen-phen. Legal depositions revealed that Excerpta Medica, the aforementioned PR company, was paid by Wyeth to supply writers who would ghostwrite or edit medical journal articles to the company’s specifications. Well-known experts were sometimes paid to lend their names as authors. Upon hearing this news, Dr. Robert Tenery, chair of the American Medical Association’s Council on Ethical and Judicial Affairs, told the Dallas Morning News (5/23/99), "What they’re doing here is clearly an advertisement."
Last year, when journalist Alicia Mundy revealed these unethical arrangements in a book about fen-phen, Dispensing with the Truth, she found it difficult to get the media to cover the story. "As a journalist, I had a great network of friends and colleagues that could have helped me to bring attention to these scandals," Mundy told Extra!, "but most of the media did not cover the story of how drug companies shape media coverage of their products."
Breast Implants: Ignoring new Science
Reporting on breast implants provides another example of media manipulation, with coverage that used to focus on science and health increasingly treating implants as a popular if questionable fad. The most important recent studies--three last year and two this year--received little attention, although they showed potentially fatal risks from implants or startlingly high complication rates. With the major public relations efforts on the "implants are perfectly safe" side of the story--paid for by implant manufacturers as well as the organizations representing plastic surgeons--the largest, best-designed studies barely attracted one day of coverage.
When two studies that linked implants to cancer were published in medical journals last year, the newspaper headlines reflected the varied coverage: USA Today’s "Studies Suggest Link Between Breast Implants and Cancer" (4/25/01) was similar to the New York Times’ "Study Links Breast Implants to Lung and Brain cancers" (4/26/01), while Associated Press (4/26/01) decided to emphasize the positive: "Breast Implants Cancer-Safe; No Risk for Most Cancers from Breast Implants, Study Says." The AP headline seems like satire--how many kinds of cancer does an implant need to be linked to in order to be considered unsafe?--but, to be fair, it was apparently taken directly from the National Cancer Institute’s press release, which led with the good news, only later mentioning that implants were linked to several cancers.
A third major study, showing that implants often broke and leakage was linked to deadly diseases, received brief mention in the Washington Post (6/1/01) and was ignored by most other media.
These implant studies were newsworthy because they were the only government studies that had been conducted, and were based on an unusually large sample of patients with a longer history of implants than in previous studies. Two of the studies were conducted by the National Cancer Institute, the other by scientists at the Food and Drug Administration along with an impressive list of medical school researchers. Since the results were not favorable to implants, there was no multi-million dollar public relations machine encouraging press coverage. Consumer groups contacted the media to tell them about the studies, but the placement of the articles, on pages B6 (Wall Street Journal, 4/25/01), D7 (USA Today, 4/25/01), A19 (New York Times, 4/26/01), and A28 (Newsday, 4/27/01), ensured that the bad news would not attract much attention; there was virtually no TV coverage.
In contrast, a 1999 report that had concluded that implants probably did not cause diseases was embraced by the implant manufacturers and plastic surgeons--and was very big news on all the major networks and newspapers. The New York Times broke a press embargo with a front-page story, "Panel Confirms No Major Illness Tied to Implants" (6/21/99), and other media followed: "Study Again Clears Silicone," (Washington Post, 6/22/99, A2); "No Deadly Danger in Silicone Implants," (USA Today, 6/22/99, D1); "Study Clears Gel Implants of Some Ills," (L.A. Times, 6/22/99, A1).
In July 2002, two unpublished studies of saline implants were presented at a public meeting of the FDA’s Advisory Committee on plastic surgery medical devices. Neither the FDA nor the two manufacturers involved publicized the meeting, so few reporters were present. The meeting focused on the first five-year studies of saline implants, and the results were important because of very high complication rates for both manufacturers and the exceptionally low response rate for the studies by one of the manufacturers. The manufacturers provided some spin in response to media inquiries, but their major goal was to keep the story quiet. Without an industry-backed PR machine, that’s exactly what happened.
Hormone Replacement Therapy: A Shock to the System
The recent controversy about hormone replacement therapy (HRT) has all the makings of another fen-phen saga--even with one of the same manufacturers--but we don’t know the entire story yet. For years, HRT has been prescribed and described as if it were a fountain of youth that prevents much of the physical and mental deterioration associated with aging. As recently as June 1999, for example, a New York Times article (6/1/99) headlined "New Therapy Builds Bone Without Unpleasant Side Effects" touted the benefits, and a week later a Times article headlined "Study Plays Down Estrogen Link to Breast Cancer" (6/9/99) minimized the one risk that was well-established. Two years later, an AP story (5/16/01) went even further, with the promising headline, "Hormones May Lower Risk of Breast Cancer’s Return."
So imagine the shock to the more than 6 million women taking HRT when just over a year later the National Institutes of Health decided it was unethical to continue administering hormones in an enormous study because the risks of the treatment were too great. The researchers concluded that HRT not only increased the risk of breast cancer, heart disease and blood clots, but it also was not as beneficial in preventing osteoporosis or other diseases as previously claimed.
The New York Times (7/10/02) captured the mood with its headline: "Hormone Replacement Study a Shock to the Medical System." Most media covered the story as if this was enormous news that came out of nowhere. The truth is quite different. For several years, article after article published in major medical journals had described the growing evidence that hormone replacement therapy increased the risk of breast cancer and did not help and possibly hurt women with heart disease. Other studies questioned the assumed benefits. Although some of these studies were covered in major newspapers, without a PR machine behind them they received limited media attention. (See Extra!, 3-4/97; CounterSpin, 7/19/02.)
Meanwhile, Wyeth and other manufacturers promoted their products directly and indirectly, with a celebrity spokeswoman and many health experts. As recently as May 2002, a nonprofit women’s health organization held a black tie, standing-room only dinner for almost 1,000 Washington, D.C. luminaries, completely underwritten by Wyeth. The theme was midlife women, and as part of the entertainment program, the audience was reminded that midlife women have better lives than ever before, thanks to hormone replacement therapy and other wonderful advances in medicine.
The media coverage also included a gem about the "father" of hormone replacement therapy, Dr. Robert Wilson. In the early 1960s, Wilson promoted hormones as a miracle cure for the "living decay" that besets the often "dull and unattractive" menopausal woman. His book, Forever Feminine, was enormously influential, and hormone replacement therapy has grown in popularity ever since. Wilson seemed to be speaking from the heart, but in interviews during the July 2002 media onslaught (New York Times, 7/10/02) the late doctor's son told a reporter that the book and his father's work were paid for by Wyeth.
Cutting Through the Hype
As I write this conclusion, I receive a call from the Detroit Free Press. The editors are interested in publishing an op-ed I wrote, but first they want to know where the center I work for gets its funds. This is the question that every reporter should be asking, every time they quote me or publish my writing on any medical issue. Almost none of them do. The caller is noticeably uncomfortable as she asks me about possible conflicts of interest, as if she’s asking some terribly personal questions. If more reporters and editors and producers don’t always ask these questions, and dig deeper when they do so, we’ll never cut through the hype that is overwhelming medical news coverage.