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It's not just about remembering to take the right drugs at the right time

Naomi Marks describes how the media are complicit in drug marketing

The lay media have long come under attack for not adequately scrutinising the information emerging from Big Pharma about new prescription drugs, but now they stand accused of helping to publicise and promote drug company products. In a hardhitting article in the current issue of the prestigious US periodical the Columbia Journalism Review, the press is criticised, in its coverage of drug industry matters, for failing as a public watchdog. “Americans have always been obsessed with all things health-related,” says the article, “but today a drug can move almost instantaneously from medical research to miracle cure through news media that too often seem more interested in hype and hope than in critically appraising new drugs on behalf of the public” (www.cjr.org/issues/2005/4/lieberman.asp).

The article's author, Trudy Lieberman, who is health policy editor of US watchdog organisation Consumers Union, blames various factors. In short, she says, journalists all too often fail to:

Find information sources and case studies other than those offered by drug companies and their public relations people

Disclose the financial or other interests of those they quote

Seek out and evaluate research data.

Other factors exacerbate the situation, she says: there is the increasingly sophisticated way that drug companies hide aggressive marketing activities; there is the growth in direct to consumer advertising leading to conflict between advertising and editorial in media organisations; and there is the hard to break culture of newsrooms in which simplistic black and white stories are seen as so much sexier than reports painted in more realistic shades of grey. Lieberman also points a finger at the US Food and Drug Administration and its “somewhat cozy relationship with the companies it regulates,” which sees those reporters asking tough questions being “frozen out.”

Overall, she says, such a mix finds the press caught up in a drug industry marketing web that leaves the public without a reliable watchdog.

Lieberman—whose article analyses coverage of various drugs that have since been withdrawn, such as rofecoxib (Vioxx)—is writing about the United States, but the scenario she outlines is recognised all too clearly by Ike Iheanacho, editor of the UK based Drug and Therapeutics Bulletin. “These themes of how the drug industry interacts with the public involving the media are universal and perennial,” he says.

Iheanacho points to the standard health reporting formula, “There's a ‘break-through,' an interview or quotes from somebody who has benefited, and maybe a quote from the manufacturer. You don't get a sense of balance, that there might be side effects, or that the drug might not even be available for a few years.” He adds, “It takes time to be truly critical. Either you have to look at the studies yourself or talk to someone or several people in detail. Having done all that you may end up with a very confused picture and that doesn't make easy journalism.”

Indeed, for journalists not content to settle for “easy journalism,” reporting can be more than just time consuming. Jo Revill, health editor of the UK Sunday broadsheet the Observer, believes that UK journalists do at least display a greater scepticism toward the drug industry than their US counterparts—but you need more than scepticism to cover the health beat critically and effectively. The big drug companies, she says, are reluctant to talk to journalists outside of the trade press, and while invitations to press conferences about drug launches are forthcoming, “when you want to ask more detailed questions about a drug it can be really difficult getting information. The PRs won't deal with these questions and people in-house don't want to deal with you either.”

On the other hand, when drug companies are keen to speak to journalists, they can be incredibly forthcoming—from offering trips abroad to attend launches to paying “honorariums” to attend evening “think tanks.”

According to Iheanacho, however, there are glimmers of hope for a better informed public. There are growing demands for clinical trial information to be made public and patients are exhibiting a new enthusiasm for asking questions about their health care. In addition, uncritical reporting often has a fixed lifespan: as in the case of Vioxx, today's miracle cure can turn out to be tomorrow's disaster. “The public will become more sceptical,” he says.

This article was first published in the BMJ (2005;331:410).