When new health threats emerge, the media is often accused of hyping up the risk to the public. But we tend to believe that health experts provide rational, independent viewpoints on the real risks posed by a new disease. But what if these experts aren’t so independent?
Take reporting of swine flu (H1N1 influenza), one of the major health risks that the British public has faced over the last few years. This was covered extensively in the media and an analysis of reporting after the pandemic found little evidence of sensationalism. But what did start to emerge afterwards were the links between top health experts and pharmaceutical companies.
A number of scientists on the World Health Organization’s (WHO) flu advisory committee, which monitors pandemics and provides guidance for governments, for example, have disclosed links with the pharmaceutical industry.
But given that the media can influence demand for pharmaceutical products and perceptions of risk, we set out to examine whether health experts commentating on swine flu more generally were also more likely to have links to drug companies.
Analysing UK newspaper coverage of the swine flu pandemic between April and July 2009 – the period in which the UK government was taking decisions on how best to respond to the emerging pandemic, including providing the public with vaccine and antiviral drugs – we looked for how often scientists were quoted in articles on the pandemic from a wide range of publications.
We then looked at these comments in more detail to see if scientists made an assessment of the risk to the public from swine flu, and if so, we compared these against assessments made by official agencies such as the Department of Health. We also judged whether the scientists promoted or rejected the use of vaccines or antiviral drugs. And for each scientist, we then looked for links with the pharmaceutical industry – or what we formally call competing interests – from a variety of sources, including scientific papers and the internet.
We found that half of the health experts that commentated on the use of antiviral drugs or vaccine had competing interests. And scientists promoting the use of antiviral drugs were eight times more likely to have a competing interest than those that didn’t comment on their use. We also found that health experts with competing interests were six times more likely than those without to predict a higher risk to the public compared to official assessments.
One caveat to our study, published in the Journal of Epidemiology & Community Health, is that it was small and only looked at one particular health issue. It should be repeated in order to confirm these findings.
Who might benefit
Our results suggest, however, that media commentary by health experts might be another way for the pharmaceutical industry to promote its products. Talking up the risk from swine flu, combined with advocacy for drugs to counter this risk, may lead to increased demand for these products. This type of influence could be even stronger for more familiar health issues, such as cancer or dementia, as the public’s response to emerging health risks is usually more sceptical. Worryingly, a study that examined news coverage of medications for chronic diseases found that out of 170 stories citing an expert or a scientific study, half cited those with links to a drug manufacturer.
This is of course not to suggest that the health experts themselves have acted improperly. All of those on the WHO’s flu advisory committee, for example, have fully disclosed their interests, which are published on the WHO website for all to see. Why, then, does this matter?
Well, we spent a lot of money on the swine flu pandemic. The UK spent around £1.2 billion on pharmaceutical drugs during the pandemic, including on vaccine and antiviral drugs. Pharmaceutical companies made profits of £4.5 to £6.5 billion from vaccines alone. This was despite the pandemic being evaluated as less severe than previous pandemics and on a par with seasonal flu.
More importantly, doubts have emerged since the pandemic over how effective antiviral drugs are in reducing the spread and complications of flu and there have been difficulties in obtaining the original clinical trial data from pharmaceutical companies.
Health experts are also very important in risk communication. Our study found that they were the second most quoted source after health ministers, showing that they occupy a unique and powerful position. However, a third of these experts estimated the risk of the emerging pandemic as higher than the official line.
Early data can be unreliable
It’s possible that health experts who are involved in modelling the risk from new health threats may overestimate the risk, as early data can be unreliable. But consensus among those seen as “experts” is important during public health emergencies, as contradictions can lead to public anxiety and lower the use of protective measures. If experts are talking up the risk, and our results suggest that those with links to pharma do this more often, it’s bad news for public health.
It’s also hugely important because scientists and doctors enjoy high levels of trust from the public. Undisclosed links to the pharmaceutical industry risks degrading public confidence, to the detriment of the whole scientific community. We could protect this credibility by asking health experts to declare any competing interests before media interviews. This is the normal procedure for scientific studies, so that other scientists can judge the study results in light of potential influencing factors, for example who funded the study.
Of course, having links to pharmaceutical companies does not necessarily mean that a scientist is influenced by them – and top scientists will often be asked to work with both drugs companies and provide media commentary. However, the public should also be able to read these comments alongside knowledge of potential influences.
Interpreting the influence of declared competing interests can be subtle, however. Complete disclosure shows potential influencing factors, not necessarily actual influence. But despite these obstacles, we must counter the increasing commercialisation of health reporting in order to keep the public’s trust in health advice and to make sure pharmaceutical companies don’t lend unnecessary – and unknown – weight.