Few news stories gave a comprehensive picture of the findings published in the New England Journal of Medicine last week from the Jupiter study. This was the well-publicized study of the use of the C-reactive protein test (CRP) in “apparently healthy people” and the use of the drug rosuvastatin.
This story presented a classic case of how our ten criteria should be applied in coverage of new treatments.
• Give absolute, not just relative risk/benefit data. Many stories reported, as the New York Times did, that drug recipients “were also almost 50 percent less likely to suffer a stroke or need angioplasty or bypass surgery, and they were 20 percent less likely to die during the study.” But few reported – as the New York Times did not – that the absolute risk reduction was only 1.2%. Few reported the number needed to treat: that more than 100 people would need to be treated for two years in order for one to benefit. Relative risk/benefit figures always make the effect size seem bigger.
• Costs. Few reported the drug cost of $1,250 a year or $285,000 per event prevented.
• Conflict of interest. Some reported that the study was funded by Astra-Zeneca and that the principal investigator holds a patent on the CRP test that would lead to more people being prescribed statins. But it took blogger Merrill Goozner to drive home the overlap of cost and conflict of interest when he wrote:
“If they can get two million more "apparently healthy men and women" on rosuvastatin, it’s an additional $2 billion-plus in sales for AstraZeneca. If they can test 10 million people to find the estimated two million with elevated CRP levels (they had to screen nearly 90,000 people to find the 17,800 eligible for the trial), it’s $200 million in test sales, which, if the royalty is only 1 percent, amounts to a hefty $2 million a year in extra income for Dr. Ridker (the principal investigator).”
• Alternative options. Few reported on the drug studied (rosuvastatin) compared with other drugs.
Criticism of many stories could mirror our review of a Los Angeles Times story:
“This news report about a significant clinical trial on statins and heart disease fails to look skeptically at the claims of the self-interested researchers. Rather than pushing back against the exaggerated claims of efficacy, safety, and imminent transformation of treatment protocols, the report magnifies them.
The report’s failures are largely due to emphasis rather than omission. The caveats are noted, but buried or otherwise minimized. …In all, 16 paragraphs make positive statements about the results. Four paragraphs call the findings into question.”
Meantime, there were three important articles last week about health journalism.
1) In the BMJ , Steve Woloshin, Lisa Schwartz and Ray Moynihan raise new questions about "who’s watching the watchdogs?" Excerpts:
"Industry sponsorship of training and further education of journalists now occurs in a variety of contexts—universities, conferences, and professional associations—raising similar concerns to those that apply to education of doctors.
The University of North Carolina’s master’s degree in medical journalism, one of the first in the United States, has at least two important forms of financial relations with drug companies. …
Like some university programmes, the American Medical Writers Association, whose members include reporters and public relations specialists, receives sponsorship from the drug industry. Eli Lilly was a key sponsor of the association’s 2008 annual conference, and the company also sponsors its student scholarships.
One of the more astonishing forms of financial ties between journalists and drug companies is the sponsored award, which often involves lucrative cash prizes or opportunities for international travel. For example, Eli Lilly and Boehringer Ingelheim have co-sponsored an award for "reporting on urinary incontinence," carrying a prize of international travel. Boehringer has an award for reporting on "chronic obstructive pulmonary disease," offering prizes worth $5000 each, Eli Lilly one for reporting on oncology, and Roche one for "obesity journalism," with a prize of $7500. Sometimes awards are sponsored by organisations that are themselves heavily funded by industry, such as the non-profit Mental Health America. Its 2007 annual report shows that almost half of its funds came from drug companies, including more than $1m each from Bristol Myers Squibb, Lilly, and Wyeth.
A powerful contemporary example of entanglement involves a television network called Accent Health (whose logo includes the words "Your target is waiting"), said to be watched monthly by more than 10 million viewers in US medical waiting rooms. The network, which is produced by CNN, overtly offers sponsors, including drug companies, the chance to boost sales of their products, by, for example, putting "your brand in front of the valuable Baby Boomer population just before they discuss their health conditions with their doctor." One of the hosts is Sanjay Gupta, CNN’s chief medical correspondent and host of at least one other CNN health programme that is funded partly through drug company advertising. …
As researchers and writers acting to improve medical journalism, we encourage journalists, educators, and professional associations to scrutinise their own relations with the industry as intensely as they do those between doctors and drug companies and to develop workable solutions. And, if they are to be good watchdogs, journalists need to mark their territory and clearly establish boundaries between themselves and the industry to avoid unhealthy entanglements."
2) Journalist Cris Russell wrote "Science Reporting By Press Release" for the Columbia Journalism Review.
3) Finally, in a related note, see the Slate piece, "Bullies Like Bullying: How did a nonstory based on an iffy study end up in a New York Times blog?&q
It’s refreshing to see these three pieces reflect on health care journalism practices. Thanks to all for enriching the discussion.