Select Committee on Health Written Evidence


APPENDIX 25

Memorandum by Ray Moynihan (PI 98)

  This brief submission will specifically address the terms of reference referring to industry's impact on "drug information and promotion", "patient education" and the industry's influence on "the press and other media."

SUBMISSION SUMMARY

  1.  The media is an important source of health information for the public, and as such, it is a key target of pharmaceutical industry public relations and marketing campaigns, promoting awareness of both drugs and diseases.

  2.  There is strong evidence from several countries that much media reporting tends to exaggerate drug benefits, play down drug harms and overlook important conflicts of interests of people quoted in stories.

  3.  Drug company "disease-awareness" campaigns routinely use "third-party" organisations including company-sponsored doctors and patients groups, to target the public via the media. The campaigns are ostensibly designed to "educate" the public about poorly understood conditions, but are often directly linked to company marketing strategies aimed primarily at expanding markets for medicines.

  4.  Health and medical journalists, and organisations representing them, have a role to play in encouraging better quality media reporting of both drugs and diseases, to help move medical reporting away from promotion and more towards journalism.

  5.  The quality of media reporting on medicine and health could be improved with much greater availability of accurate, reliable, and up-to-date information about drugs and diseases, from genuinely independent sources.

SUBMISSION

  1.  The media is an importance source of health information for the public, and it is a key target of the pharmaceutical industry's public relations and marketing campaigns, promoting awareness of drugs and diseases.

  There is good evidence that media coverage of health and medicine can influence the attitudes and behaviours of clinicians and the public.[85] A recent Cochrane review of the relevant evidence—while noting the limitations of existing studies—suggested that favourable publicity in the media was associated with higher rates of utilisation of health services.[86] Media outlets are bombarded daily with promotional material from drug companies and their associated web of marketing and public relations firms, and there is little doubt many media stories are heavily influences by those promotional strategies.

  2.  There is strong evidence from several countries that much media reporting tends to exaggerate drug benefits, play down drug harms and overlook important conflicts of interests of people quoted in stories.

  A Harvard University-based study published in the New England Journal of Medicine examined five years worth of United States television and newspaper coverage of three medicines. It found that a majority of media stories used statistics in a way that exaggerated the benefits of the drug, a majority of media stories failed totally to mention the side effects of the drug, and more than 60% of media stories which quoted an expert with a conflict of interest, failed to disclose that conflict.[87] Similar studies in Norway and Canada have found similar problems, and there is little reason to believe British media are different in this regard.[88]

  3.  Drug company "disease-awareness" campaigns routinely use "third-party" organisations including company-sponsored doctors and patients groups, to target the public, via the media. The campaigns are ostensibly designed to "educate" the public about poorly understood conditions, but are often directly linked to company marketing strategies aimed primarily at expanding markets for medicines.

  An article published in the British Medical Journal documented five case studies of what has been described as "Selling Sickness", in which media organisations were used as part of drug company-funded "disease-awareness" campaigns.[89] These case studies are part of a growing body of evidence demonstrating how drug companies work in alliance with sponsored professional and advocacy groups to help widen the boundaries of human illness, in order to expand markets for medicines. Sometimes the process is referred to as "disease-mongering".[90]

  Pharmaceutical industry marketing literature explains that drug companies are actively engaged in "branding" medical conditions in ways that maximise drug sales.

  "Branding" experts, who work with drug companies, have written about strategies used to "foster the creation" of conditions, and align those conditions with particular products.[91] These strategies routinely involve working with advocacy and doctors' groups to use the media to shape public perceptions about particular conditions.

  One of the recent examples of the corporate sponsored creation of disease involves an emerging condition called Female Sexual Dysfunction. Highly inflated and misleading statistics about the prevalence of "FSD" are being promoted by some drug companies, and that misleading information is being reported in many media stories.[92]

  A forthcoming book, titled Selling Sickness, examines 10 case studies, including high cholesterol, depression, hypertension, menopause, irritable bowel syndrome, social anxiety disorder, osteoporosis, pre-menstrual dysphoric disorder and female sexual dysfunction.[93] In each case, drug companies have worked with sponsored groups, using the media, to help change public perceptions about the nature and extent of the condition. In some cases drug companies have sponsored public relations campaigns to shift perceptions about an existing illness, and in some cases companies have sponsored and attended key medical meetings where the conditions are actually being defined. While acknowledging the importance of waging public health campaigns around heart disease and mental illness for example, the forthcoming book explores how drug-company sponsored campaigns tend to exaggerate the prevalence of many conditions, unnecessarily inflame fears about ordinary human processes, and distract attention from more efficient and potentially safer approaches to improving human health.

  Some observers have suggested that industry funded "disease-awareness" campaigns are fundamentally changing our perception of what it means to be human.[94]

  4.  Health and medical journalists, and organizations representing them, have a role to play in encouraging better quality reporting of both drugs and diseases, to help move medical reporting away from promotion and more towards journalism.

  Observers of media coverage of medicine suggest medical journalists are highly motivated to do a better job.[95] [96] For example, the United States based Association of Health Care Journalists, among other groups, has become active in trying to improve the quality of medical reporting about medicines.[97] 13 Workshops introducing medical reporters to the basic principles of evidence-based healthcare, the importance of reporting on conflicts of interest, and the need to seek genuinely independent sources and information, have proved highly successful at annual conferences. Currently, different versions of these workshops are being devised for Latin America, in conjunction with members of the Cochrane Collaboration.

  5.  The quality of media reporting on medicine and health could be improved with much greater availability of accurate, reliable, and up-to-date information about drugs and diseases, from genuinely independent sources.

  One of the side effects of the pharmaceutical industry's enormous influence over the healthcare system is the difficulty for reporters in finding genuinely independent experts, patient advocates, or commentators. There is an urgent need for a greater availability of independent sources of information about drugs and diseases—including independent educational materials, independent medical researchers and independent patient advocates.

  If the goal is a more informed and rational public debate about the appropriate use of medicines within health system, the availability of independent sources for the media—about both drugs and diseases—must be enhanced. Several organisations are now specialising in providing independent evidence-based information about medicines, (eg Cochrane Collaboration), though there are few genuinely independent sources of information about the nature and extent of medical conditions.

  Enhanced public scrutiny of company funded "disease-awareness" campaigns and greater availability of independent sources of information about disease, are urgently needed.

ABOUT RAY MOYNIHAN

  I am a medical writer and author who has been covering healthcare for almost a decade, with a strong interest in pharmaceutical marketing strategies. I write for outlets in several nations including Britain, Australia, the United States, and New Zealand. I have published extensively in print, radio and television, in the lay press and scientific journal.

  I am the North American Visiting Editor and a regular contributor with the British Medical Journal, and I was a guest editor of the special 2003 theme issue of the BMJ titled, "Time to untangle doctors from drug companies."[98] That issue documented the extent of entanglement within health care,[99] moves towards disentanglement,[100] and suggested several simple steps to achieve less unhealthy drug company influence within health care.[101]

  With colleagues at the Association of Health Care Journalists I am actively involved in trying to improve the quality of medical reporting.[102] I have developed and delivered workshops that introduce medical reporters to the principles of evidence-based health care, which encourage more scepticism in reporting, and more rigorous investigation of drug company influence within healthcare.

  I am currently co-authoring a book about the global pharmaceutical industry and medicalisation, working-title Selling Sickness, scheduled for publication in early 2005. A television documentary that I have co-created, Selling Sickness, is currently being screened in several nations, including Australia, Canada and France.

http://bmj.bmjjournals.com/cgi/reprint/326/7400/1193.pdf





85   Moynihan R, Schwartz, L, Woloshin S. Medicine and the Media, Good information or misleading hype, chapter in Freemantle N, Hill S (Eds). Evaluating pharmaceuticals for health policy and reimbursement. London, Blackwell Publishing & BMJ Books, 2004, p 158. Back

86   Grilli R, Ramsay C, Minozzi S. Mass media interventions: effects of health services utilization. Cochrane Database of Systematic Reviews 2002;1:CD000389. Back

87   Moynihan R., et al Coverage by the News Media of the Benefits and Risks of Medications Abstract N Engl J Med 2000; 342:1645-1650. Back

88   Moynihan R, Schwartz, L, Woloshin S. Medicine and the Media, Good information or misleading hype, chapter in Freemantle N, Hill S (Eds). Evaluating pharmaceuticals for health policy and reimbursement. London, Blackwell Publishing & BMJ Books, 2004, p 161. Back

89   Moynihan R, Heath I, Henry D. Selling sickness: the pharmaceutical industry and disease mongering. BMJ 2002; 324: 886-891 http://bmj.com/cgi/reprint/324/7342/886.pdf Back

90   Payer L, Disease-Mongers, Chichester, John Wiley & Sons, 1992. Back

91   Parry V, "The Art of Branding a Condition", MMM, May, 2003, pp 43-49. Back

92   Moynihan, R The making of a disease: female sexual dysfunction BMJ 2003; 326: 45-47, http://bmj.com/cgi/reprint/326/7379/45.pdf Back

93   Moynihan R, Cassels A, Selling Sickness (working title) Allen & Unwin, Sydney 2005. Back

94   Comment by David Healy in Selling Sickness, TV documentary, 2004. Paradigm Pictures. Back

95   Moynihan R, Schwartz, L, Woloshin S. Medicine and the Media, Good information or misleading hype, chapter in Freemantle N, Hill S (Eds). Evaluating pharmaceuticals for health policy and reimbursement. London, Blackwell Publishing & BMJ Books, 2004, p 166. Back

96   Moynihan R Making medical journalism healthier The Lancet 2003;361:2097. Back

97   http://www.ahcj.umn.edu/ Back

98   "Time to disentangle doctors from drug companies." BMJ Theme Issue, 31 May, 2003. Back

99   Moynihan R Who Pays for the Pizza: Redefining the relationships between doctors and drug companies. Part 1: Entanglement BMJ 2003;326:1189-1196 http://bmj.bmjjournals.com/cgi/reprint/326/7400/l189.pdf Back

100   Moynihan R Who Pays for the Pizza: Part 2: Disentanglement BMJ 2003;326:1189-1196. Back

101   http://bmj.bmjjournals.com/misc/docdrug.shtml Back

102   Tipsheet for reporting on drugs, devices and medical technologies http://www.cmwf org/journalists/moynihan tipsheet.pdf Back


 
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Prepared 26 April 2005