Newspapers highlight benefits of new drugs, ignore risks

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The information we get on new prescription drugs from a major and trusted source of information -- daily newspapers -- is incomplete and may promote unrealistic expectations about the benefits of new drugs, says a study recently released by the Canadian Centre for Policy Alternatives.

The report, Drugs in the News finds that newspaper articles more often emphasize the benefits of new drugs, while little attention is paid to possible harms. 68% of the news articles examined in more than 20 major newspapers made no mention whatsoever of possible adverse effects, and when identified, these harms were usually downplayed and mentioned towards the end of the article.

The study also found that:

  • The health effects of drugs are often presented using only descriptive terms, without also providing precise or scientific information about the drug's effectiveness.
  • Basic information that quantified the benefits or harms of the drugs was reported in only one out of every four articles, and when it was provided, 30% of the time it was presented in misleading terms.
  • When possible harmful effects were mentioned, they were more often described with language that downplayed the risk to patients ("minor" or "rare"), while benefits were more often described using language that emphasized the potential benefit ("proven remedy" or "highly effective").
  • Contraindications -- those conditions under which it is not safe to take the drugs -- were mentioned in only 4% of the articles.
  • Only one in six articles mentioned alternative treatment options (for example, an existing, cheaper drug).
  • The financial interests at work behind the scenes -- such as who funded a study about a drug's effectiveness, or the financial relationship of a patient spokesperson to the drug company -- were noted less than 3% of the time.

The study's authors agree, however, that reporting on pharmaceuticals isn't easy for journalists. "It requires an ability to interpret complex scientific information while resisting the pharmaceutical industry's aggressive marketing techniques," says Barbara Mintzes, co-author of the study. "Pharmaceutical companies make it very easy to write favourable stories about new drugs, while independent drug information is harder to find."

Dr. Joel Lexchin, an emergency department physician in Toronto and associate professor in the School of Health Policy and Management at York University, says he hopes the study will help journalists when they report on new medications. "The media needs to do a better job of following the money so that readers can be better informed."

The complete study is available at www.policyalternatives.ca or by calling the CCPA office at 604-801-5121.


What You Need to Know About Prescription Drugs – and What the Media Doesn’t Always Tell You

Drug indications
What medical conditions has this drug been officially approved to treat? Regulatory approval of a drug for treating specific conditions ensures that there is evidence that the drug has some beneficial effect for that condition. If it hasn’t been approved for a condition, there is no guarantee the drug can provide any benefit and patients may be needlessly put at risk for side effects.

Drug contraindications
Who should avoid this drug? Contraindications identify who could be more harmed than helped by a drug. (For example, atorvastatin should not be given to pregnant women or patients with liver disease.)

Clinical benefits
Do the claimed benefits of the drug have a tangible, meaningful impact on the health of patients? (Atorvastatin may lower cholesterol, but is there evidence that it lowers the chance of heart attack? Donepezil may produce changes on cognitive tests, but does it help patients with daily living activities?) Non-clinical benefits, often called surrogate or intermediate endpoints, can lead to an exaggerated impression of drug effectiveness.

Clinical harms
All drugs have risks as well as benefits. Are the harmful effects of the drug mentioned? Is this information presented in as much detail as the benefits, to provide the potential user with a balanced understanding of all of the drug’s effects?

Magnitude
Have numbers been included to unambiguously explain the degree of benefit or harm? (For example, without numbers to provide the magnitude of benefits and harms, how is a patient to know if the benefits are proportionally greater than the risks?)

Absolute numbers
Have magnitudes of benefits and harms been provided as “absolute” differences? For example, a medication may reduce the proportion of patients having a heart attack from 10 in 100 to 7 in 100. In “relative” terms, there is a 30% reduction in risk, while in “absolute” terms the risk has been reduced by 3%. Relative values can be very misleading and any numbers greater than 10% are usually relative numbers.

Time
How long do patients need to take the drug to achieve a benefit? Drug therapies for acute conditions are usually taken over a very specific period of time. Chronic and preventative therapies can be taken over an indeterminate or extended period of time. Individuals should be informed if there is a minimum length of therapy necessary to achieve any benefit and whether benefit and harm profiles can shift during long-term therapy.

Drug and non-drug alternatives
Have drug and non-drug alternatives to the drug of interest been included in the story? There are often several treatments available for a specific problem, including both drugs and other options. Different drug treatments can have radically different benefits and harms or surprisingly similar characteristics depending on their mechanism of action. However, drug alternatives create options for patients when deciding upon a treatment with their physician. Non-drug alternatives such as exercise and diet changes should also be included in any discussion of drugs in the news.

Costs
What is the price of the drug therapy? In an ideal world costs would be relevant only when comparing identical drugs, but, as the public ultimately shoulders the burden of high drug expenditures, consumers need to know the costs. (For example, do consumers feel that taking oseltamivir to possibly shorten flu symptoms from 5-7 days to 4-6 days is worth $45 or more?) The cost of diagnostic tests needed to initiate or monitor a drug prescription should also be considered.

Study design
What kind of research method was used in the study? Research data on drugs is only as good as the study’s design, and an opinion survey of 100 people is considerably less reliable than a clinical trial of 1,000 people. A randomized-controlled trial (RCT) is the study design that yields the most reliable drug data. In RCTs, researchers randomly assign patients to drug or placebo treatments with neither the patient nor the researcher knowing who received which. Studies involving more patients for greater periods of time also improve the strength of the data. Publication in peer-reviewed medical journals does not guarantee that the results provide meaningful information for evaluating the safety and effectiveness of new drugs. However, the quality of data presented only at meetings and conferences or published in non-peer reviewed journals is even less certain.

Follow the money
Has pharmaceutical industry funding of any studies and spokespeople been disclosed? Following the money trail in pharmaceutical reporting can be just as important as in political reporting. While regulatory safeguards are in place to minimize the presence of ineffective and dangerous drugs on the market, financial allegiances can strongly influence the interpretation of drug data. Likewise, pharmaceutical companies provide educational material and guest speakers for public information nights under the guise of patient groups or organizations. Below is a list of some drug information resources that are independent of the pharmaceutical industry.

Independent sources of drug information*

Australian Prescriber
www.australianprescriber.com
tel: 61 (2) 6289-7038 fax: 61 (2) 6289-8641
CMA Infobase (guidelines)
www.cma.ca/cpgs
tel: 1 (800) 663-7336 fax: 1 (613) 565-2382
British National Formulary
www.bnf.org
Cochrane Library
www.cochranelibrary.com
tel: 1 (888) 855-2555 fax: 1 (613) 236-8864
Drug and Therapeutics Bulletin
www.which.net/health/dtb/main.html
tel: 44 (20) 7770-7571 fax: 44 (20) 7770-7665
Drugs of Choice
tel: 1 (888) 855-2555 fax: 1 (613) 236-8864
Food and Drug Administration (USA)
www.fda.gov/cder
Medical Letter
www.medletter.com
tel: 1 (800) 211-2769 fax: 1 (914) 632-1733
Prescrire International
www.esculape.com/prescrire
tel: 33 (1) 492-372-65 fax: 33 (1) 480-787-32
Therapeutics Letter
www.ti.ubc.ca/pages/letter.html
tel: 1 (604) 822-0700 fax: 1 (604) 822-0701
Canadian Pharmacists Association
http://www.pharmacists.ca/
tel: 1 (800) 917-9489 fax: 1 (613) 523-0445
Worst Pills, Best Pills
www.citizen.org/hrg
tel: 1 (202) 588-1000 fax: 1 (202) 588-7798

Excerpted from Drugs in the News: How well do Canadian newspapers report the good, the bad and the ugly of new prescription drugs? by Alan Cassels, Merrilee Atina Hughes, Carol Cole, Barbara Mintzes, Joel Lexchin and James McCormack (2003). The study is available at www.policyalternatives.ca or by calling the CCPA office at 604-801-5121.

*Source: Therapeutics Initiative (based at the University of British Columbia). "Sources of Drug Therapy Information." Therapeutics Letter, Issue 35, May / June 2000. www.ti.ubc.ca/pages/letter35.htm