"Swine flu risk was inflated by experts with links to drugs industry," The Independent reports. The claim has been made by the authors of a study that analysed newspaper reporting of the swine flu pandemic in 2009.
Researchers found that academics with industry links were six times more likely to rate the potential risk of swine flu as higher.
Similarly, academics promoting the use of antiviral drugs in newspaper articles were eight times more likely to have industry links than those not commenting on their use.
This is not to say that there is any evidence of wrongdoing. If there was a bias in some academics' analysis, it could well be unconscious. If you have spent your career working with antivirals, it is only natural to discuss them when interviewed. It should also be noted that the findings of this study are based on a small sample of articles.
However, the findings do suggest some evidence of industry influence on the discussion of important public health issues. These articles appeared at a time when the government was making important decisions about antiviral medications. The UK government went on to spend more than £400 million on a stockpile of antivirals.
It is important that journalists don't assume that all academics are coming from a neutral position. Similarly, in the interests of transparency academics should make any potential conflicts of interest clear.
Both actions would help improve public trust in the pharmaceutical industry, academics, journalists and policymakers.
Where did the story come from?
The study was carried out by researchers from the London School of Hygiene and Tropical Medicine, Imperial College London, Princess Alexandra Hospital NHS Trust, Harlow, Chase Farm Hospital, Enfield, City University London, and The London School of Medicine & Dentistry. The lead author is funded by the Wellcome Trust, a charitable health foundation.
The study was covered fairly by The Independent.
What kind of research was this?
This was a retrospective analysis of UK newspaper articles on swine (A/H1N1) flu, examining the sources quoted by journalists.
In particular, researchers looked at whether academics who had been quoted in the media had any links to the drug industry.
The researchers also looked for articles about the use of antiviral drugs for swine flu – the best known of which is Tamiflu – or vaccines against flu.
The researchers point out that the UK spent an estimated billion pounds on pharmaceutical products during the 2009-10 swine flu pandemic, including antiviral medications and swine flu vaccines. This was despite the subsequent evaluation that the pandemic was less severe than previous pandemics.
There was also uncertainty about the effectiveness of antiviral medication in reducing transmission and complications of influenza. Some dissenting voices argued that the limited benefit of medications such as Tamiflu did not justify their costs.
The researchers go on to explain that after the pandemic passed in 2010, there were significant concerns that several of the experts on influential committees advising the government had competing interests, including links to the manufacturers of antiviral drugs and influenza vaccines.
There have been repeated calls for greater transparency around the potential influence of the pharmaceutical industry on the decisions made by these committees, they say.
The researchers also point out that public health academics are often asked to provide commentary and analysis on emerging health risks by the media. Media coverage of health issues has been shown to influence the public's perception of risk, demand for new drugs and policy decisions, they argue.
Like those on advisory committees, academics quoted in the media may also have possible conflicts of interest. Media commentaries, they argue, provide, "an alternative route to exert pressure on public demand", and one in which conflicts of interest are not routinely declared.
What did the research involve?
The researchers set out to examine media commentary on swine flu provided by academics between April and July 2009. This was the period in which the UK government was deciding its policy on the public provision of antiviral medication and the swine flu vaccine.
The researchers searched for newspaper articles about swine flu using a database providing full access to all UK national newspapers. Twelve UK national newspapers were included in the sample, including daily, Sunday, tabloid, middle-market and broadsheet publications on both sides of the political spectrum. They excluded TV and radio coverage on the grounds that broadcast media offers less in-depth analysis and less divergent viewpoints than print media.
Using these criteria, the researchers included 425 articles in their study. Each article was assessed independently by two of the authors using a standardised coding framework consisting of two sections.
The first section categorised the sources quoted in each article, such as:
- health ministers (England, Wales, Scotland and Northern Ireland)
- Department of Health (England Wales, Scotland and Northern Ireland)
- Chief Medical Officer (England Wales, Scotland and Northern Ireland)
- World Health Organization (WHO)
- the UK Health Protection Agency (HPA)
- the US Centers for Disease Prevention and Control (CDC)
- pharmaceutical company representatives
- named academics (defined here as a researcher or academic clinician affiliated with a higher educational body or research institute)
The second section looked in greater detail at those articles that quoted academic sources. The researchers first examined whether academics made a risk assessment of the emerging pandemic. For example, quotes such as, "this is going to affect millions of people in England" or "thousands of people could die from this virus" would constitute a risk assessment.
They then checked whether the academic cited official figures or whether there was a risk assessment made by an official body relevant to the UK population quoted within the same article, such as the WHO, the Health Secretary, or the Department of Health.
They used the official risk assessments as a benchmark to measure each academic risk assessment, judging whether it concurred with the official estimate or was higher or lower (implying more or less risk to the public).
The researchers also examined all quotes by academics for reference to the use of medication for swine flu or the influenza vaccine. Those that made reference to the drugs or the vaccine were further analysed as to whether they promoted or rejected the use of these products.
The researchers piloted this method of coding on 20 articles, with subsequent minor modifications made to definitions before coding the complete data set.
They then looked at evidence of conflicts of interest for each named academic quoted, using the protocol from a recent study.
According to guidelines, conflicts of interest are defined as when an author has financial or personal relationships that could inappropriately influence (bias) his or her actions.
For each academic, the researchers looked for associations with pharmaceutical or biotechnology companies in the form of grants (including research), honorariums, speaker fees, consultant, adviser or employee relationships, and stock ownership.
These could be personal, indicating benefits for that individual – such as honorariums – or non-personal, indicating benefits for a department or organisation for which an academic has managerial responsibility, such as research grants.
The researchers searched for conflicts of interest from the four years before the start of the pandemic. This is in line with guidelines that state that conflicts of interest should be declared if incurred in the four years before acting in an expert advisory role.
They did this by searching for:
- conflict of interest statements (where available) for four major scientific advisory committees relevant to this issue
- funding sources detailed on the individual's profile page on the website of the affiliated institution
- a general internet search using Google
- conflict of interest and funding declarations on all publications in the past four years identified through the PubMed/Medline database
They then calculated the likelihood of a risk assessment being higher than official estimates if it was made by an academic with a conflict of interest, compared with those who did not have a conflict of interest.
They also calculated the likelihood of an academic who promoted or rejected the use of antiviral drugs or vaccines for swine flu having a conflict of interest, compared with academics who provided general commentary.
What were the basic results?
Below are the main findings:
- in the newspaper articles studied, academics were the second most frequently quoted source after health ministers
- where both academics and official agencies estimated the risk of swine flu, one in two academics assessed the risk as higher than official predictions
- for academics with conflicts of interest, the odds of a higher risk assessment were 5.8 times greater than those made by academics without conflicts of interest
- half of academics commenting on the use of antiviral medications or vaccine for swine flu had conflicts of interest
- the odds of conflicts of interest in academics promoting the use of antiviral medications were 8.4 times greater than for academics not commenting on their use
- only three articles out of 425 mentioned that the academic quoted had a potential competing interest
How did the researchers interpret the results?
The researchers say there is evidence of conflicts of interest among academics providing media commentary during the early swine flu pandemic, a period critical for policy making on drugs and vaccines. Heightened risk assessments, combined with advocacy for pharmaceutical products to counter this risk, may lead to increased public anxiety and demand, they say.
"These add to the growing body of literature highlighting the potential influence of the pharmaceutical industry on policy decisions through multiple avenues, including advisory committees, drafting of guidelines, and media commentary," they note. "Academics should declare, and journalists report, relevant [competing interests] for media interviews."
Commenting on the research, the journal's editors add: "This paper clearly shows that 'scientific advice' is not necessarily independent and that it is influenced by often undisclosed interests."
This was a well-conducted study, albeit based on a small sample of articles. The finding that academics with ties to the drugs industry were more likely to make a higher assessment of risk from swine flu, and those promoting the use of antiviral drugs were more likely to have industry links, is worrying.
The general issue of academics with undisclosed links to the pharmaceutical industry being interviewed by journalists is of concern. That said, the study does not prove that media coverage either fuelled public anxiety about swine flu or the policy decisions made about drug or vaccine funding.
Similarly, there is no evidence of any wrongdoing by any of the academics identified in the study.
However, the result does highlight the worrying trend that journalists take the claims made by experts at face value in a way that they might not with politicians, for example.
Analysis by Bazian
Edited by NHS Website
Links to the headlines
The Independent, 12 November 2013
Links to the science
Journal of Epidemiology and Community Health. Published online November 11 2013