By Justin Smith

Since many people do not see their doctor regularly, and consultation times are often short in duration, the media represents the most significant source of health information for a large segment of the population.

Medical stories are not easy to report. They must be both accurate and authoritative; journalists need to understand the terminology, physiology, epidemiology, study design, and statistical analysis to keep health news in context for the viewer, listener, or reader. Unfortunately, there are few journalists who meet this standard. In almost all cases the reporting of clinical trial results involves journalists simply copying the press release issued by the pharmaceutical company doing the trial.

In 2012, the British Heart Foundation published a report detailing a wide range of heart disease statistics. One of the highlights was the decline in heart disease deaths seen between 2002 and 2010 in the United Kingdom. Reporting on this, the Daily Mail wrote “Wonder drug statins have helped slash heart attack deaths by half, research says”; the Express wrote “Proof statins save millions from heart attacks”; and the Telegraph wrote “Deaths from heart attacks half as treatment pays off.” Anyone reading the British press would be left with no doubt that statins are wonderful. However, the report from the British Heart Foundation that these news articles were based on did not mention statins at all, and statins made no measurable contribution to the decline in heart disease deaths. One can only assume that the British media were spun into believing that statins had played a part in the reduction in heart disease deaths by some careful wording in the press release associated with the publication of the report. Though the heart disease death rate has been declining in the United Kingdom since the 1970s, this is due to fewer people smoking cigarettes and better hospital treatments.

Even worse than this lazy journalism was the unwillingness of these media organizations to correct the error. I contacted each of the newspapers about their respective articles. The Telegraph did not reply at all. Giles Sheldrick, who wrote the article for the Express, replied: “I can assure you I spoke to several medical experts before the article was published.” While the Daily Mail acknowledged that they made a mistake, they removed the article from their website with no correction or explanation to its 9 million readers. This is just one of many ways that the public is given false information about the benefits of statins and other drugs. Journalists can easily become mouthpieces for those with vested interests.

Pharmaceutical Companies Influence Medical Journals

Medical journals have a reputation among the general public as being dull and obscure; however, their content influences the lives of millions. Medical journals not only affect all of the clinical decisions doctors make with individual patients but they also directly influence public health policy. There are a number of serious problems with medical journals related to how they are influenced by pharmaceutical companies.

Pharmaceutical companies influence medical journals in a number of ways, the most obvious of which is through advertising. A large percentage of doctors receive journals such as the British Medical Journal, the New England Journal of Medicine, and the Journal of the American Medical Association for free because of the financial support the journals get from pharmaceutical company advertising. Publishers of medical journals are constantly worried that these companies will cut back on advertising, and they argue that advertising produces a better financial return for the pharmaceutical industry than employing more sales representatives would.

Authorship is another problem. As Elizabeth Wager said, there are four types of lie: lies, damned lies, statistics, and the authorship lists of scientific papers. The list of authors that appears at the top of a medical research paper might not reflect true authorship. Scientific communities call this ghost authorship. Ghost authors are people who have contributed to a research study or been involved in writing the paper but whose names do not appear on the list of authors. There are a number of implications associated with ghost authorship. One of the main concerns is that the ghost author is employed by a pharmaceutical company, representing an undeclared conflict of interest. In one study, 75 percent of trials included were found to have had ghost authors. In this case the ghost authors were statisticians employed by the pharmaceutical companies supporting the trials. This is important because clinical trials are often complex and generate large datasets; the statistical report is a fundamental part of the research and it has a crucial influence on what is written in the publication summarizing the study. Not declaring the statistician, and thus hiding their affiliation, deceives the reader about the role of the supporting company.

Problems also exist with the peer review process of published papers. Richard Smith explains these problems in detail in The Trouble with Medical Journals: “Peer review is at the heart of all science. It is the method by which grants are allocated, papers published, academics promoted and Nobel prizes won. Yet it is hard to define … and its defects are easier to identify than its attributes.”

Peer review could loosely be described as getting a third party to verify the accuracy of a scientific paper or to help make a decision about whether to publish it. Ideally, the third party should not be connected with the research and should have no competing interests, but still should be in a position to technically appraise the methodology and findings. Richard Smith explains that peer review sometimes seems to be a simple case of someone saying “the paper looks all right to me,” and examples of a comprehensive, detailed review of a paper are difficult to find. These issues of conflicts of interest and lack of critical review directly impact the quality of what gets published and can mean that important information is not published if it is contrary to the belief system of the peer reviewer.

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This excerpt is from Statin Nation: The Ill-Founded War on Cholesterol, What Really Causes Heart Disease, and the Truth About the Most Overprescribed Drug in the World (January 2018), and is printed by permission of the publisher, Chelsea Green Publishing, White River Junction, Vermont, 802-295-6300; www.chelseagreen.com. 

Justin Smith is the producer, director, and writer of the documentaries Statin Nation I and II. He was formerly a personal trainer, sports massage therapist, and nutrition coach. He is based in the UK.