Online comments lead to BMJ’s disclosure of ‘competing interests’
Filed under: Conflicts of interest, Health journalism
In BMJ, Bob Roehr wrote about a report published by German researchers in the Canadian Medical Association Journal describing an apparent tendency for journals that accept pharmaceutical advertising to publish more positive drug-related articles than those that depend on subscription dollars to pay the bills. The study and the Roehr’s summary are good reading in their own right, but the comment section is where things really get interesting.
There, Age of Autism UK editor John Stone points to a commentary penned by the Alliance for Human Research Protection’s Vera Hassner Sharav and draws into question BMJ’s sources of funding. His main focus is the tension between that publication’s Andrew Wakefield investigations and its receipt of money from an arm of Merck.
Sharav’s language is somewhat incendiary, but it’s BMJ editor Fiona Godlee’s response to her commentary (and Stone’s post) that push the whole thing into the realm of the remarkable. Godlee weighs in on everything right there in the comment thread, admitting that BMJ had not disclosed those conflicts of interest in the Wakefield stories simply “because it didn’t occur to us to do so,” given that it was a story focused on research fraud rather than upon vaccines and medicine.
Although Vera’s claims may seem far fetched on this occasion, she is right that we should have declared the BMJ Group’s income from Merck as a competing interest to the editorial (and the two editor’s choice articles) that accompanied Brian Deer’s series on the Secrets of the MMR scare. We should also, as you say, have declared the group’s income from GSK as a competing interest in relation to these articles. We will publish clarifications.
The whole chain of events is a promising sign that increased interactivity in online publications may lead to increased transparency, and it’s well worth reading, at the very least, all of Roehr’s story and the comments that follow it. All the key bits are there.
Whelan: Will HuffPo ruin AOL’s health site?
In the wake of AOL’s acquisition of the Huffington Post, Forbes.com’s David Whelan has taken the time to ask the $315 million health journalism question: What will happen to AOL’s decent health offerings when what he calls HuffPo’s trademark “medical freak show” leap on board?
As fellow Rahul Parikh fans will no doubt be aware, Ariana Huffington’s Post has long been a haven for those who share her non-evidence-based medical beliefs, but to recap, here’s Whelan’s biting comparison of the two sites:
AOL Health is a helpful site with tools for losing weight, Q&A sessions with Harvard Med professors, and a Mayo Clinic-esque databank of ailments and symptoms. It has its share of sensational headlines, overplaying stories on sex and diets. But that’s only a misdemeanor in the world of health journalism.
What’s always been closer to a journalistic felony is the way that the Huffington Post’s health coverage promotes pseudoscience, conspiracy theories and dubious remedies. Rahul Parikh, a pediatrician in the Bay Area who writes for Salon, has done some the best work I’ve seen exposing the looniness. Some examples from his survey: one blogger thinks swine flu should be treated with enemas, another promotes “distance healing”, and comedian Jim Carrey spreads the harmful theory that vaccines cause autism.
Since posting, Whelan received a pointed reply from HuffPo’s senior health editor, who says the site’s days on the fringe are now in the rear-view mirror:
UPDATE: The Huffington Post’s Senior Health Editor, Alana B. Elias Kornfeld, called to say that health articles are vetted by a Medical Review Board: “This has been true since HuffPost Health launched in Fall 2010 as a vertical separate from HuffPost Living where wellness coverage appeared in the past. As such, the acupuncturist referenced in Mr. Parikh’s 2009 Salon article is not the Health editor. Myself and Associate Health Editor, Meghan Neal, are both trained journalists.”
Matthew Herper, also of Forbes, follows up by pointing out that nothing seems to have changed. Today the Post has published a piece written by David Kirby that asserts people believe in a link between autism and vaccines for a reason and thus the debate won’t go away. Part of Kirby’s argument:
I know that many people will say the vaccine issue has been thoroughly investigated and debunked. I honestly wish that were the case, but it simply is not true. All of the “vaccine-autism” studies you hear about investigated just one childhood vaccine out of 14 (MMR), or one vaccine ingredient out of dozens (thimerosal). That is like announcing that air pollution does not cause lung cancer because you looked at carbon monoxide, alone, and hydrogen sulfide, alone, and found no link.
All of the pieces mentioned here are rich with links to other interesting reading about the subject so we encourage readers to explore the subject.
Researchers examine long-term effects of vitamins, vaccines on children’s immune systems
Filed under: Children, Europe, Hot Health Headline, Public health
For a 40-minute documentary broadcast on BBC Radio 4 and produced by Anthony Baxter, reporter Richard Phinney visited a small, long-running public health outpost in Guinea Bissau where a team of Danish and African researchers has studied the long-term effects of vaccines and vitamin supplements on the immune systems of children. The team has published reams of research and influenced WHO policy, but Phinney focuses on what he calls their most “explosive” findings.
They show that the world’s most commonly used vaccines can strengthen - or weaken - a child’s immune system in the long term, and affect their ability to fight off disease. The results directly challenge the WHO’s global health advice, followed by most countries in the developing world, and could mean that thousands of young lives, in Africa and beyond, are needlessly at risk.
Programming note: The program will only be available to download worldwide for a few more days.
Update: The audio is no longer available at the earlier link but it is available, in two parts, on this page. Search the page or scroll down for “Vaccine Detectives.”
BMJ: Wakefield’s vaccine-autism study fraudulent
Filed under: Children, Europe, Health journalism, Pharmaceuticals, Public health
The Internet and other media are abuzz with the news, published by BMJ yesterday, that the study published in The Lancet in 1998 by Dr. Andrew Wakefield linking autism to the MMR vaccine was fraudulent. The study of 12 children is frequently cited as proof that vaccines cause autism or play a part in the disorder, despite the fact that it was retracted. The BMJ calls the study “fatally flawed both scientifically and ethically” in a new editorial.
Covering Health has compiled some links to interesting reading on this subject, much of it specifically for journalists.
Ivan Oransky, on Embargo Watch, looks at an entirely different facet of the news with “Does a tweet break an embargo? A case study involving the BMJ, autism, vaccines, and an alleged hoax.”
Meanwhile, Gary Schwitzer, publisher of HealthNewsReview.org, writes that the Wakefield MMR/autism dismantling demonstrates what a difference one journalist can make.
CNN’s Anderson Cooper interviewed Andrew Wakefield last night about the charges that his study was flawed. And Brian Deer, the investigative journalist who reported the BMJ story, was interviewed on CNN’s World Report.
Update: Seth Mnookin, who has spent two years looking into vaccine scares, has written an interesting post about the topic, including his view that BMJ over-hyped its story, which almost certainly helped drive media coverage. Mnookin also appeared on CNN.
By sending out breathless press releases and prepping the worldwide media for a series of bombshell stories, the BMJ created the impression that this was fundamentally new news – and it wasn’t. We knew that Wakefield’s work wasn’t reliable or accurate on January 3 – and we still know that today. The stories that are currently running are not really all that different in tone or content than the stories that ran almost exactly a year ago, when a UK medical panel found there was sufficient evidence to justify stripping Wakefield of his right to practice medicine.
Covering Health posts
- Parikh examines media’s role in vaccine-autism link
- CDC: Nearly 1 percent of U.S. kids have autism
- Autism and vaccines: A failure to communicate
- Tribune: Lupron to treat autism is ‘junk science’
- Anger at radio host shapes autism performance
- CDC working to uncover cause of autism
- Newspaper: Landmark autism study used fixed data
- Review finds no link between vaccines, autism
Tip sheets
- Background on autism from Pauline A. Filipek M.D., director of the Autism Program for OC Kids Neurodevelopmental Center and associate professor of clinical pediatrics and neurology at the University of California, Irvine, School of Medicine.
- Investigating alternative treatments for autism: Trish Callahan & Trine Tsouderos, of the Chicago Tribune, wrote “Dubious Medicine,” a look at the world of alternative treatments for autism, treatments that are often risky and unproven.
Contest entries
- Dubious Medicine, Trine Tsouderos and Patricia Callahan, Chicago Tribune
- The Truth About Autism: Scientists Reconsider What They Think They Know, David Wolman, Wired
- Is it Autism?, Norine Dworkin-McDaniel, American Baby
Covering Medical Research
Learn how to analyze and write about health and medical research studies with AHCJ’s latest slim guide. It offers advice on recognizing and reporting the problems, limitations and backstory of a study, as well as publication biases in medical journals and it includes 10 questions you should answer to produce a meaningful and appropriately skeptical report. This guide, supported by the Robert Wood Johnson Foundation, will be a road map to help you do a better job of explaining research results for your audience.
Whooping cough: Not just a problem for kids
Maryn McKenna, AHCJ board member and self-proclaimed “most vaccinated person on the planet,” writes about her own bout with whooping cough. She’d had her shots back in the day, but apparently whooping cough immunity conferred by childhood vaccines fades, and anyone over the age of 12 probably needs a booster. 
This is relevant because, while whooping cough is not generally fatal to adults, it’s easily transmitted to more vulnerable folks. And in California and across the country, it’s on the march and vaccine supplies are limited.
The worst news in this upsetting trend is this: We’re doing it to ourselves. As far as anyone can tell, the rise in pertussis is not due to any change in the organism, or to any mysterious error among the manufacturers who make pertussis vaccines. It’s due to vaccine refusal, to parents turning away from vaccines because they think the vaccines are more harmful than the diseases they prevent — or, more selfishly, because they think the wall of immunity created by other vaccinated children will protect their unimmunized ones.
That wall of immunity, McKenna says, hasn’t been helping the unvaccinated kids, who are 23 times more likely to pick up the disease than their immunized peers.
The Texas Tribune’s Ben Freed learns, through conversations with public health experts, that the “entirely preventable” disease can be stopped with vaccination rates between 80 percent and 85 percent. Unfortunately, adult rates are nowhere close to those numbers, though the state is taking steps to increase adult vaccinations.
California officials are urging people to get vaccinated as that state has now seen a six-fold increase in whooping cough this year.
Mumps outbreak hits more than 1,500 in N.Y., N.J.
More than 1,500 cases of mumps in New York and New Jersey have prompted the CDC to update the public on the outbreak in its Morbidity and Mortality Weekly Report.
According to the CDC, the outbreak appears to have originated with an 11-year-old boy who returned from a trip to the United Kingdom and then attended a summer camp for observant Jewish boys. The illness was transmitted to other attendees and staff members and has since spread as those people returned home. The CDC says 97 percent of the people with mumps “are members of the tradition-observant Jewish community.”
Child with mumps (Photo: Public Health Image Library)
The CDC’s report includes information about how many of the people found to have mumps have been vaccinated - 88 percent had received one dose and 75 percent had received two doses.
The CDC says that, since 1967, when the mumps vaccine was licensed, to the early 2000s, the number of reported cases has gone from 186,000 to less than 500 annually but points out that “the effectiveness of the mumps component of the MMR vaccine is lower than that of the measles and rubella components.”
“The CDC hypothesized that the relatively closed social world of the communities and the large family sizes within them have played a role in preventing the disease from spreading further,” according to a brief from the Center for Infectious Disease Research and Policy.
Parikh examines media’s role in vaccine-autism link
In his latest dispatch, Salon.com contributor and pediatrician Rahul Parikih describes the media as the willing enablers of the decade of hysteria brought about by what he describes as “Dr. Andrew Wakefield’s now infamous study linking the MMR vaccine to autism.” Parikh starts by describing exactly how Wakefield artfully manipulated the media from the beginning:
The anti-vaccine hysteria, after all, began like so many other big stories: with a press conference. That’s where Andrew Wakefield first staked his claim that the MMR vaccine caused autism, according to Paul Offit’s book, “Autism’s False Prophets.” Wakefield wasn’t flanked by doctors or hospital officials but by P.R. folks he had hired himself. “One case of [autism] is too many,” he said. “It’s a moral issue for me, and I can’t support the continued use of [the MMR vaccine] until this issue has been resolved.”
The problem, of course, is that a news conference loads a gun that the media usually pulls the trigger on: Headlines like “Ban Three-in-One Jab, Doctors Urge” started rolling off the presses. While measles made a tragic resurgence, few reporters attempted to scrutinize Wakefield or his audacious claim.
Finger successfully pointed, Parikh then goes on to analyze, with the help of AHCJ member Gary Schwitzer, exactly how the media was duped. He finds that it comes down to the fact that science is pretty complicated stuff, while the news cycle is not.
Frankly, progress in science and medicine occurs much more slowly than the news cycle can tolerate. “Science,” says Schwitzer, “is like a slow winding stream. It has ebbs and flows, and twists and changes in its path that, if you don’t follow, can fool you. But too many reporters, unfortunately, like to dip their toe in the water, run back and report about it without following that river to where it leads.”
Parikh also blames the reporters’ technique of adding “balance” to a story by including opposing opinions that may come from discredited fringe elements, but adds that it’s not entirely the media’s fault.
The Lancet, one of the world’s most well-known medical publications, played an enormous role here, showing us how medical journals are at risk for their own kinds of malpractice. Offit’s “False Prophets” details how Richard Horton, then the journal’s editor in chief, seemed enamored of the notion of publishing something muckraking. As Offit writes, “By ignoring the criticisms of several reviewers, the warnings of an accompanying editorial, Wakefield’s history of holding press conferences, a British press primed for controversy, and a public distrustful of pubic health officials, Richard Horton allowed the public to question the safety of a vaccine based on flimsy, irreproducible data. The loss of the public trust that followed was entirely predictable.”
Parikh ends his piece on a positive note, praising Brian Deer’s investigations into Wakefield’s research in The Sunday Times (of London).
Prisons to get H1N1 vaccines before everyone else?
Poynter’s Al Tompkins, always quick to seize on an interesting emerging story, rounds up reports that inmates are getting H1N1 vaccines before the general population.
McNeil Island Prison, in Puget Sound off the coast of Washington State, where some prisoners have already been vaccinated. Photo by worldislandinfo.com via Flickr.
Predictably, this revelation has spawned a bit of outrage. According to Tompkins, the vaccines go to prisons because they are high-risk areas in which a large number of people live in close quarters.
Will pharmacists play a role in H1N1 vaccinations?
In some states, pharmacists can administer influenza vaccinations. However, laws do differ from state to state. Some states allow pharmacists - who must be certified - to give flu shots based on an established protocol agreed upon with a physician. Other states, such as Oklahoma (until Nov. 1), require patients to obtain a prescription from a doctor before a pharmacist can administer a vaccine.
The differing standards and regulations have the potential of creating barriers to access for vaccinations, something that should be of concern as the H1N1 vaccine makes its way to health care providers.
In Oklahoma, for example, I saw about a dozen people arrive at a pharmacy counter for their flu shots, only to be told they had to get a prescription. Those people left the pharmacy, presumably to visit their doctor, a visit that likely required a co-pay or other payment. Every time someone left, I had to wonder whether they would follow through and return with a prescription. In my case, I went to a walk-in clinic where I only waited a few minutes - though I had to fill out several forms - then had my vitals recorded and answered a series of questions, first from a nurse and then from the doctor. I then returned to the pharmacy, filled out more forms very similar to what I had completed for the doctor and waited until the pharmacist was available to give me a flu shot. The whole process took about two hours - time that many people can’t afford to spend.
Presumably, states are allowing pharmacists to give influenza vaccinations to increase the public’s access and boost immunizations. But are the regulations guiding such vaccinations working or are different barriers being created? It remains to be seen whether pharmacists will be giving H1N1 vaccinations, but a number of organizations are discussing the possibility.
Carolyn C. Ha, Pharm.D., of the National Community Pharmacists Association, has provided a state-by-state breakdown of requirements for pharmacist-provided immunizations.
The Association of State and Territorial Health Officials recently released an “Operational Framework for Partnering with Pharmacies for Administration of 2009 H1N1 Vaccine” that includes information about requirements in each state. (contact: Paula A. Steib, senior director communications, Association of State and Territorial Health Officials, 202-371-9090 ext. 3173)
The American Pharmacists Association has provided information about vaccine distribution. The organization is working with the National Association of Chain Drug Stores, the National Community Pharmacists Association, state associations, CDC, and the Association of State and Territorial Health Officials to get pharmacies included in each state’s 2009 H1N1 influenza virus immunizing program.
The CDC’s has contact information for state/jurisdiction officials and guidelines for clinicians. The CDC’s Advisory Committee on Immunization Practices also will have information about H1N1 vaccinations.
For more about the certification process for pharmacists, read “Incorporating an Immunization Certificate Program into the Pharmacy Curriculum,” from the American Journal of Pharmaceutical Education and from the American Pharmacists Association.
Oransky on H1N1, pandemic, vaccination and 1976
Filed under: Health journalism, Hot Health Headline, Public health
AHCJ board member Ivan Oransky appeared on Brian Lehrer Live to discuss H1N1. The relevant segment starts at about 38:50 into the show.
Among the issues discussed:
- Why H1N1 is a “pandemic,” what that really means, and how the designation has affected the public perception of the outbreak.
- The effectiveness of the widespread adoption of hand sanitizers, especially in the context of flu and other viral outbreaks.
- Vaccination and the lessons/relevance of the 1976 swine flu “outbreak,” in which the vaccine turned out to be more dangerous than the actual flu.
- The level of immunity created by the first wave of H1N1 earlier this year.
- Media behavior during this outbreak, and the media’s responsibility to communicate as much information as possible without being “sensationalist.”
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