Of `miracle cures’ and misleading news reports

Published in The Hindu on December 8, 2005

“Believe nothing that you see in the newspapers… if you see anything in them that you know is true, begin to doubt it at once.”

Sir William Osler

Are you taken in by a news report that a drug, surgery, therapy or a particular diagnostic tool, the `first of its kind’ in Asia/India, is the solution you have been waiting for, for years? Or have you already taken the clipping to your doctor demanding that the new drug be prescribed and has your doctor either willingly or on being forced yielded to your demands? Or, as is common in India, have you headed straight to the chemist’s shop or hospital to buy the medicine or undergo the diagnostic test?

“… Patients often arrive at their appointments with news articles and Internet printouts in hand,” noted an editorial published in the reputed The New England Journal of Medicine (December 2004). Unfortunately, it is not just lay readers who depend on the lay press for medical information. “… Physicians, too, now rely in part on the media to learn about new studies, especially those outside their own specialty areas,” the editorial commented.

If you have based your decision as a patient to either buy or force your doctor to prescribe the drugs based on news reports, chances are that you would soon regret your decision. The Fen-pen drug incident will tell you why.

Fen-pen fiasco

The Fen-pen was hailed as the miracle cure for obesity in the 1990s. But in 1997 it was withdrawn from the market due to the damages that the drug caused to heart valves. What started as a stampede at shops when the drug was introduced, finally culminated in lawsuits totalling $13 billion from consumers!

Much like the phoenix rising from its ashes, Fen-pen made a comeback soon, thanks to pliant media and medical journals. One year after the drug was withdrawn, the USA Today reported that that the drug caused no heart damage, recalled Dr. Anoop Misra, Professor, Metabolic Research Group, Department of Internal Medicine, AIIMS, New Delhi.

Though the report made a mention that a pharmaceutical company paid for the study and the treatment was only for three months, what went unmentioned was the fact that the article was based not a full report but an abstract presented in a conference!

Operation manipulation

The USA Today report attracted more media reports that painted a rosy picture of the drug.

That was not the end though. Despite the fact that The New England Journal of Medicine wanted the authors to modify the analysis of the paper sent to it, the Journal of American College of Cardiology (JACC) published the article without any changes. And a report in the New York Times gave a clean chit to the drug. The catch with the paper published in JACC was that one of the authors was paid by the pharmaceutical company.

“The editorial in the same journal also supported the drug,” he noted. The fine print conveyed a different message — it was written by a consultant to Home Products that was part of the pharmaceutical company that owned Fen-pen.

Editorials in journals and peer-reviewed journals in particular are widely respected by journalists and the lay readers. The New England Journal of Medicine (NEJM)’s policy to ensure that its editors have no financial ties with pharmaceutical companies or those about whom they are writing is not followed universally.

“For private companies, publication and a positive press have cash value,” an editorial in NEJM cited (December 2, 2004). “… Policies such as ours ensure that editors remain free of financial ties to those whose work they publish.”

Dr. Misra brought the Fen-pen issue to the attention of journalists writing on health and medicine related issues during a workshop conducted by Health Essayists and Authors League (HEAL) in Jaipur recently.

The editorial in the Annals of Internal Medicine (February, 2004) starts with Sir William Osler’s quote and goes about to point out the areas of concern leading to distorted reporting of health issues in lay press.

Need for caution

The editorial urged journalists not to report the findings of Phase I trials and those presented at scientific meetings.

If journalists are duty bound to mention about the nature of the findings, readers may do themselves good by not giving much credit to such reports even if the results appear promising. “Promising reports often fail to pan out and methods, results and interpretations change over time,” the editorial cautioned.

It is important for readers to understand the significance of the results derived from a study involving a small number of volunteers or when the study has been conducted for a short duration.

Though results from such studies may appear promising, they may not stand scrutiny or achieve repeatability in a large scale trial.

There is no magic cure for any disease and if any report claims so, readers may well remember not to take it on the face value. No drug or procedure is without drawbacks or side-effects.

It is time readers understood this basic tenet and did not get fooled by reports that refrain to mention these details.

This is not to shift the responsibility to readers but to help them not to get swayed or carried away by news reports that are peppered with tall claims.

The conflict of interest such as authors being financed by companies whose products they are studying, or being an employee of the company should alert the media and readers alike.