Academics and Competing Interests in H1N1 Influenza Media Reporting

J Epidemiol Community Health: first published as 10.1136/jech-2013-203128 on 11 November 2013. Downloaded from Research report Academics and competing interests in H1N1 influenza media reporting Kate L Mandeville,1 Sam O’Neill,2 Andrew Brighouse,3 Alice Walker,4 Kielan Yarrow,5 Kenneth Chan6 1Department of Global Health ABSTRACT and influenza vaccines.78There have been repeated and Development, London Background Concerns have been raised over calls for greater transparency around the potential School of Hygiene and Tropical competing interests (CoI) among academics during the influence of the pharmaceutical industry on the Medicine, London, UK 2679 2School of Medicine, Imperial 2009 to 2010 A/H1N1 pandemic. Media reporting can decisions made by these committees. College London, London, UK influence public anxiety and demand for pharmaceutical Public health academics are often asked to 3 Accident and Emergency products. We assessed CoI of academics providing media provide commentary and analysis on emerging Department, Princess commentary during the early stages of the pandemic. health risks by the media. Media coverage of health Alexandra Hospital NHS Trust, fl ’ Harlow, UK Methods We performed a retrospective content issues has been shown to in uence the public s per- 4Accident and Emergency analysis of UK newspaper articles on A/H1N1 influenza, ception of risk, demand for new drugs and policy – Department, Chase Farm examining quoted sources. We noted when academics decisions.10 13 In the UK, extensive media advo- Hospital, Enfield, UK 5 made a risk assessment of the pandemic and compared cacy of the breast cancer drug trastuzumab Department of Psychology, fi ‘ ’ City University London, this with of cial estimations. We also looked for (Herceptin) resulted in a fast-track approval from London, UK promotion or rejection of the use of neuraminidase the National Institute for Health and Clinical 6Barts and The London School inhibitors or H1N1-specific vaccine. We independently Excellence,14 but there was subsequent debate over of Medicine & Dentistry, searched for CoI for each academic. the cost-effectiveness of the drug.15 It has been sug- London, UK Results Academics were the second most frequently gested that optimistic media portrayals may be Correspondence to quoted source after Ministers of Health. Where both more successful for pharmaceutical companies than Dr Kate L Mandeville, academics and official agencies estimated the risk of explicit promotional campaigns as “the message is Department of Global Health H1N1, one in two academics assessed the risk as higher separated from an obvious marketing agenda and and Development, London than official predictions. For academics with CoI, the often includes a trusted voice, such as a university- School of Hygiene and Tropical copyright. Medicine, 15-17 Tavistock odds of a higher risk assessment were 5.8 times greater based researcher. Paradoxically, this trust is based in Place, London WC1H 9SH, UK; than those made by academics without CoI (Wald part on a belief in the perceived independence of [email protected] p value=0.009). One in two academics commenting on university researchers”.16 Like those on advisory the use of neuraminidase inhibitors or vaccine had CoI. committees, academics quoted in the media may Received 17 July 2013 The odds of CoI in academics promoting the use of also have possible CoI. Media commentaries, there- Revised 7 September 2013 Accepted 18 September 2013 neuraminidase inhibitors were 8.4 times greater than for fore, represent an alternative route to exert pres- Published Online First academics not commenting on their use (Fisher’s exact sure on public demand and one in which CoI are 11 November 2013 p=0.005). not routinely declared. Conclusions There is evidence of CoI among We set out to examine media commentary on academics providing media commentary during the early A/H1N1 influenza provided by academics during H1N1 pandemic. Heightened risk assessments, combined the period in which the UK government decided with advocacy for pharmaceutical products to counter its policy on public provision of NI and http://jech.bmj.com/ this risk, may lead to increased public anxiety and H1N1-specific vaccine (NI/vaccine). We then inde- demand. Academics should declare, and journalists pendently searched for CoI for each academic to report, relevant CoI for media interviews. determine whether commentary from academics with and without CoI was significantly different. INTRODUCTION METHODS The UK spent an estimated one billion pounds on Design and setting on September 26, 2021 by guest. Protected pharmaceutical products during the 2009 to 2010 This study was a retrospective content analysis of A/H1N1 influenza pandemic, including neuramin- UK newspaper reporting. We excluded television idase inhibitors (NI) and H1N1-specific vaccine.1 and radio coverage, as audiovisual reporting is Pharmaceutical companies made profits of 4.5–6.5 often limited by time constraints and presents less billion pounds from H1N1 vaccines alone.2 This divergent viewpoints and in-depth analysis com- 17 18 Open Access was despite the evaluation of the pandemic as less pared with print media. Scan to access more 34 free content severe than previous pandemics and uncertainty over the effectiveness of neuraminidase inhibitors Selection of newspaper articles (a type of antiviral medication) in reducing trans- Figure 1 shows the flow of articles through the mission and complications of influenza.5 study. We used the Nexis-UK database, which pro- In the postpandemic period, there were signifi- vides full-text access to all UK national newspapers. cant concerns about competing interests (CoI) Twelve UK national newspapers were included in To cite: Mandeville KL, among experts on influential advisory committees, the sample ( January 2009 circulation figures are O’Neill S, Brighouse A, et al. including the WHO Emergency Committee.267 given in parentheses19): Daily Mirror (1 366 891), J Epidemiol Community Members of these committees have been linked to Sunday Mirror (1 244 007), The Sun (3 146 006), – Health 2014;68:197 203. manufacturers of both neuraminidase inhibitors News of the World (3 031 025), Daily Mail Mandeville KL, et al. J Epidemiol Community Health 2014;68:197–203. doi:10.1136/jech-2013-203128 197 J Epidemiol Community Health: first published as 10.1136/jech-2013-203128 on 11 November 2013. Downloaded from Research report copyright. http://jech.bmj.com/ on September 26, 2021 by guest. Protected Figure 1 Flow of articles through study. (2 200 398), The Mail on Sunday (2 134 809), The Guardian The database was searched using the following terms (an (358 844), The Independent (215 504), The Observer (427 867), exclamation mark is used as a truncator in this database): Daily Telegraph (783 210), The Times (617 483) and The H1N1, Influenza A, Swine !flu!, Pandemic !flu!, Pig !flu!. Only Sunday Times (1 198 984). These were selected in order to articles that contained at least three mentions of the search ensure coverage from tabloid, middle-market and broadsheet terms were eligible for inclusion in order to select articles where publications, daily and Sunday newspapers, and left and right H1N1 influenza was the main theme. Articles with a different political orientations so that a range of perspectives and report- focus entirely, such as business, sports and non-news articles like ing styles were represented. This typology has been used in pre- obituaries, were excluded. Search dates were between 20 April vious content analyses.20 21 and 5 July 2009, the period in which the major decisions on 198 Mandeville KL, et al. J Epidemiol Community Health 2014;68:197–203. doi:10.1136/jech-2013-203128 J Epidemiol Community Health: first published as 10.1136/jech-2013-203128 on 11 November 2013. Downloaded from Research report pharmaceuticals as part of the pandemic response were taken by assessment made by an official body relevant to the UK popula- the UK government. Key events and policy decisions within this tion quoted within the same article (defined as WHO, Health period are summarised in table 1.122News coverage dropped Secretary/Minister(s), Chief Medical Officer(s), Department(s) off considerably after this period.20 of Health or HPA). Table 1 presents examples of risk assess- Using these criteria, 712 articles were eligible for inclusion. ments from these agencies during the study period. We used the These were extracted into Microsoft Word and screened by one official risk assessments as a benchmark to measure each aca- of the authors. Duplicate articles from later editions of the demic risk assessment: judging whether it concurred with the newspapers and any remaining articles as per exclusion criteria official estimate, or was higher or lower (ie, implying more or above were excluded, leaving 425 articles in the final sample. less risk to the public). These provided a good coverage of formats, frequencies and All quotes by academics were then examined for reference to political orientation, taking into account the circulation figures the use of NI or influenza vaccine. Those that made reference to above (figure 1). NI/vaccine were further analysed as to whether they promoted or rejected the use of these products. The analysis was per- Coding framework formed according to a pre-agreed consensus on terms. ‘ ’ fi Each article was assessed independently by two authors using a Promotion was de ned as advocacy of the effectiveness, need ‘ ’ standardised coding framework consisting of two sections. for or supply shortages of NI/vaccine. Conversely, rejection The first section categorised the sources quoted in each referred to statements highlighting the adverse effects, ineffect- article. The main categories consisted of Health Secretary/ iveness of or lack of need for NI/vaccine. Minister (of England and the Devolved Administrations—Wales, The coding framework was piloted on 20 articles by both fi fi Scotland and Northern Ireland); Department of Health (of coders, with subsequent minor modi cations made to de ni- ’ England and the Devolved Administrations); Chief Medical tions before coding of the complete data set.

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