Medical News Stories Lack Qualified Independent Commentators

Diana Swift

December 19, 2016

Only one in six media news stories on journal-based medical research included comments from outside observers, and a quarter of those commenting did not have the clinical or academic expertise to comment on the studies in question, a new study has found.

Furthermore, "independent" commentators in media stories were frequently not independent in terms of academic and/or financial conflicts of interest. The study found that competing interests influenced opinions on research findings, with more positive views expressed when academic or financial interests were congruent with research results.

"Strategies to improve this aspect of communication of clinical research findings to the wider community might be developed and empirically tested by journalists and commenters," Michael T. M. Wang, from the University of Auckland, New Zealand, and colleagues write. They report their findings in an article published online December 19 in CMAJ.

Although the lack of independent commentary and conflict disclosure has long been acknowledged, it still persists, according to Gary Schwitzer, PhD, an adjunct associate professor at the University of Minnesota School of Public Health in Minneapolis and publisher of Health News Review.

"Of the 2300 stories we've reviewed, only about half get a satisfactory score on these criteria," Dr Schwitzer told Medscape Medical News. "That's a huge sample, probably the largest such sample of stories about health care interventions that anyone has analyzed, so you can judge whether a 50-50 score across the huge sample is a case of the glass half full or half empty." He strongly believes that studies exposing the lack of independent sources and conflict reporting are very much needed. "The message still isn't hitting home."

Jeanne Lenzer, associate editor at the BMJ, agrees. "While it's tempting to say we've proved this problem exists a thousand times over, we still need to have this conversation," she told Medscape Medical News. "Journalists don't abide by these criteria. I am seeing tons of commercials disguised as news." That statement applies even to respected outlets such as the Wall Street Journal.

The researchers searched a large global media database and identified 104 independent comments from 102 sources on original clinical research published in influential general and internal medicine journals during the period from January 1 to March 31, 2013. They also scrutinized 21 journal editorials on the studies. The findings appeared in such high-impact publications as the New England Journal of Medicine, Annals of Internal Medicine, JAMA, PloS Medicine, the BMJ, and the Lancet.

Each commentator was assessed for directly relevant clinical or research expertise in the field by a search of their published work in the 5 years preceding publication of the source study (2008 - 2012). Qualifying publications assessed the intervention or exposure of the source article or its main outcome.

The standard used for assessing competing financial and academic interests was the International Committee of Medical Journal Editors' definition of conflict of interest.

"Academic or financial conflicts of interest were frequently present among independent commenters but infrequently reported, and were often associated with the disposition of comments about the source research," the authors write.

For example, in contrast with recommended standards for healthcare and medical journalism, Wang and associates found that 54% of outside commentators had an academic conflict of interest, and 32% had a financial conflict of interest; only 45% of academic and 33% of financial competing interests were explicitly disclosed.

"When commenters' conflicts of interest were congruent with the findings of the source research, 97% and 93% of comments associated with academic and financial conflicts of interest, respectively, were favourably disposed toward the research. These values were 16% and 17%, respectively, when the conflicts of interest were not congruent with the research findings," the authors note.

Similar results were observed among the 21 editorial commentaries, with nine reflecting an academic conflict of interest and eight a financial conflict of interest.

Of the 33 financial conflicts of interest among independent sources, 25 were rated as high, one as moderate, and seven as low in strength. Among the eight financial conflicts found in editorialists, four were ranked as high, one as moderate, and three as low in strength.

In addition, the vetted news pieces contained 23 comments from spokespersons for advocacy organizations, and six of these had a commercial sponsor with a vested interest relevant to the source research. Again, none of these conflicts was disclosed.

On the expertise front, not surprisingly, journal-invited editorialists had been coauthors of more papers than the independent commentators in the 5-year window before the source article (median, 65 [95% confidence interval, 52 - 99] vs 30 [95% confidence interval, 20 - 38]; P = .006).

Independent commentators were also were less likely to have recently coauthored a study with a design similar to that of the source article (46% vs 90%; P < .001). In addition, they were less likely to have published a recent paper relevant to the source research (28% vs 5%%; P = .02).

As for expertise, the researchers considered just 53% of independent commentators to have appropriate academic expertise vs 86% of editorialists (P = .007). Both groups, however, had comparable degrees of relevant clinical expertise (56% of independents vs 48% of editorialists; P = .6).

However, a concerning 25% of independent sources had neither academic nor clinical expertise, although, unsurprisingly, none of the invited editorialists (P = .007) had these deficiencies. Of the 26 independent commenters with neither academic nor clinical expertise, 18 were spokespersons for advocacy organizations.

Commenting on the study, Lenzer noted that although "it provides some useful information, it nonetheless misleads on an important point. I think the authors conflated academic-intellectual with professional conflicts. They hinted at this in saying that professional conflicts can be financial conflicts." For example, a urologist will favor prostate-specific antigen testing, and both gastroenterologists and radiologists want to test for stomach distress. "So it depends on who you ask. These are actually professional conflicts that should be recognized essentially as your bread and butter," she said.

Lenzer also has a problem with adjudicating intellectual competing interests. "I don't like this idea of calling something an intellectual conflict. The people who know the most about something are always going to have strong opinions about it, and nobody should be adjudicated on that."

In a related editorial commentary, Ray Moynihan, PhD, from the Centre for Research in Evidence-Based Practice at Bond University, Queensland, Australia, and a coauthor write, "The call to develop and evaluate strategies to include more genuinely independent and informed commenters in coverage of medical research is welcome, as part of wider efforts to make medical journalism healthier — in media new and old."

In 2000, Dr Moynihan and colleagues reported that 50% of news stories about three medications cited at least one expert or study with a relevant financial conflict of interest. and only 40% of these were reported. And a review of news stories on a health journalism website revealed that 46% did not meet the criteria of including an independent source and identifying conflicts of interest.

Dr Schwitzer's media review organization provides healthcare journalists a list of approximately 100 industry-independent experts, which Lenzer helped compile and which will likely double in number in 2017. "Our message to journalists covering healthcare: if you don't know the landscape and aren't aware of the prevalence of conflicts of interest, or if you know this but fail to report on it, you don't have any business reporting on these issues," he said. "Because there's a good chance you're misleading your audience and hurting more than helping."

As to whether any expert commentators can ever be truly without intellectual conflicts of interest, Dr Schwitzer said, "Of course they can. There is a weight to the evidence. So an analytical, fact-and-evidence-based commentary about another researcher's findings does not necessarily equate to an intellectual bias or conflict."

One coauthor is supported by the Health Research Council of New Zealand. Another coauthor receives research funding from the same council and from Pharmac, the New Zealand Government's Pharmaceutical Management Agency, and is a shareholder in Auckland Bone Density, a company that provides bone mineral density measurements. All authors have coauthored publications on the reporting and dissemination of clinical research. Two coauthors have coauthored publications on conflicts of interest in the interpretation of clinical research findings.

CMAJ. Published online December 19, 2016. Article abstract

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