When The Age’s health editor Nick Miller reported on a new drug for the treatment of leukemia during our investigation, it caught our eye. The story reported that Melbourne’s Peter MacCallum Cancer Centre had played a key role in showing that a drug called Mabthera, currently used to treat non-Hodgkin lymphoma, also has substantial benefits for leukemia patients. The following day Dr Ian Haines, an oncologist at Melbourne's Cabrini Hospital, wrote a letter to The Age raising his concern that the article was misleading. "It was an exaggeration of the benefits of the treatment with no presentation of the downsides … which is that it’s incredibly expensive, it’s not without risk," he told the ACIJ. Following Haines’ letter, Miller wrote on his blog an account of how the story came about, taking the flak for omissions in the article, which, he said, were due to him "not asking the right questions and not seeking comment from a second oncologist". Miller explained the origins of the story in his blog:
"I got an email from Peter Mac -- a cancer hospital in Melbourne -- saying ''Please find attached today's press release detailing a breakthrough in adult leukaemia treatment -- following international trials in which associate professor John Seymour, from the Peter MacCallum Cancer Centre, led the Australian involvement.'"
In the original article, Miller had acknowledged that: "Professor Seymour disclosed that he has acted on an advisory board for Roche, the manufacturer of the drug." But what was absent from Miller’s initial article and his blog was that this particular PR promotion around Mabthera was being driven by Roche itself. Peter MacCallum’s communication’s assistant, Nick Sharp-Paul, told the ACIJ that the media around the drug was managed by Roche’s PR company, Cube PR: "Cube co-ordinated this for Roche, putting out the initial press release. But we obviously wanted to do our own media as well … so we put out a press release after theirs." The Peter MacCallum Centre also receives considerable funding (more than $400,000 in 2008 alone) from Roche to run collaborative research projects. Miller says he didn’t receive the Cube press release -- "Or if I did I deleted it without reading it." But according to Cube’s senior account manager, Michelle Powell, Miller requested and was provided with the Cube press release on the day the article was written along with information on the cost of the drug and Roche’s plans to apply for it to be included on the PBS. Cube PR is a specialist health public relations company that claims on its website to be an "easily accessible one-stop shop" for journalists with "all the elements needed to write your story." The company appeared on Media Watch twice last year, exposed for its efforts to promote prescription medicine to the public on behalf of its clients, which is illegal under the Therapeutic Goods Act. One of these clients, Eli Lilly Australia, was subsequently fined $60,000 by Medicines Australia after Cube’s media release was found to be in breach of the industry’s code of conduct. A quick look at the Cube and Peter MacCallum press releases reveals how closely they collaborated in promoting this media moment. Sections of the Peter MacCallum press release, including the comments provided by Professor Seymour, are identical to those in Cube’s press release. The Cube release also came with packaged audio grabs featuring Professor Seymour praising the drug. Professor Seymour refused to discuss the incident with the ACIJ, saying: "I would prefer not to have this dealt with any further in the public arena." He said a yet-to-be-published study presented at the American Society of Hematology annual meeting in November last year confirms the benefits of the drug. Meanwhile,  in relation to its connection to a rare but fatal virus called progressive multifocal leukoencephalopathy (PML), in 2007 the TGA put out a warning on Mabthera, detailing the death of a patient -- taking Mabthera -- from PML. In October this year the US Food and Drug Administration warned that at least two patients had died from PML after taking the drug. Neither The Age nor any other print media outlets reported either of these warnings. Unless you scour the letters page or follow Miller’s blog, the residual public message about this drug is Professor Seymour’s resounding affirmation that "this is the largest single advance in the treatment of this disease in the last 30 years." Not a bad outcome for a company looking to have Mabthera added on to the PBS as a cancer drug. While Nick Miller did say that the Peter MacCallum incident was a case of "a company that was trying to pass off a corporate message as someone else’s research results" he is adamant that it was a unique incident. "A lot of checks and balances went wrong and it would be misleading to use it as an example of the way that pharmaceutical companies are trying to Astroturf their claims," he said. But other journalists spoken to by the ACIJ said the engagement of third parties in providing a link between a drug company and the media is all too common in health journalism. As one specialist health reporter put it: "It’s routine to receive research seemingly done by credible independent outlets that has a commercial imperative." Veteran health reporter Ray Moynihan agrees: "It happens enormously often because third party endorsements are PR 101 for drug companies." Moynihan says the tendency of the media to uncritically present these endorsements reflects broader problems with the nature of health reporting. "The standard templates for health news coverage tend to be fundamentally unhealthy …  It’s something about the nature of news that does privilege the new to the extent of misinforming people. "When there are reports hyping up a new drug there will often be wonderful glowing testimonials of the drug. But when there are recalls or comments on side effects, there is frequently no equivalent coverage." One example is the media treatment of Bayer’s contraceptive pill Yaz, which was widely praised before its release in September last year. Under the headline "Miracle cure all", The Daily Telegraph wrote "Not only does a new pill, Yaz, act as a contraceptive, it promises to relieve pain, acne, weight gain and mood swings in what will be a godsend." One journalist told us: "The Tele ran it in such a way that it looked like it was the most amazing breakthrough since the discovery of the pill in the 1960s. But when you look at it closely it’s clear there isn’t a great difference to existing contraceptives in terms of what it does. Experts working in this space would have looked at that with shock." If they did look at it with shock, this certainly wasn’t reported by the media. Nor has it been reported that a study in the British Medical Journal found Yaz to produce a fivefold increase in the likelihood of women developing dangerous blood clots. German public broadcaster Deutsche Welle reported that seven women have died in Germany while taking drugs from the Yaz family since 2001, while in the US Bayer is reportedly facing 129 law suits due to safety concerns surrounding the drug.  None of this has made the news in Australia. Because drug companies (and even the Therapeutic Goods Administration) rarely put out media releases publicising this kind of news, journalists who rely on PR to generate their stories are much less likely to report these types of medical concerns. Updated 18/03: Deutsche Welle was previously incorrectly labeled as a "newspaper". This has been amended to "public broadcaster".