Should medical and scientific experts turn to spin doctors for advice when concerns are raised about their relationships with industry?

The question deserves consideration in the light of this email chain, which shows the industry-funded Influenza Specialist Group (ISG) recently forwarded advice from the PR company Burson-Marsteller to more than 20 senior doctors and other health care leaders.

The email was responding to a post on Croakey last month which argued if journalists reported on the lates0t ISG press release promoting vaccination and the use of antivirals they should declare the group’s funding arrangements.

The email from a Burson-Marsteller manager, Gareth Finch, said: “Should anyone approach you about this [the industry funding issue] then I would suggest a response [sic] reflects that it’s important to keep such responses in context and reinforce the fact that we are helping to promote public health messages, not push specific brands of vaccine.”

News of the email chain follows a recent report calling for a national review of the perceived conflicts of interest of immunisation advisors, in the wake of an investigation into adverse events among Australian children given seasonal influenza vaccination. The Australian has also recently run a number of stories highlighting concerns about the industry connections of policy advisors (although, like many other outlets, the Oz itself often does not declare the industry connections of the sources in its articles, including when quoting the ISG).

As I report in the BMJ this week, ethicists are alarmed by the implications of the ISG email chain.

Professor Paul Komesaroff, a physician and director of the Monash Centre for the Study of Ethics in Medicine and Society in Melbourne, says he’s concerned the relationship between industry and influenza experts disclosed by the email chain have the potential to undermine confidence in public health messages. The email chain “disturbs and maybe even alarms me”.

“It suggests that the nature of the process is to manipulate public opinion rather than to provide information which will empower people to make decisions for themselves,” he said.

Dr Leslie Cannold, an ethicist who holds positions at the University of Melbourne and Monash University, says the worrying implication is that experts are being encouraged not to respond to the substance of concerns about their industry ties, but about how to deflect them.

“That is so worrying and so telling about where we are in Australia in terms of dealing with these issues, that these are not seen still to be issues of substance, but are being responded to as issues of PR and PR management,” she said. “These are profound ethical issues and they raise very, very serious questions about integrity.”

It can’t be assumed that the email recipients were universally happy to receive the PR advice, although the email chain shows that at least one responded positively.

But one recipient, Associate Professor Michael Whitby, an infectious diseases physician from Brisbane, said he had not been actively involved in the ISG for the past three years as he had become concerned about the organisation promoting influenza vaccination for indications not supported by national guidelines, especially the promotion of vaccination of children. Responses from some other recipients of the email can be seen here.

When approached for comment on the issue, the chair of the ISG, Dr Alan Hampson, initially said he was not aware of Burson-Marsteller providing any such advice, although he later clarified this. Our email exchange is worth reading.

Hampson subsequently said the company was a contractor to the ISG, and provided media monitoring, advice and helped fine-tune and distribute the organisation’s materials to the media. He said the ISG’s work was “conducted in the public health interest and not compromised by commercial interests”.

“As noted on our website and on all relevant materials that we distribute, we do solicit funds from pharmaceutical companies and these are spent conducting programs designed and controlled by the ISG,” he said. “The relationship between sponsors and the ISG rests firmly between the ISG’s executive (via its executive officer) and those sponsors, not through BM. All of our members, including myself, provide their services pro-bono, however, we do employ an executive officer.”

The questions raised by the email are not only pertinent to experts but also to the bureaucratic response to such concerns, which so far also seems to have been driven by PR imperatives. The email chain raises issues which extend far beyond influenza policy, including whether Australian health professionals and institutions are responding appropriately to broader concerns about pharma industry influence on medical education, research and practice, as outlined by the landmark 2009 report by the Institute of Medicine in the US.

As for disclosure, Rada Rouse, a senior writer at Medical Observer and vice president of the Australian Medical Writers Association, is one of the few journalists who routinely mentions the ISG’s industry funding. Back in June she wrote:

“Australian virologist Dr Alan Hampson (Hon MD) describes recent criticism of the WHO for accepting pandemic planning advice from experts with ties to the pharma industry as a ‘witch-hunt’. Dr Hampson, a WHO and Australian Government consultant who chairs the pharma-funded Influenza Specialist Group, says it would be virtually impossible to find experts with no ties to industry because of the way research is funded.”

I asked her why she thought it important to describe the ISG as “pharma-funded”:

Medical Observer’s policy is to mention relevant affiliations and potential conflicts of interest when quoting experts. But I think any professional journalist has a duty to ensure their readers know where news is coming from, i.e. who has generated this piece of information and who stands to gain from it being read.

“When the Influenza Specialist Group puts out its press releases in March or April urging Australians to get vaccinated against flu before winter, it is not irrelevant that it is manufacturers of flu vaccine who pay a public relations company to run this annual campaign and I think journalists should say so.

“Medical journalists frequently face the issue that individuals with the greatest expertise — the most experience, the most publications — in any area of medicine you like to choose — immunisation, menopause, erectile dysfunction — are also those who are dependent for research funds on companies who want to maximise sales of their products. We do have a responsibility to ensure the public is armed with relevant knowledge to question why they are being urged to make particular health choices.”