The image is of legendary journalist Bill Haddad who did more to grapple with pharmaceutical corruption than anyone else.
The remarks came to me as a large crowd of media and journalism students assembled for a lecture on neo-medicalism. What I wondered is the difference between what a good journalist should do and what a doctor does or should do – very little difference it seemed to me while waiting to deliver the talk.
But this is not how it looks to most people, who see journalists perhaps investigating a topic but having to step to one side when they come up against the “science”. Their job is not to ask questions about medical science but to accept it as gospel truth and build their story around that.
Most journalists – and here I include anyone working in any media from documentary making to feature writers or newspaper reporters – are now coached from the start or else they have found the organization they work for changing around them so they now realise they need to avoid a False Balance. Just as it is not their job to present the views of Flat Earthers alongside those of real physicists, so also they should present the benefits of vaccines and drugs without question and not even begin to entertain thoughts of raising questions about hazards never mind the views of vaccine sceptics.
This increasingly it seems is the way doctors are supposed to behave also – bowing to the science that has been laid down by bodies drawn together to establish a professional consensus – bodies that never fail to reflect the interests of pharmaceutical companies.
It began in the 1990s
An effort began in the 1990s, and is still going on today, to persuade US courts to behave the same way. (Europe is irrelevant). If the science shows that antidepressants cannot cause suicide or homicide, then experts trying to tell the court that this person committed homicide because they were on drugs should simply be thrown out without being heard.
Very few doctors and almost no American doctors were able to answer the challenge they faced in court from pharmaceutical companies – you have anecdotes but we have science and to be allowed into court you have to have science and not anecdotes.
The few SSRI legal cases that happened though ended up exposing by accident that pharma’s science was ghostwritten and that there was no access to the data behind it.
With even minimal access to the data, pharma’s case began to crumble as it became clear that the science and the anecdotes lined up along with the documents showing how everything was ghostwritten.
Which brings us back full circle. The job of the courts – and journalists – is to cross-examine a case, the history of the event and any witnesses that can be brought into court in order to establish what probably happened.
If it seems the likeliest explanation is that the drug caused the event in question and this conclusion seems to be at odds with the science, the second job for the experts in court or liaising with journalists – or maybe for the journalist – is to ask why there is a mismatch in the case of medical drugs between what might seem to be a compelling individual case that this statin, antibiotic or anticonvulsant caused homicide or materially contributed to it and the literature that denies this possibility.
This is exactly the role doctors used to have. Faced with a patient mentioning some effect on treatment, their job was to examine and cross-examine the patient and work out what was likely happening. If the obvious explanation was the drug had triggered the problem, there was an onus on them to act – stopping the drug for instance. They might report the event to regulators.
If this weren’t the case, we would never know what the hazards of a drug might be. Our knowledge of these hazards does not come from controlled trials (RCTs) or the kinds of sources pharma cast as science – a game that involves money to get into and a commitment to the idea that we can’t depend on the observation of our own eyes – whether as doctors or patients or journalists – and we should not be let weigh the evidence ourselves.
Part of our current trouble is that regulators have been bamboozled by this where courts weren’t (thanks to a few brave law firms) and the regulators too now intone the anecdotes are not science mantra. Regulators like FDA rarely if ever discover or let anyone know that a drug can cause an adverse event.
The same is true of the makers of Guidelines like NICE Guidelines who operate on the basis of ghostwritten RCTs without access to the data and never discover or mention treatment related adverse events.
If instead of approaching regulators or guideline makers, we take our problems on treatment to politicians, they will say they depend on the advice they get from the bureaucrats in the regulatory and guideline apparatus. The politicians turn to bureaucrats rather than doctors.
There’s not really much point turning to doctors if all they will say in turn is that they depend on what they are told by regulators and guideline makers.
Doctors have essentially become bureaucrats, who sit even lower on the pecking order than folk in regulation and guidelines – folk who don’t really like meeting people and are happy for doctors to do this.
Soon doctors, sitting in a sub-middle management role, will avoid meeting people also while ensuring that nurse prescribers and physician assistants who do meet people keep using drugs as per labels issued by regulators and per guidelines.
It feels like nothing short of taking a suicide bomb into a regulatory apparatus would allow a breath of air in but even then the trap would slam shut again pretty quickly.
Coming up for Air
A forthcoming Conflict of Interest conference sponsored by Johnson & Johnson has spawned debate among people I know and regard highly. Some bioethicists and others have been asked to participate but have opted not to attend – their argument being that this meeting will enable pharma to co-opt the appearances of bioethical approval.
Journalists working in the health space note that similarly they get invited to health-related meetings – on the cost of diabetes drugs for instance – sponsored by Lilly – and refuse to attend.
This has been pitched as a recent development in the tightening grip of pharma. It’s not. Bioethicists have been collaborating closely with pharma for at least two decades and journalists have been taken to health meetings for probably three or more decades.
Those who do go to the meetings have a view that is closely related to the views of the Guardian and New York Times, as well as the BBC, PBS and other media groups – that their role is not to promote a False Balance. If the science has spoken, the role of the media and journalists is to report it.
Those who don’t attend say the sponsorship necessarily vitiates the content but de facto even without attending any meetings sponsored by Pharma, or Gates or whatever, they will not report on the adverse effects of treatments or vaccines – to do so would be the equivalent of giving equal space to a bunch of Flat Earthers. The attendees and non-attendees end up in the same position.
The idea of complaining about these pharma sponsored meetings on the basis of Conflict of Interest is understandable but a weak card to play. Attending a comparable meeting without any pharma sponsorship would come up with the same results and media copy if the brief of the media is to report around the fringes of the science rather than to take issue with it.
There is a lot of low hanging fruit about ghostwriting and lack of access to the data for journalists and doctors to take issue with – in forums sponsored by pharma or not.
But the low hanging fruit is no longer the key task for journalists or doctors – the need now is to demolish an RCT/EBM ideology that stops us believing the evidence of our own eyes, and weighing the on paper “evidence” that is designed to negate our evidence.
Unless doctors do this they will be consigned to sub-bureaucratic status in the very near future. Ditto for journalists. Working for the New York Times or Guardian won’t change this reality any more than being based in Harvard or Oxford.