THURSDAY 16 DECEMBER 2004

MS MARGOT JAMES, MR MIKE PALING, MR RICHARD HORTON, MS JENNY HOPE AND MS LOIS ROGERS

  Q540  Chairman: The worry we have with what is called disease mongering is that often the media—and I am not talking about either of your papers in particular, but the media in general—presents it in a very simplistic way. Take the Viagra debate for example. We were looking at sexual health around the time that all this was kicking around. The magic cure for erectile dysfunction is to take this pill not to stop drinking 10 pints before you try to make love. It was an imbalanced debate. How can you broaden out the debate in a way that is sensible rather than focus on what seems to be the headline issue?

  Ms Hope: It is very hard because what you are dealing with is one single issue—usually in a story rather than in a debate—and you have about 600 words to put all the points in. You have to include background; you have to include the elements of how many people are affected by this, how seriously they are affected by it and what is currently happening. It does not leave you very much space. You have to try to stand back and see how that story fits into the trajectory of a particular disease or drug. If, for example, there is new push on with diabetes you have to assess whether or not you think it is as a result of a big PR campaign to try to get a particular sort of drug into the market place. As I said in my written evidence, I feel very strongly that journalists are quite used to looking for vested interests, the hidden agenda. That does not mean, if we spot it, that it negates the story or distorts the coverage. We are aware of it in all walks of journalistic life, be it transport, be it politics, whatever. We are used to looking for it; we take it into account. That does not mean we do not run the story.

  Q541  Jim Dowd: Looking back to what Dr Horton said earlier when the Chairman asked about MMR, I do not know whether it is true of The Daily Mail or The Sunday Times or anybody else here, and I am not expecting you to answer on behalf of the whole media, but take the MMR, certainly the tabloid end of BBC—Radio 5 Live—cannot report MMR without describing it as the controversial MMR. Technically that may be true, but that gives the impression that this is a 51-49 split but the issue on MMR was one rogue—as it is now described—piece of work. Everything else, every other country in the world, every other piece of scientific information said that the MMR vaccine was perfectly safe as it was and there was no link through to irritable bowel or autism or anything else. That is not how the issue continues—continues to this very day—to be reported whenever there is a story around MMR in the media.

  Ms Hope: I would defend the use of the word "controversial" because it is a newspaper shorthand word. It sums up a whole history of controversy surrounding the drug and surrounding the vaccine and surrounding the effect it has had in Britain on immunisation.

  Q542  Jim Dowd: There was not a whole history; there was one incident.

  Ms Hope: But it has run and run.

  Q543  Jim Dowd: Yes I know, by you.

  Ms Hope: By a lot of papers. May I also add that whenever papers are asked to run stories about how poor immunisation rates are in large areas of Britain—including London—the MMR vaccine is actually attributed as the reason for this fall; the reason that parents have lost confidence is because they have lost confidence in MMR. Whether we like it or not the vaccine remains controversial.

  Q544  Jim Dowd: You do not understand what is cause and what is effect here.

  Ms Hope: I think I do. I think the story rumbles on whether or not you think it has been put to rest.

  Ms Rogers: Although we are getting off the point, do not forget that there was a huge lobby of parents of allegedly vaccine-damaged children. I suspect a lot of them were not vaccine damaged but statistically some must have been and they are quite a loud lobby group. They pop up all the time. There is an underlying problem of what you do with this minority of kids who are damaged by vaccine because in any vaccine there is a fraction of 1% that will be damaged. They also leapt onto the Wakefield study and that gave it an extra momentum of its own. It was a very unfortunate series of events I think.

  Q545  Dr Naysmith: You said about 1%; it is a tiny, tiny fraction.

  Ms Rogers: I said a fraction of 1%. I think it is several decimal points.

  Q546  Mr Jones: In terms of this study on the pharmaceutical industry the sort of story that needs to be told—whoever tells it—is not the story about the drug that works marvellously (because that is a good story) or the drug that does not work and causes dreadful problems (because that is a good story); one is a good bad story and is a good good story, but in terms of what we are doing we are mostly concerned with the drugs that do not work at all and that is not much of a story, is it? It is particularly not much of a story because people are not paying. If they were paying for the drugs that do not work, that might be a story: you are being ripped of personally.

  Ms Rogers: We do report that. We regularly report the fact that the vast majority of drugs work on a fraction of the people they are given to; a minority of the people they are given to. I do not think that that take home message gets through at all. In the same way that we were the paper that demonstrated the MMR thing was a complete con, that message clearly has not got through. It takes a long time to change public opinion and the message from the drugs industry all the time is that here is yet another treatment for cancer which has a response rate of something extraordinary which, when you unravel the statistics, it does not stack up at all. We do report the fact that only one in seven people will actually benefit from this highly toxic drug. We most definitely do, but if you have cancer you want to hear that there is going to be a drug that is going to cure you. You do not want to know that you might not respond to the drug.

  Ms Hope: We need a newspoint in order to say that a drug does not work or a class or drug does not work. For example, if you get a report in a journal—I have heard up to now about the journals and the degree of trust we can place in the reports we see—as we did recently about the fact that a blood pressure drug called Atenelol does not work, it just does not have an effect, we run the story. We ran the story but I am not going to be running stories as a matter of course and say that generally speaking drugs do not work because we actually need to have the evidence on which we can base the report.

  Q547  Mr Jones: Does Dr Horton or the equivalent of Dr Horton ever phone you up and say, "We have just discovered that this drug does not work at all" or something like that? How do you cover it in your paper?

  Ms Hope: That would be undue influence.

  Dr Horton: I have never called Jenny.

  Q548  Mr Jones: You only get pushed from the commercial side; nobody tells you from the other side?

  Ms Rogers: Yes, they do.

  Q549  Chairman: Who tells you?

  Ms Rogers: It tends to be individuals who I know who have done work.

  Q550  Chairman: Not other companies?

  Ms Rogers: No, sorry, that is not true. I did get calls about the Vioxx thing from other companies asking why we did not have a look at this. In fact, that is a very good case in point because with Vioxx I had several approaches from competitors saying that we should have a look at this because there was something going on. But unless you have actually got the hard evidence there is not much you can do. You have to say to them, "Unless we have the evidence that it causes heart disease as opposed to you saying what the rumour is, we cannot do anything at all". These are very litigious companies; you do not take them on lightly.

  Q551  Mrs Calton: What are the main sources for drug stories? Out of the articles you have published on medicines what proportion would you say come from drug companies or their representatives and publicity agents and what proportion would come, say, from government sources?

  Ms Rogers: For me, neither of those. They would come from individuals I know who are academic researchers. I can say reasonably confidently that I have never in the eleven years I have worked at The Sunday Times written a story about a drug that has come from a drug company.

  Q552  Mrs Calton: They have always come from researchers.

  Ms Rogers: Yes. Sometimes patients.

  Ms Hope: If I could just add to that point, we are very much more embargo driven so a lot of stories would come from journals and conferences where trial data—usually significant results, that is the reason why we are thinking about reporting on them—are embargoed to a certain point in time and that would affect the daily papers. We are six out of seven days and that is where a lot of our stories come from. It may well be that PR companies are drawing your attention to the fact that this is going to happen at a certain point so you can put it in the diary and it becomes a potential story of note.

  Q553  Mrs Calton: Going back to Ms Rogers and your response, with all these researchers do you enquire who is funding the research?

  Ms Rogers: Yes, absolutely

  Q554  Mrs Calton: Does that go into the story?

  Ms Rogers: Yes. Obviously it depends on whether it is relevant. Sometimes somebody would ring me up who happens to know something which is absolutely irrelevant to what they are doing at that particular point. You would ask what is their relationship with the company whose products they are attacking and because most academic research is funded by the industry in some shape or form it is inevitable that everybody has had contact in financing from commercial sources.

  Q555  Mrs Calton: Does it always come from that side, from people who are attacking another product that they are not involved with or sometimes are there people who are involved with research and are being paid by a company?

  Ms Rogers: The Viagra story which we got before everyone else—which is many years ago—I actually was told about by the person who was doing the research. In the course of conversation—we were talking about blood pressure—he said, "We have discovered this fantastic compound which is going to make a huge amount of money"—this is almost how the conversation went—"and it is going to work on erectile dysfunction and the market for that is going to be vast". The company—it was Pfizer—were not at all pleased that we were running the story because they did not want their competitors to know at that stage. That is how that one came about. It is serendipity a lot of the time.

  Q556  Mrs Calton: Do you ever feel you are being used by a drug company in a promotional sense?

  Ms Rogers: Yes.

  Q557  Mrs Calton: Could you give us some examples?

  Ms Rogers: We regularly receive approaches where people are trying to use us principally as a conduit for getting a mention of a particular drug into a story because they know that we are not going to write a story saying that this new drug is about to be launched on Thursday because Sunday papers do not do that. It would be much more to try to talk me into mentioning something in a favourable way.

  Mr Paling: Could I just make a point here? My company is not involved with the lay press in any way, shape or form. I do think we are hearing some incredibly sweeping statements about some treatments: "drugs work on a fraction of people, the blood pressure treatment atenolol (which is a beta blocker) just does not work." If that is the case—and atenolol has been genericised for many years but probably available for 25 years—I find it quite remarkable that doctors around the world (hundreds of thousands of doctors) and millions of patients are being treated with a product that does not work when it is actually very easy to measure blood pressure. It does work—I am not saying it is the best treatment and I am not an advocate for it—but I think we have to be a bit careful that we are not making incredibly sweeping statements like that.

  Dr Horton: I think it was us who published the paper on this particular drug. You can reduce blood pressure but actually it is not blood pressure you are trying to reduce. What you are trying to do is change the risk that flows from having high blood pressure: the risk of subsequent stroke, heart attacks and so on. It is a question of whether that particular drug is effective at reducing those clinical end points and there is a question about the efficacy of that drug. I think the point that has just been made is a really interesting one about our drug regulations. A drug gets licensed and there it is; it is there for prescription forever more until the company decides to stop making it. That is crazy. Surely what you should have is a regulatory structure for drugs where you have continuous assessment of the evidence and periodic formal reviews of whether that drug should still have its licence. That is something we do not have right now and I do not think it has been suggested in the oral evidence you have heard so far.

  Q558  Chairman: We have certainly had the old yellow card system criticised.

  Dr Horton: That is nonsense; that is the worst way of doing epidemiology you could possibly think of.

  Q559  Dr Naysmith: To be fair, there have been a number of occasions we have suggested to NICE (when we have had them before us) or government ministers that they should look at some of the existing treatment and see whether the work or not. They are over-loaded with work but that would be another possible way.

  Dr Horton: Five yearly periodic reviews of every drug on the market looking at what the evidence is for and against would clear our all the dross—and there is a lot of dross—and it would give up-to-date evidence for prescribers about what works and what does not work.