How the media caught Tamiflu

From a bit of a dud to the world's most sought after drug in the space of six months, surely Roche cannot believe its luck with oseltamivir (Tamiflu). Despite a silly name and a lack of convincing evidence that it will have any real impact on an influenza pandemic, sales and recognition of the drug frequently dubbed “our best hope against bird flu” have leapt through the roof.

Between 1999 and 2002 Roche sold just 5.5 million treatments. Next year the total sales of oseltamivir are projected at 150 million. Roche's share price has soared this year by 60%.

Sir Liam Donaldson, England's chief medical officer, has noted that doctors have little idea how effective oseltamivir antiviral tablets would actually be during a pandemic.

But this has not affected demand and Roche cannot make the drug quickly enough for the 50 countries currently stock-piling it. On the internet Tamiflu is trading at five times its retail price.

Of course in large part Roche has Mother Nature to thank for the turn of events. The rising spectre of an influenza pandemic and no immediate vaccine to fight it has made bird flu the medical story of the year and given Tamiflu a public profile comparable to that of Viagra.

But that's not the whole story. Roche has naturally made the most of this golden opportunity and its public relations machine has naturally milked Tamiflu for all it was worth

Credit: CHRIS RAOBURN/PA/EMPICS/PA

Like most other drug companies, its marketing department uses opinion leaders—usually professors or senior doctors from medical schools who can provide the credibility that company representatives cannot. In the case of oseltamivir, it is Professor John Oxford of Queen Mary College, London, who has led the drug's endorsement.

He routinely provides the media with positive comments about Tamiflu and has even appeared in promotional videos for the drug. However, his ties to Roche are rarely if ever mentioned in the mainstream press. He is also the scientific director of and a share owner in Retroscreen Virology, which has had contracts with Roche.

As a media pundit he denies any conflicts of interest. He told the BMJ: “I believe these drugs are very useful and I've also worked with Johnson and Johnson and Glaxo (firms that make rival treatments). I've not tried to conceal anything. But you can't mention all your grants and links every time you appear on the television or every time you're quoted, there just isn't enough time.”

But other doctors believe opinion leaders should make time to do this. Joe Collier, professor of medicines policy at St George's Hospital Medical School, London, and a former editor of the Drug and Therapeutics Bulletin, said, “It's a real dilemma who to believe.” He said that an opinion leader might be totally impartial but on the other hand he or she might not.

“The fact is we have to be suspicious,” Professor Collier said, adding, “Perhaps the media should speak to more than one person when it's looking for comments or information. Somehow the mainstream media needs to think more on what it's going to do about this.”

Respected figures in medical research, such as Professor Colin Blakemore, the chief executive of the Medical Research Council, have noted the need for leading doctors to work closely with industry to facilitate drug development. But surely this doesn't abrogate doctors' responsibility to be transparent about the nature of that relationship—nor does it relieve the press of its duty to alert readers to potential conflicts of interest.

For several years I worked as medical correspondent at New Scientist magazine, where it was standard practice to seek several opinions on a single issue. When I moved from this ivory tower to Fleet Street I was somewhat taken aback at the “any ologist will do” attitude when obtaining quotes for a story—although I soon became aware of the time constraints that made this necessary.

Another Fleet Street health correspondent whom I spoke to this week said, “When you've got three articles to write in an afternoon and news desk shouting at you for copy, you just want to get a quote that you need to make the story; the last thing on your mind is checking the background of everyone you've quoted.”

The correspondent added, “Anyway, how do we know that any doctor hasn't benefited financially from a drug company; I'm not sure there are that many left who haven't.”

A spokesman for the drug industry's UK umbrella group, the Association of the British Pharmaceutical Industry, denied the media was being manipulated. “In fact I think there's a sense that journalists will usually ring the person they think will give them the quote they want.”

Alessandro Liberati and Nicola Magrini, writing in the BMJ two years ago, called on opinion leaders to avoid “double standards” and adopt the same rigorous ethics and transparency when speaking to patients and policy makers that they would be expected to show when writing for peer reviewed journals (BMJ 2003;326: 1156-7).

You might add that newspapers and broadcasters will need to raise their game, as well. And so far the signs are not good.