Reviewed: Bubela T, Boon H, Caulfield T. Herbal remedy clinical trials in the media: a comparison with the coverage of conventional pharmaceuticals. BMC Complement Altern Med. 2008;6:35.
In a recent survey, researchers compared newspaper coverage of clinical trials on herbal remedies with coverage of clinical trials on conventional pharmaceutical medicines.
Online database searches from the United Kingdom, United States, Australia/New Zealand, and Canada found 57 herbal remedy clinical trials (HCTs) referenced in 352 newspaper articles, published between 1995 and 2005. After coding the HCTs and media articles for content, conventional drugs were identified for each medical condition studied in the HCTs, and the corresponding pharmaceutical clinical trials (PCTs) identified. Since “significantly more [PCTs] received press coverage” than HCTs, up to 3 PCTs were randomly chosen for each medical condition; 48 PCTs and 201 newspaper articles about them were included in the survey. Those PCTs and newspaper articles were similarly coded for content.
Codes included specifics of clinical trials as reported in journals, presentation of tested treatments (i.e., controversial), tone in which outcomes were discussed, and overall tone. For newspaper articles, codes included whether and how involvement of a funding agency and/or conflicts of interest were reported, format in which the story appeared, and whether the main claims in the story reflected the findings reported in the clinical trials.
HCTs had similar Jadad scores* for design quality to PCTs, but most were significantly smaller and of shorter duration. Clinical trials covered in newspapers were mostly from Western countries and published in high-ranking journals (the Journal of the American Medical Association, Lancet, New England Journal of Medicine, and British Medical Journal published 57 of the 105 clinical trials). Only one HCT reported in newspapers appeared in a complementary and alternative medicine (CAM) journal. Most clinical trials took place in public institutions. Two PCTs and 4 HCTs took place in the private sector, but most PCTs (64%) and HCTs (53%) had some private funds. Some had other conflicts of interest (46% of PCTs, 23% of HCTs). Of HCTs, 34% did not specify funding source.
Of the analyzed stories, from 131 papers in 5 countries, most reported news (60%), while one-third were features that just happened to include information about a clinical trial. In regards to framing, 43% of all articles had no controversial elements, 35% were presented as balanced (i.e., both sides of a controversy were presented), and 22% as unbalanced (i.e., only one side of the story was provided). For PCTs, the theme of almost all articles was the clinical trial itself; for HCTs, 63.6% of stories focused on the clinical trial and the rest on medical conditions, uses for herbs, and/or risks of herbs. Errors of omission were common: especially dose, sample size, and location and duration of clinical trials. Risks were underreported, especially for HCTs. However, 29% of articles on HCTs vs. 4% on PCTs said the tested remedy had no benefit. Individuals quoted in articles about all trials were overwhelmingly university or hospital scientists or physicians not specializing in CAM; clearly identified CAM researchers or practitioners were quoted in only 8% of articles on HCTs.
Newspaper evaluations of PCTs were more likely to be positive or neutral; those of HCTs, negative—a result not entirely explained by HCTs’ more frequent negative results. Overall tone was more likely to be positive about PCTs. In fact, no article on PCTs was negative overall; 21.9% of those on HCTs were negative. This was so even though significantly more risks, primarily adverse effects, were reported for conventional pharmaceutical drugs. A very large majority of newspaper stories failed to mention funding sources, involvement of funders, or other conflicts of interest for PCTs. For all stories, there was a significant association between disease condition studied and the article’s overall tone and tone of clinical trial assessment. Stories with the most negative overall tone concerned disorders associated with diet and obesity, and the most negative in assessing clinical trials were those featuring trials of the genitourinary system, mental disorders, and infectious diseases.
Despite a vast increase in the number of HCTs in recent years, there has not been a corresponding increase in newspaper articles about them. The media is not keeping up with the march towards evidence-based herbal medicine. Results suggest high-profile journals publish a significant number of CAM studies with negative results, although a general publications bias towards positive results applied to both types of clinical trials. The authors state that current newspapers are not providing the tools for informed health choices. Also, lack of reported conflicts of interest may impact public trust and respect for medical researchers. Solutions would include better reporting guidelines and training in health and science for journalists, training in media skills for clinical researchers, and scientific and media literacy programs for the public that relies upon newspapers for health-related news.
* Jadad scores refers to the system developed by Alex Jadad for evaluating the design quality of clinical trials. A review of a book by Dr. Jadad explaining this system was published in HerbalGram 81.