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Who suffered from the media splash on these medicines’ harms?

In case you missed this recent study in the Medical Journal of Australia, researchers have investigated the likely impact on the population’s health of media coverage of a rare but serious side effect associated with bisphosphonates.

In the nine months after an ABC TV report sounding the alarm about these medicines, the researchers estimate that 130 fractures and 14 deaths occurred that may have been prevented if the adverse publicity had not led to a drop in these medicines’ use.

Two of the study’s authors – Professor Philip Sambrook and Professor Judy Simpson – have filed this summary for Croakey readers. They write:

“In December 2007, the ABC screened a program on the 7.30 Report about the association between a rare dental condition (called osteonecrosis of the jaw) and drugs called bisphosphonates.

These drugs are mainly used in two quite different clinical situations, firstly to prevent fractures in osteoporosis and secondly to prevent certain types of cancer (eg breast and prostate cancer) from spreading to the skeleton with disastrous consequences.

The TV program was presented in an alarmist fashion and received wide coverage so that many patients stopped their medication.

Numerous factual errors in the program were the subject of a complaint by one of the interviewees and these errors were subsequently acknowledged in writing by the ABC.

But the immediate effect of the media coverage led to considerable misunderstanding amongst the public, since the program failed to clearly identify the different uses of bisphosphonates for cancer patients (who receive high doses) and osteoporosis patients (who receive low doses).

This difference in doses means the absolute risks of this complication for osteoporosis patients is small, about 1 in 10,000 to 1 in 100,000.

Osteoporosis patients who stopped treatment because of a perceived risk of a rare complication were consequently at increased risk of fracture and death from their osteoporosis.

Although the ABC screened a follow-up program later in an attempt to get the facts right, the impact of the first program was large and there wasa decrease in the number of prescriptions filled for bisphosphonates on the PBS of up to 29000 patients over the next 9 months.

Using sophisticated and conservative statistical analyses, the authors of this paper in the Medical Journal of Australia have estimated that over this 9-month period, the number of fractures and deaths that occurred but could have been prevented if patients had stayed on their treatment was 70 hip fractures, 60 other of fractures and 14 deaths.

Although it is important for patients to be informed of the risks of medication, incorrect and alarmist media coverage that does not balance the benefits of therapy against the risks has the potential to do more harm than good.

For example, one could imagine the public outcry if 14 people died as a complication of some treatment, yet here we have 14 preventable deaths that have been ignored.

Responsible reporting of health data to the public is a challenge. Great skill is needed to strike the right balance between alerting but not alarming. Reporters and the general public alike have poor understanding of epidemiology and the concept of personal risk.  It might get good ratings at the time but these figures show the media in Australia have to be more responsible in their reporting so that such alerts don’t do more harm than good.”

• Declaration as noted by the MJA: Philip Sambrook serves on the medical advisory boards of and has received speaker fees from Amgen, Merck Sharp & Dohme, Novartis, Sanofi-Aventis and Servier.

Croakey writes: This is an interesting study that deserves some thought and consideration by all parties involved – but not only journalists and the media.

The other side of the coin is that often we hear of new medicines being enthusiastically promoted before enough is known about their potential to cause side effects.

It would be interesting to see studies in this area also – to know more about how many people are harmed by the overenthusiastic promotion of medicines.

In either case, however, the lesson is similar. Be cautious about all health claims, especially those creating large headlines…

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