Health and Medicine Guide: Behind-The-Scenes Reporting Strategies

Editor’s Note: This guide to reporting on health and medicine issues was originally published in November 2020, during the height of the COVID-19 pandemic. Original authors Serena Tinari and Catherine Riva have updated the guide as of November 2024 and included this new chapter.

If you follow in-depth journalism on health and medicine, and the biomedical literature, you are well aware that scandals are frequent in the healthcare sector. Corruption, bad science, spurious policies with little basis in evidence, are all too common. In short, this means that journalists need to acknowledge that just because a medical intervention is being promoted and endorsed, it cannot be de facto assumed that it is appropriate. Investigating this field means taking into account that the approval and recommendation of drugs, vaccines, medical devices, surgical procedures, diagnostic tests, and preventive measures are influenced by agendas that rarely converge with just patients’ needs.

However, journalists also have a responsibility to be wary of sources or alleged whistleblowers with a clear partisan or polarized agenda. One thing is clear: a maze of actors and financial interests play a key role in this field and their interests are not always in the public interest.

Developments in the healthcare sector touted as “groundbreaking” often share a common denominator: an intervention was presented as beneficial and safe, when in reality its benefit/risk ratio was uncertain, modest or even negative. In each instance, the practice of spin – i.e. the distortion or misrepresentation of research results – was involved.

The industry interest in influencing medical prescriptions is undisputed. As it is neatly put by the authors of Mapping conflict of interests: scoping review, published in 2021: “Although these for-profit entities play a crucial role in the ecosystem, particularly in developing new tests and treatments, their primary objective is to ensure financial returns to shareholders.”

One fruitful method to avoid getting lost in this complexity is combining the principles of Evidence-Based Medicine (EBM) and investigative journalism with the analytical framework of “ghost management.” Academic Marc-André Gagnon has broken down these behind-the-scenes operations into seven types of “capture” that have an impact on policies and practices. They constitute a valuable toolbox for investigative journalists, as they highlight many layers of the influence system and simplify our task of identifying actors and strategies acting in the shadow.

Illustration: Re-Check.ch / Aleksandra Roth-Belkova

Here is a summary of what the seven types of capture usually entail:

• Scientific capture: influencing the production of knowledge;
• Professional capture: influencing the practices of healthcare professionals;
• Technological capture: influencing technological development, in particular through market exclusivities, merges, patents;
• Regulatory capture: influencing laws and regulation;
• Market capture: developing market power, limiting competition;
• Media capture: influencing journalists and their reporting;
• Civil society capture: influencing non-profit organizations, foundations, trade unions, patient organizations or other civil society groups.

This scoping review by Marc-André Gagnon and Miaoran Dong provides dozens of concrete examples of how these seven different capture effects occur in the real world. The sources of this analysis are peer-reviewed journal articles based on pharmaceutical corporations’ internal documents – mostly obtained through court litigations.

Identify Recurring Patterns: Use a Checklist

Comprehensive investigations in the field of health and medicine start with the question: Who benefits? Why is this person or institution promoting this medical intervention? Are they acting benevolently and with full knowledge of the subject? Beside the so-called key opinion leaders (KOLs) featured in this chapter of the guide, there are many more agents you want to thoroughly examine. From scientists to legislators, university medical centers to regulators, without forgetting academic societies, patients’ organizations and public health authorities.

Recurring phenomena you want to pay attention to, include astroturfing, lobbying efforts, and ghostwriting. The system is also chronically affected by revolving doors, i.e. a public servant swiftly going from working with a health or medical regulatory authority to being a pharmaceutical company employee. There is a large body of literature on the topic, see for instance FDA’s revolving door: Companies often hire agency staffers who managed their successful drug reviews, The Revolving Door In Health Care Regulation, and The FDA and Moderna’s cozy relationship: how lax rules enable a revolving door culture.

In these guidelines published within the ghost management research project, you’ll find a checklist of many agents you shall include in your in-depth research efforts.

Spot the Hidden Agents At Work

There are also cases where the most influential agent is hidden. For instance, a relatively common practice is to refer to a disease without mentioning the treatment; it’s a smart way to build momentum that will help by the launch of a new drug or vaccine. Featuring “unmet medical needs” is also strategically used to lay the ground for putting pressure on regulators and legislators. Fearmongering, thus creating a state of alert and fear about diseases or conditions, tends to benefit corporate interests.

Traditional media outlets and reporters who don’t routinely cover the medical or pharmaceutical industry are often used to promote the desired message. This more generic news coverage is very often based on observational studies, expert opinions, and various statements by decision-makers, NGOs, or patient organizations. Non-specialist journalists are easy prey for anyone wishing to gain influence over the content of their stories. Get skeptical and dig deeper when various outlets present without any critical scrutiny very similar messages of alarm, or of hope and celebration of medical progress. You might find out that behind those lines there is a company press release, a campaign being run by a public relations or a government agency, or that key opinion leaders are at work.

One of our investigations showed how extensively the call for systematic mammography screening for breast cancer captivated Swiss parliamentarians, who fought for the procedure to be reimbursed by the healthcare system 13 different times, despite the dubious benefit/risk ratio of the procedure proven in several metanalyses. These lawmakers had been approached by representatives of the systematic mammography breast cancer screening advocacy movement, who in some cases even provided them with ready-made drafts for a parliamentary inquiry, which they were then encouraged to submit. At the same time, the advocacy movement enlisted the support of the media and launched a campaign to pressure politicians, without ever mentioning the questionable benefits and notable risks. Instead of focusing on the evidence, which would have shown the intervention was unlikely to produce the desired outcomes, emotional messages were deployed, urging people to “finally do something to protect women.” It resonated with women in politics and offered mainstream news outlets a good reporting angle. This investigation received an award from the Swiss Academy for Medical Sciences.

Map Your Findings 

In the framework we suggest — which combines the tools and standards of Evidence-based Medicine (EBM), investigative journalism, and ghost management — you’ll inevitably end up collecting a large amount of information and data. To connect the dots, nothing helps like populating a map with your investigative results. On the one hand, it will give you an overview of your findings. On the other hand, it might help you spot errors, highlight an association you hadn’t identified while researching, and suggest new paths to dig deeper and verify your working hypothesis.

Serena Tinari is a co-founder of Re-Check.ch, a Swiss nonprofit organization dedicated to investigating and mapping health affairs. She as been working across print and electronic media, radio, and television since 1994. She authored dozens of investigative stories for the Swiss public broadcaster. Tinari specializes in drug safety, Evidence-Based Medicine and conflicts of interest. A trainer, speaker, and moderator, she has reported extensively on swine flu and Tamiflu.

Catherine Riva is a co-founder of Re-Check.ch, a Swiss nonprofit organization dedicated to investigating and mapping health affairs. She specializes in the design and methodology of clinical trial, public health, and Evidence-Based Medicine. A trainer and a speaker, Riva has reported on the Mediator case, breast cancer screening programs, the controversies related to HPV vaccination, and on conflicts of interest in healthcare and medical research. She has also published in biomedical journals.