Health and Medicine Guide: Tips on Traps, Hype & Ethics

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 it as of November 2024.

Although in parts of the world investigating pharmaceuticals can be physically dangerous, in others you risk your reputation rather than your life. Drug companies often hire effective and persistent public relations managers, some of them former journalists. Much less often, lawyers will be involved. They might send aggressive letters threatening legal action, for example.

Putting your editor and publisher under pressure is common practice, as this leads to delay while editors carry out further checks, often prompting you to provide additional evidence. In our experience, this exercise can be extremely time and energy consuming. What helps is being disciplined in archiving correspondence and making sure all communication with the companies is in written form. Scientists who are willing to speak out, however, can pay a high price, as this example shows: GlaxoSmithKline Tried to Silence the Scientist Who Exposed the Dangers of its Drug Avandia. The story highlights severe dysfunctions in drug regulation, exemplified by the company’s alleged efforts to silence the scientist who first revealed a higher heart disease risk. A later meta-analysis showed a 43% increased risk among diabetics taking Avandia. The FDA implemented a “black box” warning, and there were over 50,000 lawsuits from patients affected by its side effects. As this article on pharmaceutical drug recalls noted: “The drug was removed from the European market in September 2010, based on cardiovascular risks, and remains banned to this day.”

When reporting about alleged victims of a drug, you need to pay special attention to the language you use and make sure you seek comment from the company before publication — which is standard practice, of course. Media coverage and new or additional warnings on a drug’s label are known to affect sales, so companies will go to great lengths and expense to try and minimize the potential damage.

Also, Key Opinion Leaders can be especially persistent. Their reputation is also at stake. Many of them don’t see a problem in their close relationship to the industry; they can get aggressive and even sue media outlets and reporters if their name is associated with victims or malpractice.

Don’t expect a person representing the pharmaceutical industry to be forthcoming in a recorded or filmed interview. These are professionals who are well-trained in dealing with the media. Drug companies may avoid interview requests or instead offer their public relations officers to speak on the record.

Finding a whistleblower in the relevant medical or scientific community or within the industry rarely happens but can be extremely helpful. One example is the exemplary investigation into generic drugs by Katherine Eban that took many years to complete. Her book, “The Bottle of Lies,” shows how Eban also collected a huge amount of data and documents during her investigation.

Beware of Oversimplification

You should always be skeptical about information conveyed by the industry or relayed by governments. Take the time to independently assess the evidence, cross-checking the information and bearing in mind that conflicts of interest and complex agendas are ubiquitous in the field of healthcare. A gimmick often put forward by governments, nonprofits, and the industry is to compare countries in healthcare policy or epidemiological features. Either to “prove” that a specific country is “lagging behind” or on the contrary, to stress that one country knows it better. However, comparing countries is a tricky exercise, one prone to be nullified by confounding factors. Furthermore, when used as a PR or propaganda tool, comparisons are usually misleading, as they oversimplify a complex reality.

This was notably the case for Sweden during the COVID-19 crisis. The Nordic country didn’t implement measures such as lockdowns, school closures or mandatory wearing of face masks. Sweden faced intense scrutiny by worldwide media, overnight-experts, and by other governments. But did not change course and has thus unwittingly become the unexpected control group for COVID-19 response.

Fast forward to 2024, Sweden has shown what many prestigious researchers were warning against in March 2020: the effects of untested restrictive measures imposed in most countries – for which, the evidence of efficacy was notoriously lacking, as they had never been implemented before – were numerous and concerning. At the end of the day, Sweden is the country with the lowest post-pandemic excess mortality rate in the world.

For more details, there’s plenty of scientific literature like this NIH paper and the links in this Johan Anderberg opinion piece.

For our work as investigative journalists in the field of health and medicine, the take-home Swedish lesson is: don’t dismiss public health debates, and beware of oversimplification.

Beware of Social Media Labels about Health Claims

In their early days, social networks were seen as spaces of expression and freedom. They were chaotic, often narcissistic, but exchanges could take place freely. The situation has dramatically changed in recent years. Today, you should be aware that social networks are under powerful influence and governed by algorithms, large language models and other derivatives of artificial intelligence. They can “launch” stories instantaneously, or on the contrary shadowban accounts or censor them by arguing that even accurate facts are “disinformation” or “misinformation.”

During the COVID era, governments and politicians worldwide intensified their attempts to influence social media companies.

According to this peer-reviewed study, published in the quarterly academic journal Minerva, accomplished doctors and research scientists globally found themselves being suppressed or censored if they challenged the official views.

Also in the US there were reports of the Biden and Trump administrations attempting to influence social media. The Atlantic contributor David Zweig reviewed how a collection of internal Twitter documents and communications pertained to suppressing posts challenging COVID-19 policies.

A June 2024 court decision lifted an injunction restricting communication between social media companies and government officials. As a result, agencies like the FBI can now alert platforms to posts and accounts they consider threats to national security.

For the journalists covering health and medicine, these developments also mean that we need to be extra careful when using social media as a source, and be skeptical of any message they might convey.

How Whistleblowers Can Help 

Sometimes honest public servants will help you if your methods are solid. Read the GIJN guide on working with whistleblowers and make sure you protect the identity of your confidential sources.

Beside regulators, in every country there are public health authorities involved in health care. Don’t forget to investigate their conflicts of interest. They also produce extensive documentation about health interventions and assess risks, benefits, and economics. Their work is a trove of hints and facts. However, it is important to keep in mind that they are routinely under pressure by commercial entities with an interest in their decisions.

Build your own network of people whose knowledge you trust. Look for them among specialists that are strong in Evidence-Based Medicine and free of conflicts of interest with the industry and the regulators. Often emeritus professors, especially if they have strong skills in biostatistics, or in the specific field of medicine or science you need for your investigation, are very informative; they have reached the prime of their career, are not worried about how to fund their research, nor are they generally concerned with raising their profile. Make sure to do in-depth research on the background of any expert you turn to for advice, as you need to be sure you can trust her or him. Read two GIJN features on collaborating with doctors and on turning them into muckrakers.

Medical and scientific conferences can be useful for your work as well. They are crammed with advertising and pharma representatives. Also, participants don’t expect independent-minded journalists to join such events, so they can be pretty open to informal chats. Because medical societies’ conferences are routinely sponsored by industry, and often the program itself provides valuable hints on where the manufacturers are going with a class of drugs. When a rather rare or mild condition is suddenly presented as a major public health concern, that could be a red flag. Such a strategy could signal the imminent launch of a new product or a shift in marketing strategy. When joining medical conferences, look for “satellite symposia” presented by drug companies. These may be promotional events presented as scientific sessions.

Make sure you don’t accept gifts or other benefits as you will have a conflict of interest which could jeopardize your credibility. Getting too close to doctors and scientists is also a bad idea. It may seem insensitive, but make sure to question the victims’ agendas, too. Get to the bottom of their medical histories. As we have seen in the first chapter, a few thousand people or so will have tested a medical product in a controlled environment before it goes to market and ask searching questions.

Some of the bigger risks in investigating this area include getting the evidence wrong, relying on an expert who is conflicted or incompetent, and becoming a victim of the exaggerated claims made in medicine. Red flags here are keywords like “personalized medicine,” “breakthrough,” “big data,” “life-saving drugs,” “hope,” “revolutionary treatment.”

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.