February 2002
Newspapers Feature a Few Victims, Ignore Many Beneficiaries in Cisapride Story
by Lydia Miljan
Prescription drugs can prove risky, as well as highly beneficial. They relieve pain, alleviate symptoms, increase life expectancy, and improve quality of life. However, despite their various benefits, prescription drugs can also have side effects, which in extreme instances can cause serious medical complications—and even death.
The use, abuse, and risks associated with prescription drugs are not typical fodder for the news media. Not only is the topic too complicated to survive the headline news format offered by television, but neither does it often make for the sensational headlines we've come to expect of newspapers. Listing the possible side effects of each drug we take is often saved for the small print in the informational insert that accompanies the drug. More important, listing the many thousands of people who benefit from any particular drug is neither new nor urgent. The story that does make headlines is of someone succumbing to a drug's side effects. The difference between the former and the latter story type is that the latter serves the traditional needs of journalism: a tragic plot line combined with a recognized victim. That was certainly the format of the news coverage of the drug cisapride (Prepulsid™) in the fall of 2000 and the spring of 2001.
Serious side effects highlighted
Cisapride gained prominent national attention in March 2001 when an inquiry was launched after 15-year-old Vanessa Young died suddenly of heart failure. Young had been taking a heartburn drug that was prescribed widely in Canada. The inquiry set out to determine whether this drug, which had been the subject of public warnings in the United States but not Canada, was to blame for her sudden heart failure. Young also happened to be the daughter of a former prominent Ontario MPP. The National Post wrote five stories on the subject: the Globe six. The story also made the Victoria Times Colonist, both Vancouver dailies, the Calgary Herald, the Edmonton Journal, the Lethbridge Herald, the Winnipeg Free Press, the Ottawa Citizen, the Montreal Gazette and the St. John's Telegram. It did not appear on either national nightly television news program on CBC or CTV.
What is interesting about the cisapride story and the Vanessa Young incident is that the media framed the story as a negligence case. In the media it was argued that the government, the doctors, or the pharmaceutical industry failed Vanessa Young and her family. The coverage rarely examined the drug's possible benefits, despite the fact that according to media reports, Cisapride prescriptions were filled over 1 million times each year.
Vanessa Young was featured in 32 of the 41 stories on cisapride. The stories that did not mention Young still mentioned other cisapride users who suffered heart attacks or irregular heartbeats after taking the drug. Jane Goobie, for example, had been taking Prepulsid™ for a year when she had abnormal heart rhythms. She was quoted in the St. John's Telegram saying, "To me, what's frightening is you put your faith in a pharmaceutical company. You trust your doctor" (July 12, 2002, p. A1).
While the newspaper accounts featured Vanessa Young and others who suffered serious side effects after taking cisapride, they also noted that thousands of other people in Canada and the United States die from adverse drug reactions. For example, in a story printed in the St. John's Telegram, the Ottawa Citizen, Vancouver Sun, and the Edmonton Journal, Philip Lee reported on a study by University of Toronto researchers who "estimated that 100,000 people a year die from adverse drug reactions in the US, which would make prescription drugs the fourth leading cause of death in that country." Lee went further to provide estimates for Canada: "Although no comparable study has been done in Canada, it is estimated that adverse drug reactions in Canada may cause as many as 10,000 deaths a year." Interestingly, Lee provides no citation of his estimates of adverse drug reactions in Canada. In fact, according to Statistics Canada, there were 1,197 deaths attributed to accidental or purposeful poisioning by drugs in 1997. Moreover, the total reports of adverse drug reactions were 7,361 in 2000 (see Cynthia Ramsay's article, "Overkill: The Regulation of Natural Health Products in Canada," next in this issue), significantly less than Lee's estimates for drug-related deaths. In addition to the lives lost, the article provided estimates that "prescription drug misuse—which includes both adverse drug reactions and medication errors—costs the American economy $177 billion US a year and that 218,000 people died in the US last year from such abuse." Despite the story's grim estimates, no similar estimates were offered to provide balance in the report, such as the number of people who benefit from pharmaceuticals in terms of quality of life, productivity, and longevity.
Drug benefits acknowledged
Krista Foss's focus report in the Globe and Mail on Saturday, October 14, 2000 offered a better context and a fuller picture of the prescription drug story. Vanessa Young was still featured in the story, but Foss added evidence indicating that Vanessa Young had other health problems that had precipitated her need to take the drug. In addition, while Foss also referred to the aforementioned University of Toronto study, she described it as "controversial," which Philip Lee had not.
Foss also correctly pointed out that part of the challenge with prescription drugs is that the public demands them, and often takes more than one type at a time: "Let's start with the obvious: We love our drugs. Last year, we popped, injected and applied $8.3 billion worth, 11 percent more than the previous year" (p. A13). Despite acknowledging the benefits of and demands for pharmaceutical drugs, Foss still gave first person accounts only of adverse drug effects. Indeed, none of the cisapride stories explained the benefits of the drug for the thousands of people who do not have adverse side effects.
Solutions emphasize government regulation
Given the emphasis on alleged wrong-doing by the drug's manufacturer, by Health Canada, and by doctors and pharmacists, the predictable happened: the jury's recommendation for increased regulation on adverse drug side-effects was widely reported. Specifically, the jury recommended: "It should be mandatory for all health-care professionals to alert Health Canada to all serious adverse drug effects within 48 hours. 'Evidence was presented that voluntary reporting of adverse drug reactions was inadequate.'" This recommendation and other similar ones for increased regulation were reported in all the newspapers we examined
While no one can disagree that the public needs to be informed about prescription drug side effects, the fact remains that media coverage only focuses on prescription drugs when there is a spectacular case involving them. In fact, cisapride's manufacturer, Janssen- Ortho Inc., wrote letters to Canadian doctors and pharmacists as early as 1995, warning them of the risk of heart irregularities caused by the drug (Arnott, 2001). Those letters were not given the same coverage as the adverse side effect. Only after the drug was taken off the market was the public given the bad news about it. The good news and the benefits of the drug were left out.
Reference
Arnott, Wendy (2001). "Cisapride and the Vanessa Young Inquest." Letter to the editor. Canadian Medical Association Journal 165, 4 (August 21): 395.
Lydia Miljan (lydiam@fraserinstitute.ca) received her Ph.D. in Political Science from the University of Calgary. She is a Senior Research Fellow of The Fraser Institute and Assistant Professor of Politial Science at the University of Windsor.
info@fraserinstitute.ca
4th Floor, 1770 Burrard Street, Vancouver, BC, Canada, V6J 3G7
Tel: (604) 688-0221 Fax: (604) 688-8539 Book Orders: 1-800-665-3558 ext. 580
You can contact us at the above email address for any comments or information requests. Please report any dead links or technical problems.