You Choose: Vioxx vs Rofecoxib

A new paper in tomorrow’s Journal of the American Medical Association suggests many medical-news writers don’t do a good job. For all I know, that may be true (although I doubt it). But I think it’s fair to say the new JAMA paper offers scant evidence to establish the value of its critique.

The paper’s authors did a nice job of running down a lot of news stories and evaluating several elements in each. But the value of the issues they chose to focus on isn’t as cut and dried as whether a reporter spelled someone’s name incorrectly or reported a drug as triggering the wrong disease. They judged stories on the basis of such things as how often reporters used the generic name for a drug or identified whether a study had been financed by a medicine’s manufacturer.

These can be interesting elements of a story, to be sure. But there will be times when these facts won’t be all that germane to a story’s quality. And the fact that the authors don’t seem to realize this reflects, I think, a misunderstanding of our craft: journalism.

Although they don’t explicitly say this, the new report’s authors appear to view reporters as middlemen (and women) who should be telling the public what the researchers would — if they knew how to communicate effectively. And to be sure, that is part of what we do.

Our primary job, however, is to tell our audience what it may need to know or would appreciate knowing. And that might include telling our audience what the researchers wish we wouldn’t (because it embarrasses them, highlights the work of competitors, or even dares to quote people who challenge the importance of the initial team’s work). Good journalists will do this accurately. They’ll also guide their audience in wading through a story’s ideas and findings through the use of colorful language, transitions, and maybe a useful metaphor. (After all, reading a news story should not feel like work.)

So let’s get to the new JAMA study. In it, Michael Hochman of CambridgeHospital (in suburban Boston) and his colleagues turned up 306 new stories that had covered industry-funded drug-safety or -efficacy trials. All of the stories had appeared in major newspapers or online media over the four-year period ending April 30, 2008. Forty-two percent of the stories did not identify that a drug company had a financial tie to the reported study. And of the 277 stories involving a drug for which a generic version was available, 67 percent of the news stories referred to the drug by its brand name most of the time.

Those are interesting stats. But hardly damning.

In this blog, let’s consider the easier issue (at least for me): How should we refer to a drug? (Tomorrow I’ll return to the ideas in this paper and take up the issue of what to do with information about a drug company’s tie to a study.)

I’d argue — and the editors at Science News agree — that both generic and brand names for a drug should be included in most stories. However, which name we use most often will depend on which is most likely to resonate or be accessible to our readers.

Take Vioxx, Viagra and Avandia. All have become household names. But what about rofecoxib, sildenafil citrate and rosiglitazone maleate? Do you know which is the generic version of the brand-name drugs listed at the top of the paragraph?

Reporters know that it does no good to use a name that readers or listeners don’t identify with and/or likely can’t remember: like sibutramine hydrochloride monohydrate. That’s the 12-syllable version of Meridia, the anti-obesity drug that’s been promoted in TV commercials.

Consider also who gets prescribed the most meds? It’s usually the elderly. And I can tell you there’s no way my 90-year-old mother-in-law can remember amlodipine besylate. She’d trip over trying to just read it, let alone commit it to memory. But she can tell you that she’s been taking this Norvasc (its commercial name) for years.

Hochman’s group argues that the public should learn the name of a medicine’s active ingredient and call it by that name — rather than reinforcing the brand name, which may benefit the marketing for a pharmaceutical company. Moreover, this team correctly points out that when patients know a drug by its generic name they’re more likely to recognize when a doctor or pharmacy incorrectly offers them a prescription for the wrong medicine.

But there’s a problem with this lofty goal. Drug companies come up with ungainly generic names that few of us have any hope of remembering. And manufacturers recognize this, which is why they tend to brand their products with memorable monikers — like Vioxx.

Exceptions will turn up where, in the best interests of clarity, it makes sense to refer to a drug primarily by its generic name. One example that comes to mind: Sometimes a generic drug — or its naked active ingredient — doesn’t perform comparably to the name brand’s formulation. Supposedly inert binders, colorants and coatings in a drug may affect how quickly its ingredients break down or become absorbed, for example, or whether they trigger some side effect in sensitive individuals. Here, a responsible story would typically refer to the generic-named ingredient — except when referring to distinct attributes associated with the brand name formulation.

As our editor Tom Siegfried put it today, “the most important thing is to communicate information effectively.” And if that means referring to a drug as Vioxx on most references, instead of rofecoxib (how do you even pronounce that?), so be it.