Swine flu pandemic media pundits with pharma links more likely to talk up risks and promote drugs

Contact: Stephanie Burns sburns@bmj.com 44-020-738-36529 BMJ-British Medical Journal

 

Competing interests should be declared — and reported — to maintain credibility of public health, say researchers

Academics with links to the pharmaceutical industry were more likely to talk up the risks of the 2009-10 swine flu pandemic in the media and promote the use of drugs than those without these ties, finds research published online in the Journal of Epidemiology and Community Health

During the 2009-2010 swine flu pandemic, the UK spent an estimated £1 billion on pharmaceuticals, including antiviral drugs (neuraminidase inhibitors) and an H1N1 specific vaccine.  Pharma made £4.5-6.5 billion out of H1N1 vaccines alone.  

Concerns were subsequently raised about the links (competing interests) experts on influential scientific advisory committees, including the WHO’s Emergency Committee, had with drug companies. 

Researchers retrospectively analysed UK newspaper print coverage of the HIN1 swine flu pandemic, to assess the extent of competing interests among sources quoted on the topic between April and July 2009—the period when major decisions were being made about how best to respond to the emerging threat. 

Daily, Sunday, tabloid, middle market, and broadsheet publications on both sides of the political spectrum were included, to reflect a range of perspectives and reporting styles. Broadcast media were excluded on the grounds that print media offered more in-depth analysis and more divergent viewpoints. 

The final sample of 425 articles was scrutinised for the sources quoted, the assessment of the risk to the population made by each source, and the promotion or rejection of drugs/vaccines. 

Competing interests for each named academic quoted were then unearthed, using conflict of interest statements, funding sources detailed on profile pages, Google searches, and funding declarations on all publications in the previous four years. 

Grants, honoraria, speakers’ fees, consultancies, advisory roles, employment, and directorship/stock ownership were all considered competing interests. 

The analysis showed that during the study period, health ministers were the most frequently quoted source (34%) in media articles on swine flu, followed by academics (30%). Sixty one academics were quoted, 18 (30%) of whom had competing interests. 

The academics made 74 risk assessments, over half of which (44; 59.5%) were higher than those made by official agencies, such as the Department of Health, in the same article.  

Of these, 35 were made by academics with competing interests, meaning that risk assessments from these academics were almost six times as likely to be higher than those from official agencies, compared with risk assessments made by academics without any industry links. 

Twenty academics commented specifically on drugs/vaccines in 36 articles (8.5% of the total). Half of them had competing interests—a higher proportion than the one in three on the WHO’s Emergency Committee. 

Half of the commentators promoted the use of antiviral drugs and around half (45%) promoted the use of a vaccine. Some 15% promoted both. 

Academics promoting the use of antiviral drugs in newspaper articles were eight times more likely to have pharma industry links than those not commenting on their use.  

Only three articles out of the 425 mentioned that the quoted academic had a potential competing interest. 

The researchers acknowledge that the interviews may have contained more nuanced views than appeared in print, and that journalists may have sought divergent views to balance a story or increase its newsworthiness.

But academics are a trusted and accessible source of comment for journalists and are in a unique and powerful position during emerging public health threats, they say.

“Our results provide some evidence that the provision of higher risk assessments and the promotion of [antiviral drugs] are associated with [competing interests] among academics,” they write. 

“These add to the growing body of literature highlighting the potential influence of the pharmaceutical industry on policy decisions through multiple avenues, including advisory committees, drafting of guidelines, and media commentary,” they note.

“Undisclosed [competing interests] degrades public confidence in medical research, to the detriment of the whole scientific community,” they write, concluding: “Academics should declare, and journalists report, relevant [competing interests] for media interviews.”

Commenting on the research, the journal’s joint editors, Martin Bobak and Jim Dunn, add: “This paper clearly shows that ‘scientific advice’ is not necessarily independent and that it is influenced by often undisclosed interests. From an editor’s point of view, this is disturbing, because there are limits as to how far journals can go in establishing authors’ conflicts of interest.”

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[Academics and competing interests in H1N1 influenza media reporting Online First doi 10.1136/jech-2013-203128]

Scientists create hybrid flu that can go airborne : Mixed Genes from H5N1 & H1N1

H5N1 virus with genes from H1N1 can spread through the air between mammals.

02 May 2013

Researchers have crossed two strains of avian flu virus to create one that can be transmitted through the air — and possibly settle on the cilia of lung cells as in this conceptual image.

KARSTEN SCHNEIDER/SCIENCE PHOTO LIBRARY

As the world is transfixed by a new H7N9 bird flu virus spreading through China, a study reminds us that a different avian influenza — H5N1 — still poses a pandemic threat.

A team of scientists in China has created hybrid viruses by mixing genes from H5N1 and the H1N1 strain behind the 2009 swine flu pandemic, and showed that some of the hybrids can spread through the air between guinea pigs. The results are published in Science1.

Flu hybrids can arise naturally when two viral strains infect the same cell and exchange genes. This process, known as reassortment, produced the strains responsible for at least three past flu pandemics, including the one in 2009.

There is no evidence that H5N1 and H1N1 have reassorted naturally yet, but they have many opportunities to do so. The viruses overlap both in their geographical range and in the species they infect, and although H5N1 tends mostly to swap genes in its own lineage, the pandemic H1N1 strain seems to be particularly prone to reassortment.

“If these mammalian-transmissible H5N1 viruses are generated in nature, a pandemic will be highly likely,” says Hualan Chen, a virologist at the Harbin Veterinary Research Institute of the Chinese Academy of Sciences, who led the study.

“It’s remarkable work and clearly shows how the continued circulation of H5N1 strains in Asia and Egypt continues to pose a very real threat for human and animal health,” says Jeremy Farrar, director of the Oxford University Clinical Research Unit in Ho Chi Minh City, Vietnam.

Flu fears

Chen’s results are likely to reignite the controversy that plagued the flu community last year, when two groups found that H5N1 could go airborne if it carried certain mutations in a gene that produced a protein called haemagglutinin (HA)2, 3. Following heated debate over biosecurity issues raised by the work, the flu community instigated a voluntary year-long moratorium on research that would produce further transmissible strains. Chen’s experiments were all finished before the hiatus came into effect, but more work of this nature can be expected now that the moratorium has been lifted.

“I do believe such research is critical to our understanding of influenza,” says Farrar. “But such work, anywhere in the world, needs to be tightly regulated and conducted in the most secure facilities, which are registered and certified to a common international standard.”

Virologists have created H5N1 reassortants before. One study found that H5N1 did not produce transmissible hybrids when it reassorts with a flu strain called H3N24. But in 2011, Stacey Schultz-Cherry, a virologist at St. Jude Children’s Research Hospital in Memphis, Tennessee, showed that pandemic H1N1 becomes more virulent if it carries the HA gene from H5N15.

Chen’s team mixed and matched seven gene segments from H5N1 and H1N1 in every possible combination, to create 127 reassortant viruses, all with H5N1’s HA gene. Some of these hybrids could spread through the air between guinea pigs in adjacent cages, as long as they carried either or both of two genes from H1N1 called PA and NS. Two further genes from H1N1, NA and M, promoted airborne transmission to a lesser extent, and another, the NP gene, did so in combination with PA.

“It’s a very extensive paper,” says Schultz-Cherry. “It really shows that it’s more than just the HA. The other proteins are just as important and can drive transmission.” Chen says that health organisations should monitor wild viruses for the gene combinations that her team identified in the latest study. “If those kinds of reassortants are found, we’d need to pay high attention.”

Knowledge gap

It is unclear how the results apply to humans. Guinea pigs have bird-like receptor proteins in their upper airways in addition to mammalian ones, so reassortant viruses might bind in them more easily than they would in humans.

And scientists do not know whether the hybrid viruses are as deadly as the parent H5N1. The hybrids did not kill any of the guinea pigs they spread to, but Chen says that these rodents are not good models for pathogenicity in humans.

There is also a chance that worldwide exposure that already occurred to the pandemic H1N1 strain might actually mitigate the risk of a future pandemic by providing people with some immunity against reassortants with H5N1. In an earlier study, Chen and her colleagues showed that a vaccine made from pandemic H1N1 provided some protection against H5N1 infections in mice6.

“If you take [antibodies] from people who have been vaccinated or naturally infected, will they cross-react with these viruses?” asks Schultz-Cherry. “That’s an important study that would need to be done.”

Ironically, Chen’s team is now too busy reacting to the emerging threat of a different bird flu — H7N9. Research on H5N1 will have to wait.

Journal name:
Nature
DOI:
doi:10.1038/nature.2013.12925
http://www.nature.com/news/scientists-create-hybrid-flu-that-can-go-airborne-1.12925

66th Health Research Report 29 SEP 2009 – Reconstruction

 Editors Top Five:

1. Zero tolerance, zero effect

2. New vitamin K analysis supports the triage theory

3. Study reveals 2/3 of prostate cancer patients do not need treatment

4. Gut worms may protect against house-dust mite allergy

5. Medical ethics experts identify, address key issues in H1N1 pandemic

In this Issue:

1. Scientists cure color blindness in monkeys

2. Rich people don’t need friends

3. New evidence that green tea may help improve bone health

4. Zero tolerance, zero effect

5. Chemobrain – the flip side of surviving cancer

6. New vitamin K analysis supports the triage theory

7. ANTIOXIDANT CONTROLS SPINAL CORD DEVELOPMENT

8. Scientists find that individuals in vegetative states can learn

9. Early results: In children, 2009 H1N1 influenza vaccine works like seasonal flu vaccine

10. Insufficient levels of vitamin D puts elderly at increased risk of dying from heart disease

11. New research provides new insight into age-related muscle decline

12. Medical ethics experts identify, address key issues in H1N1 pandemic

13. Study reveals 2/3 of prostate cancer patients do not need treatment

14. Heparin can cause skin lesions

15. Gut worms may protect against house-dust mite allergy

16. Most would refuse emergency use H1N1 vaccine or additive

17. Young Adults May Outgrow Bipolar Disorder

Health Research Report

66th  Issue Date 29 SEP 2009

Compiled By Ralph Turchiano

www.healthresearchreport.me www.vit.bz

www.youtube.com/vhfilm www.facebook.com/engineeringevil

www.engineeringevil.com

H1N1 Pandemic Virus Does Not Mutate Into ‘Superbug’ in UMd. Lab Study

2009 study posted for filing

 

COLLEGE PARK, Md. – A laboratory study by University of Maryland researchers suggests that some of the worst fears about a virulent H1N1 pandemic flu season may not be realized this year, but does demonstrate the heightened communicability of the virus.

 

Using ferrets exposed to three different viruses, the Maryland researchers found no evidence that the H1N1 pandemic variety, responsible for the so-called swine flu, combines in a lab setting with other flu strains to form a more virulent ‘superbug.’ Rather, the pandemic virus prevailed and out-competed the other strains, reproducing in the ferrets, on average, twice as much.

 

The researchers believe their study is the first to examine how the pandemic virus interacts with other flu viruses. The findings are newly published in an online scientific journal designed to fast-track science research and quickly share results with other investigators, PLOS Currents.

 

“The H1N1 pandemic virus has a clear biological advantage over the two main seasonal flu strains and all the makings of a virus fully adapted to humans,” says virologist Daniel Perez, the lead researcher and program director of the University of Maryland-based Prevention and Control of Avian Influenza Coordinated Agricultural Project.

 

“I’m not surprised to find that the pandemic virus is more infectious, simply because it’s new, so hosts haven’t had a chance to build immunity yet. Meanwhile, the older strains encounter resistance from hosts’ immunity to them,” Perez adds.

 

Some of the animals who were infected with both the new virus and one of the more familiar seasonal viruses (H3N2) developed not only respiratory symptoms, but intestinal illness as well. Perez and his team call for additional research to see whether this kind of co-infection and multiple symptoms may account for some of the deaths attributed to the new virus.

 

Among other research findings, the pandemic virus successfully established infections deeper in the ferret’s respiratory system, including the lungs. The H1 and H3 seasonal viruses remained in the nasal passages.

 

“Our findings underscore the need for vaccinating against the pandemic flu virus this season,” Perez concludes. “The findings of this study are preliminary, but the far greater communicability of the pandemic virus serves as a clearly blinking warning light.”

 

Perez and his team used samples of the H1N1 pandemic variety from last April’s initial outbreak of the so-called swine flu.

 

The research is funded by the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health.

Swine flu vaccine linked to child narcolepsy: EU Confirmation

By Agence France-Presse Saturday, September 22, 2012 1:15 EDT

vaccine.istock

A swine flu vaccine used in 2009-10 is linked to a higher risk of the sleeping disorder narcolepsy in children and teens in Sweden and Finland, the European Centre for Disease Prevention and Control said Friday.

The EU agency studied the effects of the Pandemrix vaccine on children in eight European countries after Sweden and Finland reported higher incidences of narcolepsy among children who were inoculated with the vaccine during the swine flu pandemic in 2009 and 2010.

“The case-control study found an association between vaccination with Pandemrix and an increased risk of narcolepsy in children and adolescents (five to 19 years of age) in Sweden and Finland,” the ECDC said.

“The overall number of new cases of narcolepsy being reported after September 2009 was much higher in Sweden and Finland … compared with the other countries participating in the study,” it said.

In the six other countries — Britain, Denmark, France, Italy, The Netherlands and Norway — no link was found based on a strict statistical analysis, which tried to address media bias.

However, other confirmatory analyses did identify an increased risk, the report said.

The report included several recommendations for further study to try to distinguish between true vaccine effects and media attention.

An ECDC spokesman said that while the study did not quantify the increased risk compared with non-vaccination, national studies showed the risk of developing narcolepsy after taking Pandemrix, which is produced by British drug company GlaxoSmithKline, was around one in 20,000 for children and adolescents.

Narcolepsy is a chronic nervous system disorder that causes excessive drowsiness, often causing people to fall asleep uncontrollably, and in more severe cases to suffer hallucinations or paralysing physical collapses called cataplexy.

In Finland, 79 children aged four to 19 developed narcolepsy after receiving the Pandemrix vaccine in 2009 and 2010, while in Sweden the number was close to 200, according to figures in the two countries.

Both countries recommended their populations, of around five and 10 million respectively, to take part in mass vaccinations during the swine flu scare. Pandemrix was the only vaccine used in both countries.

Meanwhile, a recent study in the medical journal The Lancet said that between five and 17 people in Finland aged 0-17 are estimated to have died as a direct result of the 2009-10 swine flu pandemic, while the same number for Sweden was nine to 31.

In the past year, the Finnish and Swedish governments have both agreed to provide financial compensation for the affected children after their own national research showed a link between the inoculation and narcolepsy

Researchers Map Molecular Details That Encourage H1N1 Transmission To Humans

The 2009 H1N1 pandemic influenza virus appears to have required certain mutations in order to be transmitted to humans, according to a paper in the September Journal of Virology. The research could prove extremely valuable for efforts to predict human outbreaks.

The 2009 influenza pandemic was caused by a swine influenza virus that mutated in a way that made it transmissible among humans. The researchers, led by Hualan Chen of the Harbin Veterinary Research Institute, Harbin, China, have determined the probable details of the mutations that led to human transmission.

In this study, Chen, who is director of the National Avian Influenza Reference Laboratory at the Institute, and her collaborators have shown that two specific mutations in each of two proteins appear to be critical to transmission to, and among humans. One of those mutations, of a single amino acid in the virus’ hemagglutinin protein, gives the virus the ability to bind to human receptors, and enables transmission in mammals via droplets of respiratory fluids.

That amino acid, in the 226th slot in the protein, is glutamine. The researchers showed its importance by causing a mutation from glutamine, the amino acid in that position seen in viruses from infected humans, to argenine, as seen in swine. Working in cell cultures, the researchers showed that the switch dampened the virus’ ability to bind the human receptor, while boosting its ability to bind to the avian receptor. They showed further that the change rendered the virus non-transmissible via respiratory droplets in guinea pig models, and unable to replicate in the lungs of ferrets—results that suggest, but do not prove that the same may happen in humans.

Also in guinea pigs, changing an amino acid in the virus’ PB2 protein abolished transmission in guinea pigs via respiratory droplets, while that change, plus another single amino acid change in the hemagglutinin protein, killed such transmission in ferrets.

It gets still more convoluted. The same amino acid in the PB2 protein that enables virus transmission via respiratory droplets, which is located at position 271 in that protein, can also encourage the afore-mentioned mutation in hemagglutinin position 226 to glutamine, which enables the virus to cleave to the human receptor.

The value of all this information, says Chen, is that it provides a means for predicting outbreaks of human-transmissible H1N1.

(Y. Zhang, Q. Zhang, Y. Gao, X. He, H. Kong, Y. Jiang, Y. Guan, X. Xia, Y. Shu, Y. Kawaoka, Z. Bu, and H. Chen, 2012. Key molecular factors in hemagglutinin and PB2 contribute to efficient transmission of the 2009 H1N1 pandemic influenza virus. J. Virol. 86:9666-9674.)

Download a copy of the article at http://bit.ly/asmtip0912b

Adjuvanted flu vaccine associated with child narcolepsy in Finland

A sudden increase in narcolepsy in Finnish children at the beginning of 2010 was likely related to the Pandemrix vaccine used in response to the H1N1 2009 flu pandemic, according to two reports published Mar. 28 in the open access journal PLoS ONE.

The authors of the studies, led by Markku Partinen of the Helsinki Sleep Clinic and Hanna Nohynek of the National Institute for Health and Welfare in Finland, found that the average annual incidence of narcolepsy between 2002 and 2009 among children younger than 17 was 0.31 per 100,000, and in 2010, this incidence was about 17 times higher, at 5.3 cases per 100,000. In contrast, the incidence rate for adults over 20 was essentially unchanged over that same time period.

To further evaluate the potential connection between the vaccine and narcolepsy, the researchers collected vaccination and childhood narcolepsy data for children born between January 1991 and December 2005.

They found that the narcolepsy incidence for vaccinated individuals within this age group was 9.0 per 100,000 people, as compared to just 0.7 per 100,000 for unvaccinated individuals – almost 13 times lower.

Together, these results provide compelling evidence that the Pandemrix vaccine, used in 2009 and 2010 in association with the H1N1 flu pandemic, contributed to narcolepsy in patients between the age of 4 and 19 in Finland, the authors conclude.