The dark side of The Star’s Gardasil episode: when doctors and regulators are painted as the enemy

loh bwLawrence Loh is an adjunct professor in the Division of Clinical Public Health at the Dalla Lana School of Public Health, University of Toronto

Author's note: The views expressed in the following post are the author's own.

My first job as a public health physician after my residency training was in vaccine safety at the Public Health Agency of Canada. I learned all about the systems that are used to conduct post-marketing surveillance to continuously monitor vaccine safety and protect the health of Canadians. While reviewing different reports of adverse events, I personally observed the rigorous attention that each serious report received to determine whether, based on seemingly interminable criteria and safeguards, the vaccine given could have even remotely caused the outcome of concern.

This was a great experience for a young public health physician, and in my parallel work as a practicing front-line family doctor, I was reassured that the everyday vaccines I gave were safe. One project I worked on gave me the honour of presenting preliminary safety data on quadrivalent human papillomavirus (qHPV) vaccine at the 2013 American Public Health Association meeting.

Cue the February 2015 Toronto Star exposé on qHPV (pulled down from their website), which misused and misreported data from the very database with which I had worked. Although I was empathetic to the unfortunate patient stories described in the article, I quickly agreed with other articles that explained where The Star had gotten the science wrong. But it didn’t end there. I started to wonder about a deeper motive behind The Star’s publication.

I started with their official editorial statement: “This story is about transparency […] concerning a vaccine that is given to hundreds of thousands of Canadian girls.”

So it’s just about transparency, right? Not so fast. There was more. The original piece declared “As [patients] struggled to learn what ailed them... [believing] that Gardasil played a role, doctors dismissed their concerns.”

Heather Mallick’s now infamous response, written to defend the original piece, made further accusations.

“We live in a country of silence and official secrecy, where institutions from governments to medical colleges are obliged to reveal almost nothing about spending, competence and safety ... parents and girls are not always being told what they need to know.”

The underlying motivation could be seen in the social media engagement by The Star. #BlockedByMallick trended on Twitter as academics and physicians who attempted to Tweet at Mallick to explain where she’d got the science wrong were blocked by her as she closed herself off to the contrary view. Similarly, when called out on the science by another media outlet, the editor of The Star’s advised that reporter to “stop gargling [the Star’s] bathwater".

Finally, while agreeing with the scientific critiques, John Cruickshank, publisher of The Star, doubled down on what seemed to be the newspaper’s central premise when he condemned a supposed “erosion of pharmaceutical regulation” in Canada.

Taken together, these elements made the Star’s motivation seem a little clearer. Throughout this episode, the actions of The Star’s correspondents and leadership have shown their belief that physicians and health regulators are “the system” or "the enemy" — seemingly opaque and causing harm. In fact, we’ve become so much so the enemy that correspondents like Ms. Mallick would rather ignore us than listen to reason. By publishing half-baked findings, The Star highlighted its distrust of physicians and the vaccine safety system. Front-page news exposé: here is the secret story you aren’t being told.

As a public health physician, this anti-science trend is unsettling to me. Having trained long and hard, I have dedicated my career to my patients and to population health, to protecting the health of Canadians and to primum non nocere. My advice on Gardasil is supported by domestic and international data that establishes no increased risks of adverse outcomes after immunization and enables me — in good conscience — to continue to offer Gardasil to my patients, believing it will help them. And when I come home after a day’s work to my newborn daughter, I know that when the time comes (in the absence of contrary evidence, which is highly unlikely) that I will decide that Gardasil is right for her. How does any of this make me “the enemy”?

To its credit, The Star has attempted to make amends around the science. On February 12, it published an op-ed from 65 health care and public health professionals on the main section’s back page. Around the same time, the paper's Public Editor went on record stating that this action should balance out the harm of the original splashy front-page lead. A full retraction followed on February 20, with a deletion of the original article from The Star’s website, replaced with a note from the publisher.

That note , however, still played into the “regulators and doctors are the enemy” idea, stating that the original article “sought to note that acknowledged risks are not properly communicated.” In essence, the retraction still leaves open the door to controversy, and reinforces the suspicions about the commitment of physicians and systems to doing no harm. This resolution is ultimately disappointing; instead of conciliation, the note continues to feed an unhelpful and unwarranted distrust of medical professionals and regulators dedicated to protecting the health of Canadians.

I cannot help but feel that media, medicine and public health ought to support each other in spreading truth in science and health. Can we work collaboratively, rather than confrontationally, to support the betterment of health for all Canadians? Can we not trust each other and agree that, in health, there are only partners, not enemies? Certainly, both sides have a part to play in improving transparency and opening lines of dialogue. This must be done, because the frightening alternative is status quo: it is only a matter of time before physicians and regulators are on the “other side” of yet another “exclusive media story” that misuses data in influencing the public’s perceptions, leaving people’s health hanging in the balance.

For that reason alone, I can’t help but feel unsettled by the epilogue of The Star’s Gardasil saga. The story may be gone, but the distrust seems to remain.

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