 Merdwch wrth gweithio, wrth gweithio. I'm Kate McRill, I'm a PhD candidate in Health Psychology from the Faculty of Medical and Health Sciences. And today I'm talking about how media coverage of a drug switch can influence side effect reporting. But first, I'd like to clarify side effects. You see, side effects are not always due to the chemical components of a drug. Rydw i'n rhanol iawn awch. When a person expects to get side effects, this increases their bodily awareness. They start to notice various physical sensations, and then misattribute benign transient symptoms to a drug. This phenomenon was first demonstrated in randomised control drug trials, where the placebo group radddo i'r cyfeirwyr amdegwyd yn ysbynnal. Mae'r cyfoes â'r cyffredin … … o'r hwnnw ynddochion yn mynd i oedd y cybeirwyr. Rydych yn dda'n rhoi dda'r meddwl gyda mewn cyfeirwyr o'r cyfeirwyr… … o'r rhan o'r meddwl a chynebu i'r cyffredin ar hyn sy'n gymynghwys … … ond mae wedi mynd i'r meddwl i'r cyfeirwyr am statyn… … og yn arsyniatau canut arnaeth ymwysil. Felly, yn y cyfrifau twel ystafell a'r statyn… Tained therapy. Yn participant y blindad y treatment group, hefyd tydw i ddaf yn am군 o muscle pain. But as soon as they're told they're in staton group, there's a sudden increase in muscle related side effects. So as this in mind I want to talk about the New Zealand vanilla vaccine brand switch. So vanilla vaccine is a last line anti-depressant for treatment resistant depression. There are currently 45,000 New Zealanders taking vanilla faxine. For the past three years, Ffarmack has funded two types of this medication. There's a Fixor, Pfizer's original branded version, and a generic called Arabina vanilla faxine. But in 2017, through a competitive tender process, the funded brand has changed to another generic, Nlaffax, made by Milan. the aim of the switch was to save $19 million over five years and the savings would be used to fund other medicines. So these three drugs all contain the active ingredient venylifaxing and have been approved by Medsafe as being by-equivalent meaning they have the same efficacy, safety and side effects. So the only difference with enylifaxe compared to the other two .. simplicity. At 51, y cyfnod dwych yn effeithio gyda'r cypool. Mae'r cyfnod dweud bod yr angeni wedi y byddai'r byddahol.. .. sydd y cyfnod cyfnod bod gweithio'r byddai. Mae pob ei wneud fy modd y dal probyladiaeth gennym y cerdd... .. sydd yn hollu cael y siwrhau... .. dda'r bobl mwyaf sy'n bobl yn disgynnu... .. sy'n gweithio'r bobl wedi'u ganodig. Ac yn dweud cyfnod yr angeni y cyfnod yn cofod... .. rhai yna'r hyn deall y rheswyd yn gwneud.. and this was picked up by the media. On February 28, this year both the New Zealand Herald and Stuff Online released an article which discussed in detail the specific experience of two patients. The New Zealand Herald also listed the side effects that had been reported following the switch to end effects, Mae'r drwg yn eich bod yn dweud, ac mae'r dweud yn dweud yn gwybod. Rwy'n gwaith bod yn unrhyw ymwneud, rydyn ni'n gweithio'r llyfr yn ymwneud, ac mae'n ddych chi'n ddiweddio'r parwysau o'r ddwylo'n sgwrsiau yn ymddangos. Yn ymddangos i'r ddweud, mae'r ddweud yn ddwylo'n sgwrsiau ..an bwysig hiad bod i niwl sydd y cyfrifau cyflawn gyda'r bydd ar gyfer cyfrifau cyfrifau cyfrifau. Y costau fach iddo eich gweithiaid yddur i gael cyfrifau cyfrifau ar y centre ffobl yn cyfrifau cyfrifau cyfrifau... ..eg coriam, a drosio ddiwrnod ariadau sydd yn cyfrifau cyfrifau cyfrifau. Felly, rydyn ni'n mynd i gael ceisio eich cyfrifau cyfrifau cyfrifau... ..i gael ceisio y cyfrifau cyfrifau cyfrifau. Ond o dweud o ddechrau ni, mae gennymu sut y rhai cyfarchiaid yn rhywbeth ddim yn hystyried maen nhw'n ddweud. Er ffyrwm 2017 ar y gyfer y Ddllifat wyrddod 2018, mae gwirionedd rhai yn gweithio yn canuniaeth sydd wedi tynnu gif Punktau Creswell Cymru. Mae hynny yn dweud ddiweddaint y mae oedd hynny'n rhaid yn drws. Efallai os ydydd ynghylchu'r ysgolwyddiwyll arCOFs yn y cyd-rysiau y mlynebu ac mae y cyd-rysiau yn cyd-rysiau yn cyfarchiaid yn cyfarchiaid, ac five equally common side effects not mentioned in the media. And since the media coverage was released at the end of February and April, we compared the March and May averages for these outcomes with their pre-media monthly average using an interrupted time series analysis. So there were 100 adverse event reports in this time. 70% of reporters were female and the average age was 44. So what did we find? Well, there was a sudden increase in adverse event reporting in the months directly after the media coverage. There was a significant increase in the reports of decreased therapeutic response with an interruption effect of 15.49, meaning the difference between the pre-media average and the March and May average. The number of side effects reported also increased, going from an average of seven per month before the media focus to 65 in March and 33 in May. And when looking at the specific side effects mentioned in the media, all apart from fatigue and anxiety significantly increased, but the greatest change was for suicidal thoughts. However, there was very little change in the side effects not mentioned in the media. Only dizziness seemed to have a slight increase. So from these results, we can see that the media coverage of the vanilla vaccine brand switch was associated with a large increase in side effects and reports of decreased therapeutic response. And ultimately, the side effects mentioned in the media increased more than side effects that weren't mentioned. These results show the noceba effect in action and how the media can influence people's expectations about the experience of side effects from this drug, despite it being bio-equivalent to their previous medication. However, it should be noted that this is a snapshot of adverse event reporting. These are the people who voluntarily reported to come. So these results probably don't capture the full extent of the noceba effect. And we also don't know the outcomes or the consequences of these adverse event reports. But from the study, we can see that the noceba effect can be transmitted to a wide range of people very quickly and very easily through the media. We know from past research that the noceba effect is associated with non-adherence to medical treatment. So that is a likely consequence in this case, keeping in mind that this is an antidepressant. And as we saw in the results, the side effect that increased the most was suicidal thoughts, which is extremely concerning. So what can be done? Well, I'll leave you with two thoughts. Firstly, from the media side of things, there needs to be more balanced reporting. In the vanilla vaccine case, the media focused on two patients out of 45,000. So it's probably necessary to acknowledge that not everyone has or will experience these side effects. We could also educate the public about the noceba effect. See, people know a lot about placebo, but noceba is relatively unknown. We could use the media to spread information given its wide reach. And finally, to us, this may have seemed like a simple medicine switch. But some people, particularly those with depression, are more sensitive to medicine changes and need greater support managing this process. The support should have come from their health care professionals, their doctors, pharmacists, the gatekeepers of the medication, and not the media. Thank you.