Syracuse reporter James Mulder cracked this story.
As with the Chicago Tribune story cited earlier today, this story ends with a powerhouse quote from one observer:
"You may not think you are being biased, but if you make 10 minor decisions in a row that are all slightly biased, all those little biases add up in the end. It's an unhealthy situation."
Hat tip to Pia Christensen for the tip on this.
Here's another problem with the practice of TV networks using physician "contributors" to comment on health care news. They may have a clear conflict of interest that is not addressed.
When the American Cancer Society released its updated guidelines on prostate cancer screening today, Fox News reported:
"Dr. David Samadi, a Fox News contributor and chief of Robotics and Minimally Invasive Surgery at Mount Sinai School of Medicine in New York City, said he thinks the new guidelines could cause unnecessary deaths.
"In my practice, we find men in their 30s and 40s that are at high-risk and develop prostate cancer," Samadi said."Knowing your PSA is power, it is educational; you follow it all the time. You can find a silent prostate cancer that will not affect you, and there is a possibility to over-diagnose, but that's a risk the patient needs to take. You could also find cancer that could lead to death."
The number of prostate cancer deaths continues to decline because of regular screening, Samadi added.
"I really recommend (the age) of 40 as a baseline age," Samadi said."
Doesn't Fox see that he has a blatant conflict of interest on this topic as one who runs a robotic surgery center? There are countless ways to counter these short quotes from Dr. Samadi, but I'm not going to run through them here. Read the Cancer Society report and you'll find all of them there - in dispassionate, non-conflicted, evidence-based depth.
Look at how Katie Hobson of US News & World Report included an expert urologist's input, and one with a much more open-minded and balanced perspective.
"... the gist of all this is a firm end to the notion, still held by some clinicians, that screening for prostate cancer is "the same as colorectal cancer screening or cholesterol screening," says Durado Brooks, director of prostate and colorectal cancers for the ACS and coauthor of the report.
"There has to be a conversation," says John Davis, assistant professor in the department of urology at the M. D. Anderson Cancer Center in Houston. "And these guidelines give some very nice bulleted points and Web links you could build into an information sheet and give to patients."
Blogger Alison Bass jumps on a Journal of Bioethical Inquiry article that says that "while evidence-based medicine is a noble ideal, marketing-based medicine is the current reality."
Bass consistently tracks medicine's conflict of interest issues. Her blog would be a good bookmark for you if you care about these issues. And her book, "Side Effects: A Prosecutor, a Whistleblower, and A Bestselling Antidepressant on Trial," is terrific.
I've told my students that covering health care conflicts of interest could be a fulltime beat - and you still wouldn't keep up.
In the first half of this year, the drug giant Eli Lilly paid 3,971 doctors and other medical professionals an average of about $11,230 each. The payments were for participating in an average of 12 speaking or consulting engagements during those six months, according to a company spokeswoman.
Dr. Manoj V. Waikar, for example, a physician among the top five earners this year, received $74,850 for consulting and speaking at 51 events, according to Lilly's on-line faculty registry. The company caps payments at $75,000 for each health care provider in any calendar year.
He's an adjunct instructor at Stanford. Stanford's ban on regular faculty members participating in drug company speakers' bureaus doesn't apply to adjuncts - as long as they're not using the Stanford name.
As blogger Merrill Goozner writes:
Waikar gave 51 talks last year to earn that $75,000. That's one a week, week after week, all year at $1,500 a pop. Think about it. Same slides, same talk. Just show up for two hours and the check is in the mail. Do that for three companies and you're earning over $200,000 annually. And you were wondering how the man earns a living on an adjunct faculty's salary.
Meantime, it doesn't take the NY Times to dig into conflict of interest issues. A student journalist with the Minnesota Daily points out how medical students receive free textbooks from drug companies promoting their products. Case in point: an otolaryngology text given out by a company making an ear infection drug - with the company's logo on it, and with the beginning of each chapter crediting the drug company.
The student journalist also pointed out that the University of Minnesota has no policy to ban such practices.
It's good that this student journalist starts looking at conflict of interest issues now. If she stays on this beat, she's going to be busy on COI stories for a long time.
Start lining up the awards for the series on conflict of interest published by the Milwaukee Journal-Sentinel this year.
"As fears were growing about the link between hormone therapy and breast cancer, a drug company paid the University of Wisconsin to sponsor ghostwritten medical education articles that downplayed the risks, records obtained by the Journal Sentinel show.
The five articles were funded by Wyeth, the company that made the top-selling hormone therapy products. The articles, published in 2001, appeared under the names of doctors who specialized in diseases common to menopausal women, but actually were written by professional writers paid by the company.The articles came shortly before a long-term $1.5 million arrangement between Wyeth and UW to educate doctors and patients around the country about hormone therapy. The initiative promoted the benefits and softened the risks of drugs that produced sales of more than $1 billion a year."
The article also showed two faces of health care on this issue. Excerpt:
"The company's ultimate goal is to sell more drugs, said Steven Miles, a physician and professor at the Center for Bioethics at the University of Minnesota Medical School.
"These ghostwritten articles are advertising masquerading as scientific reviews," he said. "It's dishonest."One of the listed authors, Leon Speroff, then a professor of obstetrics and gynecology at Oregon Health Sciences University...said the practice of ghostwriting remains commonplace, and he defended it.
"There is nothing dishonest about it," he said.
He laughed at the idea that someone might be offended by the lack of transparency.
"If you don't like the way it works, that's your business," Speroff said."
In another in a continuing series of stories about doctors, drug companies and conflicts of interest, John Fauber of the Milwaukee Journal-Sentinel writes about the disease-mongering promotion of low testosterone or "Low T." Excerpts:
"A rash of television commercials in recent months have told millions of middle-age men that their diminished sex life and somber mood may be the result of low levels of testosterone.
Setting the stage for the ads was a series of medical journal articles that first appeared four years ago. The articles, which were sponsored by the University of Wisconsin School of Medicine and Public Health, read more like promotions than rigorous research, touting the benefits of testosterone and downplaying the risks.While the TV commercials were intended for consumers, the medical articles were written for thousands of doctors who could earn continuing medical education credit by reading them. Presumably, they also would write more testosterone prescriptions.
Both the ads and the articles were paid for by Solvay Pharmaceuticals, the company that dominates the testosterone therapy field and which allegedly conspired to pay off generic drug makers to keep their testosterone products off the market.
The campaign seems to have paid off.
Over the last few years, prescriptions for testosterone, especially Solvay's AndroGel, have boomed despite concerns that it may increase the risk of prostate cancer and cardiovascular disease. Aside from the potential health risks, there is a lack of science that the expensive drugs provide real benefit for middle-age and older men whose testosterone levels are declining as a result of normal aging. ...
UW was an active participant in the testosterone surge. Solvay paid about $1 million to fund UW-sponsored doctor education in 2005, 2006 and 2007 such as dinner meetings around the country and newsletters designed to reach more than 50,000 physicians. UW directly received about $115,000 of that amount."
Here's how Solvay bought space on WebMD to promote AndroGel in an ad that is meant to look like normal editorial content.
The Politico.com story about the Washington Post "pay for access" proposal isn't astonishing to Merrill Goozner, who writes:
It's a long standing practice by one of the few sections of the news business that remains profitable -- the newsletter and trade journal business. There's also a vibrant conference sponsorship industry that sells exclusive access to top government officials.
For instance, a Texas-based outfit called Pharma Education Concepts, Ltd. is running one of its trademarked "Pharma Conferences" in Cambridge, Maryland in late-August. Dubbed "GMP By The Sea," the meeting brings top drug industry executives together with Food and Drug Administration officials to hear the latest thinking on globalization and the regulation of drug and biologic manufacturing processes. Featured speaker this year is Murray Lumpkin, deputy FDA commissioner for international and special programs. Pricetag: $1,495 a ticket.In mid-June, a scrappy industry newsletter called FDAWebview filed a citizens petition with the FDA demanding journalistic access to this and any private meetings where FDA officials appear. Its editor couldn't afford the $1,495 needed to send a reporter to cover the GMP By The Sea meeting where Lumpkin, a public official, might say something newsworthy.
The real issue is what will be the ground rules for these Post-sponsored conferences. The public has the right to know what gets said in these meetings with its elected representatives and civil servants. I stand with FDAWebview. Any session where a top government official appears should be open to the news media, right on down to the lowliest blogger.
As always, thanks for the perspective, Gooz.
Paul Scott writes about the documentary, "Depression: Out of the Shadows," which won a Peabody Award.
He criticizes that "its broad survey of the science of the illness included frequent appearances by Charles Nemeroff, M.D., a leading--some say powerful--mood disorders researcher from Emory University. Last fall, Nemeroff also became one of the most prominent psychiatrists to be rebuked for failing to disclose funds earned from the drug industry." ...
The heart of his critique, though, is this:
"That PBS producers either did not know about Nemeroff's drug industry entanglements or did not believe they tainted his discussion of the science of depression is disappointing. Indeed, the science of the illness and antidepressant medications is far less uniformly agreed upon than is depicted in the documentary. Disputes are ongoing over the efficacy, mechanism of action, and "targeted" nature of antidepressants--blockbuster drugs that remain the recipient of favorable press coverage even while now going off patent.
But what made the praise bestowed on this PBS documentary particularly troubling were the erroneous, drug-industry serving statements made by Nemeroff within the film--statements which had the potential to negatively affect public health, and which the documentary left unchallenged."
Read the entire piece.
I have written to the National Press Foundation stating my concern with the fact that they have accepted funding from the drug company Pfizer to offer journalism fellowships on cancer issues.
I read about this in an e-newsletter sent by the Society of Professional Journalists. The SPJ newsletter wrote that "Fifteen fellowships will be awarded and they all include lodging, airfare and most meals."
This is the notice as it appeared in the SPJ newsletter:
I wrote to the SPJ president about my concerns, stating that "I don't think SPJ should be encouraging journalists to take these pharma-funded all-expenses-paid trips by promoting them in the newsletter."
All I got was a "Thanks for your note" response.
As an SPJ member, and as the keynote speaker at a recent SPJ ethics week event, I expected more. As a thank you gesture for my participation in that SPJ event, the national president gave me a plaque with the SPJ code of ethics on it. I remind SPJ that its own code of ethics includes these clauses:
Journalists should:
If taking free airfare, lodging and meals from a drug company whose work you cover isn't at least a perceived conflict of interest, I don't know what it is. And I don't think SPJ should promote events in its own newsletter that, in my reading, invites journalists to violate the SPJ code.
More on SPJ in a moment.
I also wrote to the National Press Foundation and had a long e-mail exchange with its president. In a nutshell, he defended their acceptance of the drug company money - just as he did when Merrill Goozner wrote about his concerns with NPF's handling of another drug company-sponsored journalism event last fall. (See "Jeer to the National Press Foundation")
Now back to SPJ.
At its national conference in Indianapolis this August, SPJ will offer a tour of the Eli Lilly drug company corporate headquarters and "a professional development session on the reporting of mental health issues." SPJ invites journalists on its website, with: "you can participate in a networking reception with Lilly leaders to learn more about Lilly's history--and future--from the very individuals who are working to shape it."
Lilly makes:
Why don't journalists see any problem with these arrangements? Actually journalists did see problems with such activities - at one time. The ones who wrote the SPJ code of ethics. Something about "Refuse gifts, favors, fees, free travel and special treatment....avoid conflicts real or perceived...etc."
In their article, "Who's Watching the Watchdogs?" in the BMJ on November 19, 2008, Schwartz, Woloshin and Moynihan wrote:
"As watchdogs the media play a vital role in highlighting interconnections between doctors, researchers, and the drug industry. But who watches the watchdogs? Financial ties between medical journalists and for-profit companies they cover in their reporting have received little attention in the media or from the research community. Such ties warrant scrutiny, not least because many of us first learn about new treatments from the news media, and these reports can affect the way the public uses health care."
The authors conclude:
"Training and further education of medical journalists should not be funded by the healthcare industries that the journalists cover."
We urge the National Press Foundation and the Society of Professional Journalists to re-evaluate their policies.
Merrill Goozner, who headed the Integrity in Science Watch project at the Center for Science in the Public Interest for the past five years, has been axed by CSPI.
The good news is that he'll now have more time to devote to his terrific blog, GoozNews.com, for which, in the past, he had to cobble together an hour or two in the morning or an hour or two in the evening - or more - to fuel the blog. Or maybe he'll come up with a new initiative worth watching. He won't sit still - although he says a few rounds of golf will come first.
Gooz helped put health care conflict of interest on the public radar screen during his five years at CSPI. He has an eye and an intellect to hone in on troublesome tidbits that others may miss. We can't lose his regular contribution to journalism in whatever form that takes.
We wish him the best.
A devastating indictment. That's what Dr. Daniel Carlat - on his blog - called yesterday's piece in the Milwaukee Journal Sentinel, “Drug firms' cash skews doctor classes: Company-funded UW courses often favor medicine, leave out side effects.”
I'm late in weighing in on this, so I'll just refer you to Carlat's analysis.
But I will add this: somehow that little paper in Milwaukee continues to publish top-notch tough investigative health care journalism and their readers should appreciate what they're getting while they're still getting it. This story was more than 2,500 words of important news - not the usual 300 word drivel trumpeting breakthroughs from the medical journals. Carlat said "Occasionally, a piece of investigative journalism sets into motion processes that strike corrupt business practices at their core. ...it will become required reading for all those involved in health care policy."
St. Paul Pioneer Press reporters Jeremy Olson and Paul Tosto have been awarded a Frank Premack Public Affairs Journalism Award for their series on the death of Dan Markingson in a clinical trial at the University of Minnesota.
The Premack judges wrote: “Through the eyes of one patient, this story shed considerable light on the complicated and competing interests between the development and path to market of new drugs, funding needs of the University and the integrity of medical research. The judges are hopeful that the new ethics task force implemented at the U of M is resulting in changes in conflict of interest policies.”
Also this week, Professor Carl Elliott of the University of Minnesota Center for Bioethics published an editorial in the Pioneer Press, "Create counterweights to the influence of money on drug studies," regarding the Markingson story. In it he concludes:
"Any serious attempt to clean up industry-sponsored research must do at least two things. First, it must minimize the internal pressure faced by researchers to raise money for their departments. Second, it must eliminate the external financial incentives that lead researchers to recruit patients into studies instead of giving them proven treatment. Unless these conflicts of interests are eliminated, universities will continue to repeat the mistakes that preceded the death of Dan Markingson."
Congratulations to Olson, Tosto, and the Pioneer Press for this terrific investigative piece. Kudos to Professor Elliott for addressing the ongoing ethical issues in clinical trials.
We can't lose this kind of important contribution in daily journalism at the local level.
The Milwaukee Journal Sentinel has done it again.
This tough "medium market" (if I can call it that) newspaper faces tough economic times by scrapping to do more tough journalism. Just two weeks ago we blogged about one of their stellar health journalism efforts.
Yesterday they published a 1,700-word story (that's rare these days) raising more conflict of interest questions at the University of Wisconsin medical school. It begins:
The conclusions were clear: Women who took hormone therapy drugs were at increased risk for breast cancer, heart disease, stroke and blood clots.The findings were so strong that researchers stopped a clinical trial in 2002, five years early, because it would have been unethical to continue giving the drugs to women.
But that same year, the University of Wisconsin-Madison's School of Medicine and Public Health began a medical education program for doctors that promoted hormone therapy, touted its benefits and downplayed its risks.
For the next six years, thousands of doctors from around the country took the online course that was funded entirely by a $12 million grant from Wyeth Pharmaceuticals, which makes the hormone therapy drugs used in the study, Prempro and Premarin.
The university received $1.5 million of that total, and university faculty received money as well.
Even after the course was no longer available, the Web site and course material remained on the Internet, accessible to consumers and doctors. The university dropped the site Jan. 15, one day after the Journal Sentinel began questioning UW officials about the propriety of the program.
The influence of drug companies on doctors - and, by extension, medical schools - is coming under increased scrutiny, with critics saying programs like the UW one are essentially marketing exercises.
The Milwaukee Journal - a paper facing all the struggles (and maybe some more) that any news organization faces - continues to shine through it all with its health news coverage.
Reporter John Fauber has a two-part series this week on "doctors moonlighting for drug companies." Excerpt:
It's a practice that increasingly is drawing criticism because of concerns that it can influence patient care and raise the cost of treatment, in addition to blurring the line between research and marketing.The deans of the state's two medical schools say they would like to ban the practice or severely limit it.
"I am very bothered by our faculty using our school's name in giving non-academic promotional, marketing talks," said Robert Golden, dean of the UW medical school. "It's a major issue we are talking about now."
In October, the Wisconsin Medical Society, as part of its recommendations for ethical behavior, said doctors should not serve as speakers. The group has no authority to regulate or stop the practice.
NPR's "On the Media" program this weekend looked at drug industry influence on media messages, including an interview with Senator Charles Grassley about his investigations of the industry.
The program also featured an interview with me about our HealthNewsReview.org project and about other issues involving health care news sources' conflicts of interest.
In the BMJ this week, Steve Woloshin, Lisa Schwartz and Ray Moynihan raise new questions about "who's watching the watchdogs?" Excerpts:
"Industry sponsorship of training and further education of journalists now occurs in a variety of contexts—universities, conferences, and professional associations—raising similar concerns to those that apply to education of doctors."The University of North Carolina’s master’s degree in medical journalism, one of the first in the United States, has at least two important forms of financial relations with drug companies. ...
Like some university programmes, the American Medical Writers Association, whose members include reporters and public relations specialists, receives sponsorship from the drug industry. Eli Lilly was a key sponsor of the association’s 2008 annual conference, and the company also sponsors its student scholarships.
...
One of the more astonishing forms of financial ties between journalists and drug companies is the sponsored award, which often involves lucrative cash prizes or opportunities for international travel. For example, Eli Lilly and Boehringer Ingelheim have co-sponsored an award for "reporting on urinary incontinence," carrying a prize of international travel. Boehringer has an award for reporting on "chronic obstructive pulmonary disease," offering prizes worth $5000 each, Eli Lilly one for reporting on oncology, and Roche one for "obesity journalism," with a prize of $7500. Sometimes awards are sponsored by organisations that are themselves heavily funded by industry, such as the non-profit Mental Health America. Its 2007 annual report shows that almost half of its funds came from drug companies, including more than $1m each from Bristol Myers Squibb, Lilly, and Wyeth.
...
A powerful contemporary example of entanglement involves a television network called Accent Health (whose logo includes the words "Your target is waiting"), said to be watched monthly by more than 10 million viewers in US medical waiting rooms. The network, which is produced by CNN, overtly offers sponsors, including drug companies, the chance to boost sales of their products, by, for example, putting "your brand in front of the valuable Baby Boomer population just before they discuss their health conditions with their doctor." One of the hosts is Sanjay Gupta, CNN’s chief medical correspondent and host of at least one other CNN health programme that is funded partly through drug company advertising. ...As researchers and writers acting to improve medical journalism, we encourage journalists, educators, and professional associations to scrutinise their own relations with the industry as intensely as they do those between doctors and drug companies and to develop workable solutions. And, if they are to be good watchdogs, journalists need to mark their territory and clearly establish boundaries between themselves and the industry to avoid unhealthy entanglements.
The Integrity in Science Watch project of the Center for Science in the Public Interest, in this week's e-newsletter, has two different but related "jeers" for failure to disclose conflicts in two different health journalism efforts. Their posting:
Jeer to the National Press Foundation for an omission on its agenda for the Oct. 23 forum for journalists on “The New Understanding of Pain,� which was funded in part by the unit of Johnson & Johnson that makes pain medications. The agenda does not disclose that presenters Howard Heit of Georgetown Medical School and Aaron Gilson of the University of Wisconsin have consulted for Purdue Pharma, maker of the controversial pain medication OxyContin, and other manufacturers of pain medications.
Jeer to Erik Eckholm and Olga Pierce of the New York Times for failing to disclose in an August 15, 2008 article on methadone risks that Howard Heit of Georgetown Medical School, who is quoted warning about those risks, has served as a consultant for Purdue Pharma, maker of OxyContin, a rival drug.
CJR's column, "Something's Rotten in Roanoke," raises some important questions, although it doesn't answer any of them.
It is clear that the once formidable wall that once stood between the advertising departments and the news departments now looks like Swiss cheese in many news organizations.
We've posted the following Publisher's Note on HealthNewsReview.org.
Conflicts of interest among sources of health/medical news and information represent an enormous – and growing – problem.Health care consumers, and news consumers, are often not told of the biases that may exist in medical research, in clinical care, or in health care professionals’ continuing medical education because of financial ties to drug companies and medical device manufacturers.
Journalists, broadcasters, editors, and producers too often rely – wittingly or unwittingly – on drug industry sources. The result: medical news often helps sell drugs to the public, accentuating the positive and minimizing risks, rather than giving readers a balanced, accurate view.
To counter claims that it is impossible to find experts who are not on the payroll of industry, independent journalists Jeanne Lenzer and Shannon Brownlee have compiled a list of more than 100 experts from several nations with expertise across a wide range of disciplines. There are two parts to the list. One part includes experts who have no financial conflicts of interest, or conflicts that are irrelevant to most stories. The second part includes experts with a variety of potential conflicts. Some of these experts have ended their pharma ties – but only within the past five years. Others may have current financial conflicts of interest. These experts, despite their commercial ties, are included in the list because they have provided important insights into the inner workings of industry – effectively biting the hand that fed them in some instances --and/or because their conflicts did not limit their ability to comment in areas unrelated to the conflicts.
The experts include: two former editors of the New England Journal of Medicine, the former editor of the western journal of medicine, current editors of American Family Physician and Public Library of Science-Medicine; former FDA advisors; physician educators; researchers; bioethicists; epidemiologists, methodologists, geneticists, and clinicians from a various specialties; medical whistleblowers; and several medical journalists.
Information about the list appears in the “Journalist Toolkit��? section of the site at: http://www.healthnewsreview.org/independentexperts.php. If you’re a journalist, you’ll be given instructions about how to acquire the list, complete with experts’ contact information. The general public will be able to see the list of names without any contact information.
It’s our hope that this list helps journalists find and use sources who do not have financial conflicts of interest. We hope that the general public understands the gravity of these issues and their impact on the integrity of medical science.
For further information on the list see: Naming Names: Is There an (Unbiased) Doctor in the House? BMJ July 23, 2008.
From time to time, I've highlighted how the Integrity in Science Watch project of the Center for Science in the Public Interest tracks news coverage (or lack thereof) of conflicts of interest in medicine and science.
• Cheer to Andrew Pollack of the New York Times for disclosing that Eric L. Matteson, chairman of rheumatology at the Mayo Clinic, has consulted for many companies developing arthritis medication. Matteson is author of a recent study examining the link between various arthritis medications and cancer.• Jeer to Audrey Grayson of ABC News’ Medical Unit for failing to note that Michael J. Manos, head of the Pediatric Behavioral Health Center at the Cleveland Clinic’s Children’s Hospital, consulted and served on the speakers’ bureaus of Eli Lilly, McNeil Consumer and Specialty Pharmaceuticals, and Shire US. Manos was quoted supporting use of pharmaceuticals to treat Attention Deficit and Hyperactivity Disorder rather than St. Johns Wort.
• Cheer to Marilynn Marchione of the Associated Press for disclosing that Michael Gnat, a professor at the Medical University of Vienna, consults for Novartis, AstraZeneca, and other breast cancer drug makers. Earlier this month, Gnat announced results of his recent study showing Novartis’ bone drug, Zometa, can slow the spread of breast cancer.
Jeanne Lenzer and Shannon Brownlee have a piece in Slate today that asks, "Are doctors shilling for drug companies on NPR?"
The piece begins:
"A few weeks ago, devoted listeners of National Public Radio were treated to an episode of the award-winning radio series The Infinite Mind called "Prozac Nation: Revisited." The segment featured four prestigious medical experts discussing the controversial link between antidepressants and suicide. In their considered opinions, all four said that worries about the drugs have been overblown.The radio show, which was broadcast nationwide and paid for in part by the John D. and Catherine T. MacArthur Foundation, had the air of quiet, authoritative credibility. Host Dr. Fred Goodwin, a former director of the National Institute of Mental Health, interviewed three prominent guests, and any radio producer would be hard-pressed to find a more seemingly credible quartet. Credible, that is, except for a crucial detail that was never revealed to listeners: All four of the experts on the show, including Goodwin, have financial ties to the makers of antidepressants. Also unmentioned were the "unrestricted grants" that The Infinite Mind has received from drug makers, including Eli Lilly, the manufacturer of the antidepressant Prozac.
We don't know just how much funding or when the show last received it, since neither Goodwin nor the show's producers responded to repeated requests for interviews. But the larger point is that undisclosed financial conflicts of interest among media sources seem to be popping up all over the place these days. Some experts who appear independent are, in fact, serving as stealth marketers for the drug and biotech industries, and reporters either don't know about their sources' conflicts of interests, or they fail to disclose them to the public."
Disclosure: I am interviewed in the story. But don't let that stop you. The piece is worth reading.
I've blogged in the past about TV news operations accepting sponsored news deals with local medical centers. In these deals, oftentimes the news only includes perspectives from that sponsoring hospital.
Now, in the first instance I'm aware of, the trend has come to newspapers. The HometownAnnapolis.com website of The Capital newspaper yesterday announced:
Partnership should improve health coveragePublished March 16, 2008
By TOM MARQUARDTIn today's editions we are experimenting with a new concept that could alarm some readers: Anne Arundel Medical Center, or AAMC, has paid us to provide content for our Health & Fitness page once a month.
Newspapers don't normally sell access to news pages, and certainly we would not give away content privileges on any other news page. I'm sure County Executive John Leopold would love to have his staff write the stories for the front page, but that's not going to happen for any price.
But partnering with the hospital on the Health page seemed to make sense. We don't have a health reporter to write about medical issues and often use stories from syndicated services that quote doctors from other cities.
The local hospital is giving us stories about local physicians and programs it has to offer - in their words, without an effort to balance the copy with comments from other hospitals or from doctors who don't practice at AAMC.
The stories are written in newspaper style and the hospital staff is responsible for the page's design. To be open and transparent about the partnership, a disclaimer is clearly displayed at the top of the page.
I'm not entirely comfortable with the arrangement, purely for journalistic reasons. But in the end I think the reader benefits - and that's my goal.
Instead of generic stories originating from another city, the reader will have local news featuring people they recognize, doctors they use and services that are available to them. The hospital staff is getting to the stories we are not able to write because of other priorities.
Is the page more readable now? You tell me.
Wow. "Partnering" - or being paid by a hospital to provide their news? Actually, he calls it content, not news. Whew. Because we used to call that advertising.
Also a relief - "the stories are written in newspaper style and the hospital staff is responsible for the page's design." So they'll look professional! Just like, or maybe even better than, real news.
And who cares if we give readers only one side of a story? Maybe a side that is so incomplete it can hurt them? And so what if we don't disclose the financial conflicts of interest of the doctors who might appear in the stories written and designed by the hospital itself? And so what if there are other opinions or other approaches from other doctors on the other side of town that don't get covered?
The main thing is: "Is the page more readable now?"
Don't let the special interest campaign catch you napping!
Dozens upon dozens of stories about Americans lacking sleep are popping up from news organizations all over the country this week, driven by another of the National Sleep Awareness Week campaigns of the National Sleep Foundation.
Few - if any - of these stories will tell you that it is industry special interests - sleeping pill makers, sleep labs, mattress makers - who are paying for this campaign. They do it every year. And news organizations fall into line like sheep and report the "new" findings every year.
Examples:
USA Today reports:
U.S. workers are silently suffering from a dramatic lack of sleep, costing companies billions of dollars in lost productivity, says a study out Monday.Nearly three in 10 workers have become very sleepy, or even fallen asleep, at work in the past month, according to a first-ever study on sleep and the workplace by the non-profit National Sleep Foundation. The late-2007 survey was based on a random sample of 1,000 workers.
Hey you! Dozing at your desk! Wake up, go home and get more sleep! That could be the message from a survey released Monday by the National Sleep Foundation. The survey of 1,000 people found participants average six hours and 40 minutes of sleep a night on weeknights, even though they estimated they'd need roughly another 40 minutes of sleep to be at their best.
CNN, WebMD, UPI, the St. Louis Post-Dispatch and many, many more news organizations are reporting the same stuff - handed to them by the industry-funded campaign.
Yawn.
Wake me when the next disease-mongering campaign comes around.
I've blogged earlier about something being smelly about the ENHANCE trial, comparing the cholesterol drug Zetia plus Zocor versus Zocor alone.
This week, a commentary in the Journal of the American Medical Association addresses some of the stink. Excerpts:
The unusual release on January 14, 2008, in the news media and on a drug company Web site, of a portion of the Effect of Ezetimibe Plus Simvastatin Versus Simvastatin Alone on Atherosclerosis in the Carotid Artery (ENHANCE) trial data resulted in numerous articles and commentaries in the lay media. The availability of only fragmentary information created massive confusion and raised many more questions than answers for patients, physicians, pharmaceutical companies, and regulators. A full report of the ENHANCE trial in a peer-reviewed medical journal is not expected for months, and the first public presentation of the study's findings in a medical setting will not occur before late March 2008.Lesson 1: Drug Trials Should Not Be Done for Marketing Purposes Only
Lesson 2: The News Media Must Be Sure to Get the Facts Straight. Errors in Reporting Can Cause Serious Damage, and Patients May Be Harmed or Become Distressed From the Resulting Confusion
Lesson 3: Leading Scientific, Patient-Oriented, and Disease-Oriented Organizations Must Scrupulously Avoid Conflict of Interest
Ben Goldacre, in this week's BMJ writes:
I was surprised last week by an email circular I received from a science writers' mailing list. It was from the Aspirin Foundation, a group funded by the drug industry, and it was offering—on behalf of Bayer Healthcare—to pay expenses for journalists to attend the European Society of Cardiology's conference in Vienna.Now aspirin is without doubt an excellent and cheap drug. But in my naivety I had no idea such things went on. I pinged off a few emails to friends and colleagues. Most poked fun at my innocence—quite rightly—but some were helpful. Not only is it extremely common for journalists to take money from drug companies, but there have been some astonishing cases in recent history, including one memorable case where a PR company invited journalists to "an exclusive preview" of new laser eye technology, with the offer to "discuss free treatment in return for editorial features."
"I organise the media programmes for a number of medical conferences run by scientific societies," said one person who, without wishing to be melodramatic, has asked to remain anonymous, "and I reckon at least 50% of the journalists present are paid for by drug companies. They get pretty well looked after too—first class travel, five star hotels, posh dinners, etc. Some of them indulge in double dipping, where they are paid by the day by the drug company and then by the publication that takes whatever they have written. Sometimes they don't even use the press room, spend all their time in company hospitality suites, and just go to company sponsored satellite sessions and press conferences."
Perhaps I'm naive, but I don't buy Ben's claim that it's "extremely common for journalists to take money from drug companies." But the points he makes about pharma's pervasive and troublesome influence on some journalists and news organizations is worth noting. He wrote:
"...There are real dangers in being too close to PR people: lovely though they may be, their trade is, by definition, manipulation. Drug companies are businesses, with responsibilities to their shareholders, and they wouldn't pay for journalists to attend their events if they didn't think it would affect media coverage of their product. After all, a journalist's article is far more credible than a paid advertisement, for anybody's money, and more likely to be read by potential consumers. ...It's much easier to get someone to take your calls when they've taken your money. And I, for one, will in future read outraged media reports of academic conflicts of interest with a wry smile indeed."
If you didn’t see 60 Minutes last Sunday (April 1), go to their website and read the story and watch the video link for the segment called “Under the Influence.� It’s the story of the incredible manipulation of Congress by the drug industry that took place to get the Medicare Part D legislation passed.
Excerpt:
The unorthodox roll call on one of the most expensive bills ever placed before the House of Representatives began in the middle of the night, long after most people in Washington had switched off C-SPAN and gone to sleep.The only witnesses were congressional staffers, hundreds of lobbyists, and U.S. Representatives like Dan Burton, R-Ind., and Walter Jones, R-N.C.
"The pharmaceutical lobbyists wrote the bill," says Jones. "The bill was over 1,000 pages. And it got to the members of the House that morning, and we voted for it at about 3 a.m. in the morning."
Why did the vote finally take place at 3 a.m.?
"Well, I think a lot of the shenanigans that were going on that night, they didn't want on national television in primetime," according to Burton.
"I've been in politics for 22 years," says Jones, "and it was the ugliest night I have ever seen in 22 years."
Despite what a terrific piece this was, one wonders why it took 60 Minutes several years to catch up to this story. Some viewers wrote to CBS about how late this report came. Examples:
“Great story, AWESOME Story!!! Too bad CBS & 60 minutes waited over 3 YEARS after President Bush Jr. signed the bill into law to report on this. Perhaps if we the American people had heard this story back in early 2004, we would have made different choices when the 2004 presidential election came around.�“CBS, where the hell were you in reporting this when it happened. Everyone else who was paying attention knew we were being screwed by this legislation, that it was just a give away to the drug companies. but like all (mainstream media), you were totally going to let it pass. Shame on you for taking so long wake up.�
Gardiner Harris of the New York Times is all over issues about drug company influence on doctors and on the FDA this week. Today he writes:
Expert advisers to the government who receive money from a drug or device maker would be barred for the first time from voting on whether to approve that company’s products under new rules announced Wednesday for the F.D.A.’s powerful advisory committees.Indeed, such doctors who receive more than $50,000 from a company or a competitor whose product is being discussed would no longer be allowed to serve on the committees, though those who receive less than that amount in the prior year can join a committee and participate in its discussions.
A “significant number��? of the agency’s present advisers would be affected by the new policy, said the F.D.A. acting deputy commissioner, Randall W. Lutter, though he would not say how many.
Yesterday, Harris' story on "Doctors' Ties to Drug Makers Are Put on Close View" simply blew away the competition - better by far than any other story I saw on the subject in many media across the country - including right here in Minneapolis. He and Janet Robert reported on records in Minnesota, where drug makers are required to disclose payments to doctors.
The Minnesota records are a window on the widespread financial ties between pharmaceutical companies and the doctors who prescribe and recommend their products. Patient advocacy groups and many doctors themselves have long complained that drug companies exert undue influence on doctors, but the extent of such payments has been hard to quantify.The Minnesota records begin in 1997. From then through 2005, drug makers paid more than 5,500 doctors, nurses and other health care workers in the state at least $57 million. Another $40 million went to clinics, research centers and other organizations. More than 20 percent of the state’s licensed physicians received money. The median payment per consultant was $1,000; more than 100 people received more than $100,000.
The reporting on this latter story was complete and comprehensive, with many examples of Minnesota physicians receiving surprising amounts of money from drug companies; ten doctors and one dentist received more than $500,000. You should read the entire story. But be ready to take an anti-anxiety pill when you're done.
Broadcasting & Cable magazine reports:
"The sponsorship of a PBS program on obesity by diet drug maker GlaxoSmithKline has one veteran noncom TV watcher a bit exercised, but PBS says it is by the book.
Jeff Chester, executive director of the Center for Digital Democracy, and a frequent critic of what he sees as the increasingly commercialization of noncommercial broadcasting, has written to PBS ombudsman Michael Getler to complain about what he sees as too lax sponsorship policies.
Glaxo is underwriting the April broadcast of 'Fat: What No One is Telling You' ...
'We note that funding comes in part from GlaxoSmithKline,' Chester wrote Getler. 'The drug giant just happens to have a recently approved for over-the-counter drug on the market-under the brand name Alli, that is for 'use by overweight adults along with a reduced calorie, low-fat diet.' ...
PBS program executives need to 'cut the fat' out of their sloppy review of what's appropriate for underwriting,' said Chester."
Getler responded on his PBS ombudsman blog: "My view is that Chester’s eagle-eye provides a continuing, very useful challenge to PBS, a challenge that I agree with even though I sympathize with PBS’s constant search for funding, the difficulty of finding sponsorships to bolster more traditional funding, and that fact that some funders simply have an interest in seeing subjects aired and are willing to take their chances on how the program will come out. But in this case, there is little doubt how a program about obesity is going to turn out. Even though GlaxoSmithKline came in late and, under PBS policy, has no say in any of the content, this kind of possible conflict can undermine credibility and, without knowing the financial details, doesn’t seem worth it. "
(GS note: Thanks to one of my blog readers for tipping me off to this controversy.)
A Vancouver Sun story is a good example of an imbalanced story that fails to address health policy issues with context and completeness. The story reports on an advocacy group report and, in so doing, takes a flawed advocacy stance itself.
The story begins: "Cancer patients are increasingly having to pay for important new drugs administered in public hospitals, the latest symptom of Canada's inconsistent and often inadequate funding of cancer treatment, an advocacy group reported Monday."
The story says, "One breakthrough leukemia drug is paid for by just a single province, (British Columbia)." The story didn't explain what qualifies as a breakthrough.
Then the story dipped into the language that is usually used when cost-effectiveness decisions are made by government officials - "rationing." The story says, " 'Essentially, we will continue to ration life-saving cancer treatment, and some Canadians will live and some will die simply because of where they live,' said the report."
Late in the story, it finally disclosed that the advocacy group was financed largely by pharmaceutical companies.
The report also looked at the availability of PET (positron emission tomography) scans and mammograms for cancer patients, raising questions about what the report said was underuse of the two technologies.
But overuse of PET and other scanning technologies is generally a bigger concern than underuse. And who's to say that women aren't choosing to forego mammography after weighing the evidence? The story certainly didn't look into that possibility.
Journalists will not contribute to a meaningful discussion on health care reform if they take the party line of a pharma-funded advocacy group as gospel.
The editor of the Journal of the American Medical Association says that for the third time in three months, the Journal was misled by authors failing to disclose their ties to drug companies. This time it was in a study appearing in this week's Journal linking migraines to heart attacks in women. All six authors of the study have had financial ties to drug companies making products for migraines or heart problems.
The Associated Press reports that "the authors said they did not report their financial ties because they did not believe they were relevant to the study."
JAMA was burned last week when authors of a depression study failed to report their connections to drug companies making antidepressants. And two months ago authors of a study on arthritis drugs and cancer failed to fully disclose.
The engtanglement of conflicts of interest in the dissemination of health, medical and science news is worsened when journalists don't question researchers about potential conflicts of interest, or when they take as gospel anything that is published in a journal. Consumers are hurt when there is not full disclosure. They're not getting the full story. That's why, on our HealthNewsReview website, we give an "unsatisfactory" score to any news story that fails to pursue questions of conflicts of interest in the sources used in a story.
This situation must change.
