Psychiatrist Daniel Carlat, on his terrific blog, raises questions - just as Senator Chuck Grassley is doing - about a WebMD TV commercial that leads viewers to take an online depression screening test. The test was funded by Eli Lilly--information that was apparently omitted from the TV commercial.

Carlat says the WebMD test takes the DSM-4 list of nine possible symptoms of depression, but adds a tenth:

"I'm having frequent headaches, stomach problems, muscle pain, or back problems.Yes or No"

Carlat believes that happens, as he writes:

"Because Lilly markets Cymbalta as the "go to" antidepressant for patients who have both depression and physical pain. This is not really a "depression screening test" at all. Instead, it is a "Cymbalta-requester" screening test.

WebMD is telling the public a big lie. The say that "this content is selected and controlled by WebMD's editorial staff" when in fact the crucial aches and pains questions was selected by Eli Lilly's marketing team to encourage patients to ask their doctors for Cymbalta."

In a Forbes column, Matthew Herper writes:

"When people talk about expensive drugs, they usually are referring to drugs like Lipitor for high cholesterol ($1,500 a year), Zyprexa for schizophrenia ($7,000 a year) or Avastin for cancer ($50,000 a year). But none of these medicines come close to making Forbes' exclusive survey of the most expensive medicines on the planet.

The nine drugs on our list all cost more than $200,000 a year for the average patient who takes them. Most of them treat rare genetic diseases that afflict fewer than 10,000 patients. For these diseases, there are few if any other treatments. So biotech companies can charge pretty much whatever they want."

Overactive bladder is one of the poster children for disease-mongering. Some have written that it's a "created new disease."

Others have analyzed that its prevalence has been over-estimated.

The folks at WorstPills.org (Best Pills, Worst Pills - a project of the Public Citizen's Health Research Group) write that there are huge questions about the drugs created to treat it:

"All of the drugs currently approved in the U.S. to treat overactive bladder work about the same. The results are all statistically significant, and they are better than nothing, but their effect is minimal (a reduction of about one urination per day compared to a placebo)."

They explain that the six drugs - yep, count 'em: six drugs for overactive bladder - are so-called anticholinergic agents.

"Unfortunately, these anticholinergic effects are both what makes them effective and what makes them potentially harmful. Although for patients with overactive bladder difficulty urinating is the intended effect of the drug, that same difficulty is, in a sense, a side effect of the drug. Taking more of the drug strengthens all of the side effects -- including both the desired effects, such as reduced urination, and the ones you do not want."

Hmm. Did you learn any of that in the TV drug ads?

Make sure you see the onslide slideshow accompanying this article about how the FDA is cracking down on drug companies for ads that underplay serious risks.

The slideshow gives you details on the ad or promotional campaign behind the drug and includes copies of the warning letters the FDA sent to the companies responsible for the false promotions. The FDA slaps are for things like omitting or minimizing side effects, implying that the drug could be used for something for which it hasn't been approved, or exaggerating effectiveness claims.

The ten products promoted in the ads are these:

• Latisse eyelash thickening drug - starring actress Brooke Shields
• Cymbalta - depression and pain drug
• Treximent - migraine
• hormone-releasing IUD Mirena
• Depakote ER for bipolar disorder
• Ertaczo - cream for foot fungus
• Fosrenol - kidney failure drug
• Visipaque - used in heart imaging procedures.
• Dacogen - for certain rare blood cell disorders and blood cancers.
• Kaletra - HIV drug - with ads featuring former NBA star Magic Johnson

Excerpt from the article:

"It's almost impossible for the public to actually parse the ads and come to their own independent conclusions," says Cleveland Clinic cardiologist Steven Nissen, a fierce critic of drug ads.

But Nissen is suspicious of most drugs that are advertised because he thinks that the marketing campaigns distract and mislead consumers. His advice: avoid the most heavily advertised drugs and stick to generics.

How can you avoid getting misled by drug ads? One way is to skip over the glowing patient testimonials and seek hard data about the medication's risks and how it performed in clinical trials. Every drug Web site also includes a link to the drug's official FDA label (the link usually says something like "Full Prescribing Information.") It's heavy reading, and many doctors don't even bother to do it. But it will have definitive, unvarnished information on how effective the drug was in its clinical trials and exactly what all the side effects were.

Great piece. Terrific online slideshow. I don't know how they limited themselves to just ten misleading drug ads.

NOMNATED FOR 2009 BEST MEDICAL BLOG

John Mack, on his terrific Pharma Marketing Blog, gives us a pharma marketing perspective on the creation of an Omega-3 fatty acid prescription drug. Excerpt:

"The pharmaceutical industry is often criticized for developing new Rx drugs having little value over current medications. Such drugs are called 'me-too' drugs because of their similarity to existing Rx drugs. Glaxo has now taken this to a completely NEW level: developing an Rx drug that is a 'me-too' of existing over-the-counter dietary supplements. I am talking about LOVAZA, aka omega-3-acid esters approved by the FDA for the treatment of high triglycerides."

Mack goes on to do a cost and ingredient comparison, and explores what might be the clinical reality of the introduction of this new prescription drug. Read his entire blog entry.

Here's an ad for LOVAZA, which Mack cut out of this week's Newsweek Magazine:

Glad to see Naomi Freundlich on Maggie Mahar's Health Beat Blog address a column that the New York Times published last month, "Not All Drugs Are The Same."

Freundlich points out, appropriately, that:

"The "controversy" over generic drugs is really less than meets the eye. There have been scattered concerns--some based on patient or doctor reports, others from proprietary drug makers--about generics not being biologically close enough (bioequivalent) to name brand meds. But the issue is mired in complexity and misinformation. For example, many doctors accept significant payment from drug companies to promote their name brand drugs--especially cardiologists and psychiatrists. It can be hard to remain unbiased when a pharmaceutical company is paying the tab on research."

She quotes Aaron Kesselheim, an instructor in medicine at Harvard Medical School who has authored studies comparing generic and name-brand drugs saying the NYT column was "pretty irresponsible" because it doesn't reflect the body of evidence supporting the use of generics. "For the vast, vast, majority of pills and the vast, vast majority of patients there is no evidence of problems substituting generics for brand name drugs," he said.

I heard similar complaints about the column from Larry Sasich, consultant to the Public Citizen Health Research Group and co-author of "Worst Pills, Best Pills" --- and from Dr. Stephen Schondelmeyer of the University of Minnesota College of Pharmacy. Sasich wrote me: "The journalist covered the science but then used the experience of a patient and a physician as rebuttal to the evidence that there has been no credible evidence that generic drugs harm patients. This seems counter to good scientific journalism as uncontrolled observations were evidence that generics can cause harm." Schondelmeyer has told me for years that he continues to be perplexed by people who continue to breathe life into the "generics aren't safe or aren't equal" arguments.

NPR offers an in-depth look at the creation or re-definition of a disease and, as they call it, the "complicated biography of a medication" to treat it. Important story.

The New York Times published a couple of good articles that touched on the theme of disease-mongering this weekend.

One documented how drug companies sold hormone replacement therapy by making menopause into a disease.

The other showed how drug companies are turning premature ejaculation into a disease that requires treatment.

Disease-mongering for men and women. An equal opportunity marketing tactic. Find it in play in a drug ad near you.

The Wall Street Journal Health Blog published an interesting inside look of - as they put it - "how drug makers can try to lay the groundwork for sales well before a new therapy hits the market."

The topic is premature ejaculation.

Some might call the methods "disease-mongering."

A Bloomberg story reminds us that 6 years ago journalist Ray Moynihan in the British Medical Journal called female sexual dysfunction (FSD) "the freshest, clearest example we have" of a disease created by pharmaceutical companies to make healthy people think they need medicine.

Now that the Boehringer Ingelheim drug company has announced results of a trial of its female libido drug, flibanserin, the disease-mongering is in full bloom again.

Some journalists injected some skepticism - like Susan Perry of MinnPost.com in her article:

"The bitter irony of the FSD controversy, says the Guardian's Ottery, is "the disempowering message that women who are having sexual problems are all ill."

For women, one of the primary causes of loss of sexual desire is "relationship issues," she says, "so feeling empowered to communicate what you want could be crucial in resolving this. Nevertheless, some women will want a magic bullet solution to their sex life problems. It is a tempting idea in our time-poor lives to pop a pill and not take the time to work out the root cause of issues and address them."

As I said, get ready for more annoying commercials."

And get ready for more annoying news stories. The Newark Star-Ledger bombed on the story, in our reviewers' opinions:

• No cost data was provided for flibanserin. But an estimate of the potential U.S. market, up to $100 million in sales, was given. Those sales estimates had to be based on some price assumptions. What where they? It doesn't seem that you should provide the one number without providing the other.
• This story misses the mark by failing to address the larger issue of whether acquired hypoactive sexual desire disorder in pre-menopausal women is a condition being promoted by pharmaceutical manufacturers to create a market for a new drug and to sell more drugs.
• This article cites very little medical or scientific evidence. The story should have noted that more reliable information would have come from more rigorous research published in peer-reviewed scientific journals.
• No adverse effects of the drug were reported in the story. Safety data reported indicates that potential side effects include dizziness, nausea, fatigue, somnolence, and insomnia.
• Most of the benefits reported in the story were described in general, lay terms: having more sex, wanting more sex and experiencing less distress related to lack of desire. The story should have placed any benefits in context and noted that while results were statistically significant the medical or individual significance appears to be quite small. For example, the story should have noted that women taking flibanserin had an average increase of 1.7 "sexually satisfying events" over the course of 6 months compared to an average increase of 1 event in women taking placebo.

Can local TV news do more than scratch the surface on important health news? My former student Jeff Baillon (There - the disclosure is out of the way) shows once again how well it can be done. He reported this week on the widely-prescribed proton pump inhibitor drugs for heartburn. But his angle was not one of breathless awe. Rather, he reported that "there's scientific evidence that these medicines might also cause the problem they're designed to cure."

NPR explores an issue many others haven't, reporting that in "three critical months, PhRMA and its member companies spent $40 million lobbying Congress. That's more than $3 million each week."

Finished Tom Nesi’s book, “Poison Pills: The Untold Story of the Vioxx Drug Scandal.”

Chilling.

Sickening.

Everyone should read this story.

Christopher Lane interviews journalist Philip Dawdy, who has written about the "astonishing" rise in the number of diagnoses of ADHD and bipolar disorder in teens and preschoolers.

If there's any doubt about the impact of public relations efforts on news coverage of health products, look at what the PR company Fleishman-Hillard brags about on its website. They describe a campaign for a diarrhea vaccine. From their website:

Don't Leave Home Without It

Fleishman-Hillard launches Dukoral. A three-pronged media relations campaign resulted in 19 million impressions (triple the project goal), physician acceptance and consumer demand for Dukoral.

Dukoral, the first and only oral vaccine for protection against most common causes of Traveller's Diarrhea. For the project spokespeople were identified in key Canadian Markets (Vancouver, Toronto, Montreal-bilingual) willing to speak to the media about Dukoral. The spokespeople represented Dukoral to travel, healthcare and consumer media. All media coverage has had a direct impact on the target audiences. Media coverage incorporated key messages about Travellers' Diarrhea and Dukoral's role in the prevention of this potentially serious illness. Attributed to the extensive media coverage physician have reported to sales team that many patients have asked for Dukoral bringing in articles consumers themselves have read.

Journalists love toilet jokes in their stories. Melody Petersen, in her book, Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs, wrote that too many journalists too easily fall into drug company plans to create a market for a drug, such as, in one case, a drug for “overactive bladders.” “Dozens of journalists at newspapers and television stations across the country wrote stories about the disorder said to be destroying the lives of millions of Americans,” she wrote. “Editors and television news directors loved these reports. Silly stories of people running to the toilet brightened the day’s news.”

Dukoral is not yet approved by the FDA.

Thanks for the tip to Alan Cassels, who also points out questions about the vaccine's effectiveness and its cost.

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.

See part one.

And part two.

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.

At a conference yesterday, Scott Hensley of the Wall Street Journal Health blog showed off a story I had missed. Since it's the last day of March and basketball's Final Four is now set, the time is just right to look at it. See the Journal's “Our March Madness: The Drug Company CEO Bracket�.

They explain:

Restless shareholders, listless labs and a tidal wave of generic competition confront the top executives at drug makers around the globe. Big Biotech has plenty of problems of its own. Did we mention pushback on prices?

So we wonder who among the leaders of the current executive pack will win the test of endurance to remain the last CEO standing? Take a look at our second annual bracket by clicking on the image at the right. Feel free to start your own office pool.

The posting is fun. It's interactive. You can vote on the poll. And the user comments are worth reading. One wrote: "A more relevant question is - which CEO has the most integrity?"

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

The Los Angeles Times last week published a series of articles on drug marketing.

Excerpts:

"In a nation that consumed $279-billion worth of prescription medications in 2006 - spending 80% of that on brand name drugs - their efforts appear to be paying off. Americans filling a prescription choose brand-name products 37% of the time, even though three quarters of all prescription drugs in the U.S. are available in cheaper generics."

"Each day in the United States, an army of roughly 100,000 pharmaceutical company sales reps storms the waiting rooms and offices of the nation's 311,000 office-based physicians."

"The drug industry, according to estimates by the Center for Public Integrity, has spent $758 million on lobbying - more than any other industry - since 1998."

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.�

A Wall Street Journal story today looks at an important question in science, in policy-making, and in journalism: "What do the results of animal studies really tell us about humans? That question still puzzles researchers even though guinea pigs, lab rats and their brethren have long been part of experiments."

Two examples from the story:

Many times, however, subtle results in animals are unclear and scientists just don't know what to make of them. In the case of the new Novartis drug Galvus, James Shannon, the company's global head of pharmaceutical development, told investors that Novartis researchers "do not understand -- do not know -- the mechanism of the skin findings" in monkeys. They do know that "humans appear to react to Galvus in a very different way."

Another example of the confusing disparities that can arise in testing is the case of the popular sleep drug Lunesta. It won FDA approval despite the fact that tumors appeared when rats and mice took huge doses of a closely related chemical cousin of the medication. Some FDA reviewers were concerned enough initially to recommend rejection of Lunesta. After further analyses, however, agency officials concluded the data from human testing didn't suggest a signal for cancer in people. But you won't see the issue highlighted in the company's ubiquitous green-moth commercials for the drug.

Journalists who report on preliminary findings from animal research without strongly emphasizing the inherent weaknesses in trying to interpret such findings are not serving the public.

Earlier this week, I pointed out how - on one day - the Wall Street Journal appeared to favor positive drug news out of the American College of Cardiology meeting more than negative drug news. But day in and day out, the WSJ is one of the few news organizations to put negative drug news on page one. And today they should be praised for the spot they gave the story headlined, " 'Miracle' Obesity Pill Looks Less Miraculous." It begins:

"When Sanofi-Aventis SA reported data on a new obesity pill at a medical conference in March 2004, it generated instant buzz.

Hundreds of newspaper and television reports around the world the next day referred to the drug, Acomplia, as a "super pill" and a "miracle drug." With a new approach to obesity, Acomplia promised not only to help people shed pounds but also to raise good cholesterol and cut diabetes risk. It even showed signs of working as an antismoking aid.

"That is amazing. People are going to want this drug today, I'm sure," effused an anchor on ABC's "Good Morning America."

Three years later, Acomplia is looking less like a miracle. The drug still hasn't hit the market in the U.S. The Food and Drug Administration has asked for more data and repeatedly put off approval for the drug as an obesity treatment, while rejecting it for smoking cessation. Side effects associated with Acomplia -- including depression and anxiety -- are likely giving the FDA particular cause for concern, analysts and doctors say."

This episode is repeated many times each year: journalists trumpeting preliminary unproven claims made by drug companies or pharma-funded researchers without exercising appropriate skepticism and caution.

Thanks to the WSJ for not only pointing this out, for doing so in its prominent page one position.

You're seeing lots of cardiovascular news this week because the annual meeting of the American College of Cardiology is going on in New Orleans.

I applaud the health news coverage of the Wall Street Journal, but even their coverage shows a bias toward the positive and against negative findings.

In today's WSJ, the front page of the "Marketplace" section, page B1, has a story on the "blockbuster drug plavix" and a pack of new rivals on the horizon.

But negative findings on two other drug studies are relegated to pages B6 and B7, deep in the paper and deeper in that section.

Stories headlined "Crestor Fails to Clear A Bar in Arterial Study" and "Two Heart-Failure Drugs Fail to Reduce Death, Admissions" were important, but got neither the quality nor quantity of space given to the generally positive Plavix (and rivals) story.

American consumers need to be reminded that not all drugs are blockbusters, and that hopes at the beginning of trials are often dashed at the end. Page 1 placement would drive that point home.
(But at least the WSJ reports on the negative findings somewhere - don't get me wrong.)

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.

Merrill Goozner suggests that the FDA announcement late last Friday afternoon, issuing an official warning against giving cancer patients erythropoietin drugs (Epogen, Procrit, Aranesp) for anemia, was timed to minimize bad news or embarrassment. Goozner writes:

"What struck me most about yesterday's announcement was its timing. It has long been a hallmark of White House public relations staff that the best time to release bad news was late on Friday afternoons. That way, the least number of people will hear about it through traditional news media sources. It's too late to make the Friday evening newscasts; and the print stories usually wind up inside the Saturday papers, which are the least read of the week. (The New York Times story, at least, got mentioned on the front page.)

This late Friday afternoon release shows as much as anything how the culture of the agency has been transformed in recent years from industry watchdog to industry lapdog."

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.

AdAge.com is the latest publication to report that Michael Moore's pending documentary on the health care industry has industry execs rattled.

AdAge.com reports that drug company execs have told their employees not to talk with Moore. Quotes in the article:

"A review of America's health-care system should be balanced, thoughtful and well-researched to pin down what works and what needs to be improved," said Ken Johnson, senior VP for the Pharmaceutical Research and Manufacturers of America. "You won't get that from Michael Moore."

Added a spokesman for one of the top 10 pharma companies: "We expect it will be one-sided and
biased, just like his other documentaries."

Hmmm: one-sided and biased. Kinda like direct-to-consumer drug ads, in other words?

Moore has written, "I don't think the country needs a movie that tells you that HMOs and the pharmaceutical companies suck. Everybody knows that. I'd like to show you some things you don't know. So stay tuned for where this movie has led me. I think you might enjoy it."

The movie may not be released until early 2007.