The following is a guest blog post by William Heisel, one of our story reviewers on HealthNewsReview.org.
When writers mention conflict of interest in a story it typically is in one context: researchers taking money from Big Pharma. But conflicts abound in medical research, so much so that documenting all the conflicts can seem daunting, especially in a breaking story.
Matthew Perrone at the Associated Press made it look easy last week with the story New device uses light to screen for melanoma, which Dr. Steve Atlas and I reviewed for HealthNewsReview.org. Under deadline pressure, Perrone did a terrific job on the story and, in writing about conflicts, went well beyond what most reporters do. Here are some of the conflicts he found that other health writers should look for:
Physician groups. Commonly, stories about a disease or device quote a past or present official with the relevant professional association. The first quote in Perrone’s story is from a well known dermatologist, Dr. David Pariser, who says, “Every day patients come in with 20 moles on their back and the dilemma is, which ones are suspicious and need to be biopsied?” Pariser, as Perrone notes, is the past president of the American Academy of Dermatology, but he also has a stake in the device’s success. He “consulted for the device’s maker, Mela Sciences Inc. of Irvington, N.Y., on its presentation to FDA.”
Expert sources. Perrone contacted Dr. Leonard Goldberg for some outside expertise on the device. Goldberg seems like a good choice. The former Chief of Dermatologic Surgery at Baylor College of Medicine has published numerous papers on skin cancer. In describing Goldberg, though, Perrone made sure to point out that Goldberg has at least one significant corporate tie that might play into how he views skin cancer. He called Goldberg “a dermatologist at the Texas Medical Center and vice president of the Skin Cancer Foundation, a disease awareness group that accepts donations from makers of sunscreen.”
Decision-makers. When Perrone researched Dr. George Elias, a Maryland oncologist, and found that he “had no ties to the company or the device,” he might have decided just to quote him without any caveats. But he made it clear to readers that Elias, too, had placed his faith in the device’s success. “Elias voted with the majority of an FDA panel that narrowly endorsed the device last year.” This is important context because, as Perrone explains, the decision to approve the device was not easy. “At a meeting last fall, FDA scientists said Mela Sciences had not shown how its device would influence day-to-day decisions by doctors. The agency also worried about its use by general doctors not accustomed to identifying suspicious skin moles. Despite these concerns, the panel of advisers narrowly backed the overall safety and efficacy of the device in a 8-7 vote.”
Regulatory agencies. The debate over whether to approve a new device or drug is not uncommon, but you would not get that impression from most news stories on approvals. Time-pressed reporters often just take the press release from the company involved and interview a few people for quotes. The regulatory history is deemed just that. Perrone, though, set the stage for what may be a troubled future for this device. He did this, in part, by holding the U.S. Food & Drug Administration accountable the same way he held everyone else in the story accountable. “Regulators worried that the device could give physicians a false sense of certainty, leading to fewer biopsies,” Perrone wrote. “Another concern was that doctors could misinterpret the device’s feedback, particularly error messages when a mole cannot be scanned. …Regulators said this week that they ultimately approved the device after Mela Sciences agreed to limit its use to board-certified dermatologists who undergo a specialized training course.” Perrone pressed Christy Foreman, the director of FDA’s Office of Device Evaluation, for an answer on why the agency did an about face. “This device represents new technology. At the end of the day I don’t know that this will be the best technology out there, but it is a step forward to allow continued innovation in this area,” Foreman said. That’s far from a ringing endorsement and a nod to the agency’s dual role as both a safety watchdog and an “innovation” booster.
Perrone’s piece is a nice reminder of the importance of pointing out conflicts, even with just a phrase or two. There’s no need to belabor them in a quick story or to make it seem like something nefarious is going on. Readers deserve to know, though, where your sources stand, how they are connected to the issue at hand and whether they have a stake in the outcome.