Michael Joyce produces multimedia at HealthNewsReview.org and tweets as @mlmjoyce.
In February, two University of Kansas journalism professors sent out a survey to nearly 1,100 health care journalists across the country with this stated objective:
“to better understand attitudes, opinions and beliefs of journalists and editors about chronic pain, chronic pain patients and opioid medication use and abuse.”
What motivated the survey is somewhat unclear, but in their email to journalists the professors mention the survey “would definitely help our knowledge of the drivers and barriers on reporting about opioid abuse and chronic pain.” This raised eyebrows among some journalists who were invited to participate.
Here’s why: One of funders of the survey–the Center for Practical Bioethics (CPB) — has established ties to the pharmaceutical industry. The Center for Practical Bioethics was one of seven organizations targeted in a recent Senate Finance Committee investigation for their decade-plus relationship with Purdue Pharma. Purdue is a major producer of oxycodone and other opioid-based painkillers, and in 2007 pled guilty to misleading the public about the addiction risk with oxycodone.
Carol Smith— an award-winning journalist best known for her investigative health and environmental reporting with InvestigateWest–was one of the journalists who received the survey invitation. Because she was aware of the ties between Purdue Pharma and CPB, she was perplexed about why the professors would include this line in their survey request:
“To our knowledge there are no pharmaceutical industry funds used to sponsor this research and the results will not benefit or be shared with the pharmaceutical industry.”
I called survey coauthor Scott Reinardy, PhD, and asked if he was aware of the funder’s ties to the pharmaceutical industry.
“I know that when I developed the survey I was not aware of that,” said Reinardy, a journalism professor at KU. “I wrote the survey to better understand how journalists are covering the issue.”
In a follow-up I asked him, now that he knows about such ties, does he think this represents a conflict of interest? His reply: “That’s a good question. And it’s something that would have to be considered. I’m wandering into an area I’m unfamiliar with to a degree.”
It seems strange that a professor of journalism–who has taught media ethics courses–would consider this unfamiliar terrain. Stranger still that he would continue working on a grant while admitting uncertainty of the funder’s background and whether that constitutes a conflict of interest. It almost sounds like a classic case study he could use in one of his media ethics classes.
Next, I asked principal investigator, Mugur Geana, MD, PhD–a professor of strategic communications in healthcare who has been looking at opioids and chronic pain issues since 2012–if he was aware of CPB’s ties to Purdue Pharma:
“We had no idea that they (CPB) received funding from Purdue Pharma,” said Geana by phone. ” But when journalists pointed this out to us we asked them, and they said that money was not directed to our survey.”
Geana’s answer raises an even more fundamental question: Is it ethical for a journalism professor to take money for a survey regarding opioids from an organization that is funded by an opioid manufacturer?
I asked Geana if he thought this represented a conflict of interest. “This is academic research,” he said. “The funders had no input at all into how we designed our survey, the questions we asked, or how we analyze our results. There was no interference. And we are not abiding to any kind of framing or any kind of angle as we do our research and communicate our data.”
That’s a line we hear a lot from people who insist there is no conflict of interest. But connect the dots. The Center for Practical Bioethics (CPB) considers pain management a “moral imperative.” They receive funding from Purdue Pharma, a major manufacturer of pain medications. CPB is funding a survey about issues related to opioid pain medications. It’s not a survey on climate change or traffic accidents. So there is a direct link between the KU survey topic and the pharma money that their funder received.
What we don’t know is who approached whom regarding this survey. Whose idea was it? I asked Geana this by email and got no answer. If CPB goes to KU and says we want to fund a survey about opioids, that’s clearly a problem in that the topic was determined by the funder, not KU. But if it was KU’s idea to do the survey, why would they intentionally go to a funder with a blatant conflict of interest and who was the subject of a Senate Finance Committee investigation?
I turned to Jane Kirtley,JD for comment. She’s the Director of the Silha Center for the Study of Media Ethics and Law at the University of Minnesota School of Journalism and Mass Communication. Her response:
“If they are purporting to be independent of the funding sources then they have an obligation–at the very least–to have done due diligence about their funding sources and then be transparent with full disclosure. This strikes me as either disingenuous on their part or–at the very least–misleading to those they are surveying.”
In the email soliciting survey participation, it is clearly stated “… the results will not benefit or be shared with the pharmaceutical industry.” When I interviewed Geana, he was emphatic that no framing or angle would be employed in how they communicate their data.
Enter another veteran journalist who also received the survey.
Felice Freyer is a medical reporter at the Boston Globe who covers health policy and public health. She’s been on the board of the Association of Health Care Journalists (AHCJ) for eight years. AHCJ is holding its annual conference next week and Freyer will moderate a panel discussion entitled “Chronic Pain: Why are a third of Americans suffering?” She was curious about the Kansas survey results and wondered if they were finalized so her panel might discuss them. She wrote Professor Reinardy about the results and he offered to join the panel and present them. But Freyer declined. She was not looking for another panelist.
Then, she said, things got interesting.
About a month later she received an email from Tracie Thomas, the Director of Strategic Communications for PAINS (Pain Action alliance to Implement a National Strategy). It is a program run by the Center for Practical Bioethics and overseen by CPB’s founder and former president Myra Christopher. Like Reinardy, she offered to “share and present the results.”
“I said after I saw the results,” recalls Freyer, “I could consider mentioning them in my introduction.”
Thomas wrote back to Freyer informing her that Myra Christopher had gone ahead and contacted one of the panelists–without consulting Freyer as moderator–asking that the panelist include a slide of the results.
Professor Geana had assured me this was independent academic research without outside interference, and that no framing or angle would be used in communicating the data. But it’s clear that two members of CPB, which makes no secret of its agenda, had access to the survey results before they were peer-reviewed and were aggressively promoting their dissemination at the country’s largest conference of health care journalists.
Timothy Caulfield LLB, LLM, is a Professor of Law and Canada Research Chair in Health Law and Policy at the University of Alberta. He’s published hundreds of articles on the ethical and legal aspects of a variety of health issues. I asked him what he thought about how the survey and its results have been handled. He said this:
“The question isn’t ‘Was there actual interference by a funding agency?’ The question is whether there could be a perception of bias. In science communication — now more than ever — we need to have public trust. Our research tells us that receiving industry funds has an impact on the interpretation of study results as well as how the results are communicated. Not only that, but the public trusts the results significantly less. So could this work be discredited by perceived ties to pharma? You bet.”
The KU survey of journalists is not an isolated incident. It is part of a growing number of disconcerting trysts between cash-strapped advocacy groups, deep industry pockets, and publicly-funded academic institutions. We published a summary of just how ubiquitous these trysts are a few months ago.
Last month the New England Journal of Medicine published a study investigating the financial ties between advocacy groups and drug/device/biotech companies. It found that over 80 percent of the largest patient advocacy groups in the U.S. received financial support from such companies. Over a third of the advocacy groups had a current or former industry executive on their board.
Members of the general public may be impressed that these advocacy groups have noble names and noble missions. Many walk the walk with integrity. Others not so much.
The tentacles of industry money reach so far and into so many places nowadays that most of us can’t be bothered to keep up.
And academia? The prevailing public perception (although this may be changing) may be that the ivory towers are unstained and the real bottom line is teaching, not money. But you only need to speak to a few academics to get a more honest view of reality.
Just last week The BMJ published a feature about how Coca-Cola funded journalism conferences at the University of Colorado in a not-so-subtle attempt to shift the focus from sugar to lack of exercise as the real culprit in our “obesity epidemic.”
Myra Christopher and the Center for Practical Bioethics (CPB) are a good example of how noble-sounding agendas and industry profits can support one another. When she was acting president of CPB–a very vocal and influential advocacy group strongly focused on assuring adequate pain relief for people with chronic pain–Purdue gave $1.5 million to CPB as seed money for an endowed “chair in pain and palliative care” that is still held by her. This was covered by veteran health care reporter, Alan Bavley, in this excellent article published a year ago in the Kansas City Star. The Kansas City Star is just 42 miles from the KU journalism school and has — by far — the largest circulation of any paper in the area.
Another example was brought to light last month by David Armstrong of STAT. In his article, Armstrong highlights a documentary about chronic pain called The Painful Truth, produced by a physician “with significant financial ties to the manufacturers of opioid medications.” The physician, Lynn Webster, MD, told STAT he received no industry funding for the documentary and it was paid for by him and his wife.
Here is what we know:
I asked Charlie Ornstein, a Pulitzer award-winning, senior reporter at ProPublica for his reaction. He has considerable experience, not just with conflict of interest stories in general, but specifically with opioid advocacy groups and pharma money. He wrote:
“At this point, it’s indisputable that conflicts of interest are pervasive in medicine and, at minimum, they should be out in the open. This is particularly apparent in the area of pain medicine and opioids. We saw this years ago when writing about the now-defunct American Pain Foundation, which described itself as the largest advocacy group for pain patients. In fact, nearly 90 percent of its funding came from industry and its positions largely tracked those of its funders. The public–and journalists who cover these issues–should not be left to guess whether the news they’re reading, or the surveys they are taking part in, are covertly in service of an undisclosed mission.”
The University of Kansas survey leaves us in exactly that kind of bind.
Update 4/12/17: This post has been updated to reflect that Lynn Webster, MD told STAT that he received no industry funding for his documentary on chronic pain. The post originally stated that Webster made that claim in a “rebuttal” to the STAT piece.