Kevin Lomangino is the managing editor of HealthNewsReview.org. He tweets as @KLomangino.
[Editor’s note: In response to our reporting, STAT has retracted the flawed op-ed that is the subject of this post and revised its policies on authorship and conflict of interest disclosure in its opinion columns. See here for details.]
The physician whom STAT lists as author of a now-retracted op-ed praising the vital role of drug company sales representatives didn’t actually write the piece.
Robert Yapundich, MD revealed this key detail in a telephone interview with me yesterday. He stated unequivocally that he did not come up with the idea for the article or compose the first draft of the piece. He said he provided “edits” to material that originated elsewhere.
Who wrote the article, then?
Here is Yapundich’s account of how the events surrounding the op-ed unfolded:
That’s when the problems began in earnest.
As we reported earlier this week, Yapundich received more than $300,000 from the drug industry between 2013 and 2016, according to the federal Open Payments database. And yet disclosure of that conflict of interest was initially missing from Yapundich’s op-ed; it was added only after an outcry in the comments section of the STAT piece and on Twitter.
Yapundich says he understands the importance of such financial disclosures and that the omission was unintentional. It resulted from miscommunication with AfPA and uncertainty regarding the disclosure requirements.
“In regards to COI, I’m not sure what is needed,” he recalled writing to his AfPA liaison. “Do you need the company names? Which years? What type of COI?”
His contact reportedly wrote back: “Hold on financial info. Hopefully only needed for AfPA and not for you individually.”
That’s the last Yapundich heard about the disclosure issue until STAT called him to clarify, he says.
STAT acknowledged the omission by revising the author bio that originally appeared at the end of the article. Here’s how it reads now:
Robert Yapundich, M.D., is a neurologist practicing in Hickory, N.C., and a member of the Alliance for Patient Access. The alliance, which receives funding from pharmaceutical companies, supports regulations that expand manufacturers’ ability to discuss off-label uses, particularly those that are accepted in compendia and practice guidelines or reimbursed by the government and insurers. According to OpenPaymentsData, Dr. Yapundich was paid $332,294 by industry between 2013 and 2016.
Editor’s note: This article was updated to include Dr. Yapundich’s ties with industry, which were not disclosed to STAT.
So STAT finally clarified – more than four days after first publishing the piece – that Yapundich has a significant conflict of interest regarding this topic. But in clarifying the extent of the author’s financial relationship with the drug industry, STAT raised yet more troubling questions about the article’s provenance and authenticity.
Pat Skerrett, who edits the First Opinion section where the op-ed appeared in STAT, offered a slightly different explanation than Yapundich for the missing drug industry disclosures. Writing in an email he said:
I just now got off the phone with the [Yapundich]. He confirmed the industry payments, and said he had mentioned them to the PR company he was working with but that they were not passed along to STAT. [emphasis added]
This was the first indication I’d received of any PR company involvement with the article.
The PR firm, which Skerrett identified as Keybridge Communications, touts itself as a “DC-based public relations firm that specializes in op-eds, issues advocacy, writing, media placement, and web development.” Here’s their promotional pitch:
We brand thought leaders. Our goal is to get your message in front of your target audience, whether it’s influencers and consumers or lawmakers and voters. Opinion media drives the public debate – and enables our clients to expand their footprint, sway attitudes, and achieve their strategic goals.
Exactly whose message was Keybridge trying to advance with placement of the STAT op-ed?
Bill Snyder, an associate at the firm, whose name was given to me by STAT’s Skerrett, declined to answer specific questions about who was paying the bills for the op-ed and what role his firm may have played in the editorial development of the piece. He cited client non-disclosure agreements.
His explanation of the financial disclosure confusion appears to cast blame on STAT for not being thorough enough. But it may also reflect failure to respect accepted standards for acknowledging conflict of interest.
“As you know,” Snyder wrote, “Dr. Yapundich has many relationships with the pharmaceutical industry. This is no secret; the relationships are publicly detailed here. We didn’t send this along as we were under the impression that the editor was asking about the Alliance for Patient Access, and Dr. Yapundich wrote the piece in his capacity as a member of AfPA.”
Without seeing the entire exchange, it’s hard to know whether Keybridge’s “impression” here is justified. No matter what capacity Yapundich was writing in, his personal financial relationships are obviously relevant. They should have been included if there was any doubt at all as to what STAT was asking for.
Keybridge is well known for ghostwriting on political and health care issues. It has acknowledged a previous client relationship with the Pharmaceutical Research Manufacturers Association of America (PhRMA), among other pharmaceutical interests. It seems apparent that they also have some involvement with AfPA, the pharma-backed advocacy group.
For his part, Yapundich suggested that the initial draft originated somewhere within AfPA. But given the financial backing this group receives from the drug industry, this may be a distinction without much difference. Moreover, Yapundich named Susan Hepworth as the Alliance employee who sent him the draft. She is also listed as a media relations expert for a different DC public relations firm, Woodberry & Associates. According to her bio, “She focuses on driving and echoing strategic messages for its health care and education clients through the development and execution of an earned media strategy that includes both traditional and digital media, as well as surrogates.”
It seems that wherever the op-ed originated, it received careful attention from PR messaging pros before it ever reached Yapundich’s desk.
The practice of op-ed ghostwriting is common among politicians and celebrities and is accepted by many editorial page editors.
But the STAT situation is different and poses significant ethical concerns, says Charles Seife, a professor of journalism at New York University.
“Ethically ghostwriting becomes a problem when you have a big concern like a pharmaceutical company that’s trying to put words in the mouth of the little guy,” he told me. “Why is it necessary to omit the name of the person who actually wrote the piece, unless you’re trying to obscure the hidden hand of someone behind the scenes who’s more powerful?”
Seife drew a parallel to Wyeth’s use of ghostwriters to promote the hormone replacement therapy Prempro in the medical literature. He said the company penned journal articles and recruited physicians to put their names on them. “The reason you do that is to hide the influence of the drug company and to increase the impact more than you would’ve had otherwise,” he said.
“It’s shocking if STAT is allowing this to go on,” he added. “It’s a real blow to their credibility.”
Writing in the comments section of the STAT piece, Seife had previously drawn attention to what he described as an implausible story about Yapundich’s interaction with a drug company sales rep. Yapundich is listed as a promotional speaker for Acadia Pharmaceutical’s drug Nuplazid in the Open Payments database. However, the STAT piece suggests that he had learned of this particular medication from a company-sponsored ‘lunch program.” That knowledge led to a patient encounter that resulted in a direct clinical benefit, according to the op-ed.
Thanks to what I had learned at the lunch program, I informed the family about this new medication and wrote a prescription for it. The drug eased the patient’s symptoms enough that family has been able to continue caring for him at home.
I’ve heard shifting explanations as to how this particular anecdote actually went down, and I second Seife’s call for an investigation to reconcile the discrepancies.
According to an email from STAT’s Skerrett, “[Yapundich] said he absolutely did not fabricate any stories, as Charles Seife alleged. He said he heard about the Parkinson’s drug from an industry rep, and spoke on its behalf later.”
But in my telephone conversation with Yapundich, he told me that he was already being paid to speak on behalf of the drug when the sales rep interaction occurred. In fact, Yapundich said, his ghost-written article didn’t correctly convey the details of what took place in the anecdote.
“It didn’t come out the way I intended it to,” he said, speaking of the op-ed that carried his name. “The article made it seem like I’d never seen the drug before and that was not what I intended.”
He told me he was well aware of the drug at the time of the encounter with the sales rep, and that the rep had said something interesting about the drug — “new medication data,” Yapundich called it — that “set off a light bulb” in his mind and subsequently led to the positive patient encounter.
“I hope there aren’t other parts of the article that escaped my editorial oversight or review,” Yapundich said. “The next time I do one of these op-eds, I should be the one doing the drafting and they should be the ones doing the editing and reviewing.”
It’s worth repeating that STAT has a well-earned reputation for editorial excellence and hard-nosed reporting. A single lapse won’t tarnish it.
Yet the issues raised by this situation cut to the heart of STAT’s credibility as a news source. And they’re not the only issues that we’re concerned about.
Here are my takeaways and suggestions for how STAT could proceed to repair the damage:
Lastly, I would encourage STAT to work more proactively to ensure the quality and authenticity of opinion page submissions. While authors of op-eds may get more latitude than they would in a straight news piece, the boundaries shouldn’t be so wide as to include ghost-written puff pieces from PR companies.
When I raised pointed questions about my concerns with STAT editors, they declined to offer a detailed response or even make an attempt to investigate further and get back to me. They told me I was “welcome to do that [myself].”
It is the job of STAT to correct this. Not HealthNewsReview.org or any other external entity. STAT has a big, well-funded operation – some of it supported by drug companies. It’s a matter of ethical decision-making. What kind of operation do they want to be?