Kevin Lomangino is the managing editor of HealthNewsReview.org. He tweets as @KLomangino.
[Editor’s note: In response to our reporting, STAT has updated the patient 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 the addendum at the bottom of this post for details.]
The author of a STAT op-ed headlined “You can complain about TV drug ads. They may have saved my life” says a PR company with ties to the pharmaceutical industry asked her to write the piece and edited it.
Deborah Dushane, whose op-ed credits television ads for hepatitis C drugs with motivating her to talk to her doctor about her condition, says the idea for the piece came to her from Meredith Crowder, an employee at what Dushane described as “an advertising company” located on Water Street in New York.
Though Dushane didn’t know the name of the company, we found an online listing for a senior account manager named Meredith Crowder working for WCG, a public relations firm. It describes itself on LinkedIn as “a global communications company that empowers you to connect with audiences in ways that are both meaningful and relevant.”
Reached by phone, Crowder confirmed that Gilead, a San Francisco-area pharmaceutical company that makes the hepatitis C drug Harvoni, was the WCG client whose interests were being promoted. She declined to answer any questions about the matter and referred me to Gilead’s public relations staff.
“[Crowder] called and asked me if I’d write something for the Boston paper,” Dushane said, referring to STAT.
Dushane’s essay reacts to a preceding STAT story that focuses on a $100 million advertising “blitz” by drug companies to stir up demand for their hepatitis C drugs. Those drugs have drawn fire for costing up to $90,000 per patient.
I asked Dushane if she had seen the preceding STAT story that she refers to and if that’s what motivated her to write. She said she hadn’t seen the STAT piece until Crowder brought it to her attention.
“She called me and talked to me about it. She asked me if I’d be willing to write something about my positive experience [with drug ads].”
It’s the second time in two weeks that the provenance of a STAT op-ed has been called into question and the influence of pharma PR handlers exposed. More problematic editorials with undisclosed conflicts of interest are flagged below. The revelations have led to renewed calls for STAT to examine its policies.
“Of course this is wrong, and it’s wrong because it’s deceptive,” says Carl Elliott, MD, PhD, a professor at the University of Minnesota Center for Bioethics and an affiliate faculty member in the School of Journalism and Mass Communications.
“I think the editors need to explain just what their policy is about corporate influence on the editorials they publish,” Elliott said. “Do they permit editorials that are completely ghosted by pharma? By a PR company working for pharma? What if the author wrote it himself or herself, but was paid to do it by pharma or a PR company? What if the author wasn’t paid directly to write the editorial, but was coached what to write and got other benefits from a company? All of these scenarios seem disturbing to me, and I’d like to know if they are disturbing to the STAT editors too.”
Arthur Caplan, PhD, a New York University bioethicist, said: “Any industry role in editing, funding, or writing articles must be disclosed. No exceptions. All news organizations need to be 100% committed to transparency. STAT needs to be sure its policies are clear about advertising, ghostwriting, sponsorship and editing.”
Charles Seife, a professor of journalism at New York University, called the situation “a breach of trust.” He said the incident involving Dushane raised the same concerns as last week’s exposure of ghostwriting in a STAT op-ed. That piece was finally retracted — four days after it was published — in response to an outcry from concerned readers and reporting by HealthNewsReview.org. Writing in Slate today, Seife said the listed author of that retracted op-ed had been drafted as a “sock puppet” to parrot industry views.
“The whole point of ghostwriting is to hide the hand of an actor — to make an industry position seem like it’s coming from an unaffiliated individual,” Seife told HealthNewsReview.org. “That’s deception. It’s meant to disarm the natural skepticism that we have when an industry makes self-serving statements. And when someone tries to disarm our skepticism, well, it ain’t good.”
Seife added: “From an editor’s point of view, taking part in deception, even unwittingly, undermines the credibility of the editor’s outlet. The reason that ‘fake news’ claims don’t stick to good news outlets is precisely because they don’t try to deceive. So it’s vital that they don’t cross that line.”
Reached by phone, STAT’s Executive Editor Rick Berke said his organization would never knowingly publish a piece that was ghostwritten. “We do not condone or accept pieces that use figurehead authors to disguise the role of any institution or company,” he said. He added that payment, editing assistance, or any other editorial contribution by parties other than the author should be disclosed.
He said that STAT had already started reviewing their policies regarding authorship and conflicts of interest and would be issuing new guidelines soon. He offered to share them with HealthNewsReview.org. He said they would also start looking more proactively at the federal open payments database to reconcile author disclosures with federal records.
Despite being made aware of a confirmed instance of ghostwriting and non-disclosed financial conflicts, however, STAT had not gone back through its archives to look for similarly deceptive material, Berke said.
Informed of the specific circumstances surrounding Dushane’s op-ed, Berke initially was adamant that I share with him what I proposed to write. Most serious journalists would consider such a request as anathema and ignore it, as we did. Later, Berke said he would have to withhold final judgment until someone at STAT was able to speak to Dushane. He said his initial inquiries with the editor who handled the piece didn’t raise any red flags.
Asked if he was concerned that the original idea and editing for this article came from a pharma-backed PR company and this fact wasn’t disclosed to readers, Berke said: “Nothing I have heard about this situation so far makes me uncomfortable. I think we’ve handled ourselves impressively.”
As far as I know, Executive Editor Rick Berke’s comments to me represent STAT’s first public statement on the issue of ghostwriting. STAT avoided the issue entirely in the editor’s note announcing last week’s retraction.
The editor’s note cited an “inaccurate” anecdote as the reason for withdrawing the article. But a correction – not a retraction – would be more appropriate if STAT truly believes that inaccuracy was the article’s main or only problem. Some critics have said that retracting and removing the original piece is hiding it – that web publishing ethics would dictate that the flawed original be left in place with clear explanation of what happened.
The more serious flaw in the piece, which astonishingly is not even mentioned in the STAT retraction notice, is that the physician who was listed as the author admitted that he didn’t actually write the piece and he doesn’t know who did. The fingerprints all point toward pharma-linked PR handlers.
Berke said that’s STAT’s evaluation showed that the retracted piece was “substantially false, and that renders everything else moot as far as I’m concerned.”
We disagree. It’s troubling that STAT failed to mention this deeper level of corruption directly to its readers. And it’s troubling that they didn’t publicly acknowledge potential flaws in their editorial vetting process that could lead to undisclosed conflicts of interest. It suggests an attempt to address this quietly without exploring or acknowledging other deceptions that may have already occurred.
The specifics of Dushane’s story are unsettling and should prompt STAT to dig deeper.
Although the idea for her STAT piece clearly originated with a PR company, according to Dushane, she says that she wrote the piece herself, wasn’t paid for it, and that her draft received only minor editing from the PR company. However, she said she also had received extensive coaching from Gilead-affiliated PR experts about how to communicate her message.
She told me about training sessions with what she described as “media people” where she was instructed to “always stay on message.”
I asked her, “What was that message?”
“If you have hepatitis C, it’s not about being judgmental,” she replied. “It is treatable and it’s curable. All you have to do is go to your doctor.”
She said she also has a message for insurance companies that balk at the high price of Gilead’s drug: “It’s cheaper than a liver transplant.”
Dushane says her journey from retired educator to advocate started with an email from Gilead inviting her to fly out to the company’s headquarters in California. At the company’s expense, she says she joined about 40 other people who’d been treated with Harvoni for a series of presentations on Gilead’s work over the course of two days.
“The president of the company spoke to us and we got to see the labs where the drug was developed, ” Dushane said. “They told us about the humanitarian projects they were supporting in Africa for people with hepatitis. I was impressed by what they’re doing.”
Gilead showed the group a preview of a new commercial that Dushane said was targeted at Baby Boomers. “It had trees and an outdoor theme that felt a little bit more palatable than the last one, which had someone telling you ‘It’s time.’ It felt almost like they were shaking their finger at you because you were a bad person.” (You can view the ad here.)
Gilead’s messaging also emphasized the need for people to get screened for the disease. “If you’re in a certain age group, get checked,” was the advice Dushane said was being promoted — the idea that doctors should be encouraged “to at least give an initial blood test” to everyone within a certain age range.
According to the investor-focused website FiercePharma, this message is part of a Gilead “awareness push” intended to reverse flagging sales for Harvoni. “Targeting unaware baby boomers could unearth new patients that need treatment,” according to the piece.
After returning home from California, Dushane said she was contacted by someone at an advertising company. “They said they’d be booking us to speak in different places,” she said. “I’ve been on TV a few times, usually it’s very early in the morning and only for 5 or 10 minutes. But you’d be amazed how many people come up to you afterward and say, ‘I saw you on TV!’”
On one of her appearances on NBC 24 in Toledo (click here for video) Dushane kicked off the interview by declaring in no uncertain terms what the take-home message was: “There are a number of drugs you can take in regards to hepatitis C, but the one I would like to promote now is Harvoni because it’s a 12-week treatment, very few side-effects and miraculously I’ve been cured after having the disease for 30-plus years.” [emphasis added]
Our reporting demonstrates unequivocally that undisclosed pharma relationships have occurred repeatedly in past STAT op-eds and continue to this very day.
Case in point is this March 2016 op-ed that carried the pharma-friendly headline, “Why some drug prices should be high.”
You might imagine this is something that would come out of a pharmaceutical company marketing department. But the two co-authors of the piece describe themselves merely as “physicians caring for patients and health policy researchers studying drug pricing and health care markets.” The bio at the end of the STAT piece makes no mention of any financial disclosures.
Running a simple search on the open payments database tells a somewhat different story. Author Anupam Jena, MD, PhD received some $14,000 in the year prior to writing the op-ed from a variety of pharmaceutical companies including Vertex, Bristol-Myers Squibb, Novarits, Pfizer, and others.
Small potatoes, you say? Consider that these are only the traceable payments. He is also on the payroll of Precision Health Economics, a consulting firm which has counted at least 25 different pharmaceutical companies on its roster, according to ProPublica. Among these are Gilead, Amgen, Bristol-Myers Squibb, and AbbVie, the leading makers of expensive new cholesterol and hepatitis C drugs. Those types of drugs figure prominently in the argument put forth by the STAT op-ed.
Precision Health Economics touts its ability “to lead “formal public debates in prestigious, closely watched forums” via its all-star roster of academics like Jena. STAT seems to be playing right along with the firm’s marketing plan, and failing to give readers the context they need to evaluate the arguments being made.
And just today — amid continuing strong criticism of STAT’s failure to properly vet conflicts of interest — Jena is listed as a coauthor on a STAT First Opinion piece headlined, “How one city’s VA health system has greatly reduced opioid prescribing.”
At first glance the piece may not appear to raise any conflict of interest concerns, but a critical reader might catch this line: “One is to work with providers to help them taper their patients off opioid pain relievers and transition them to non-opioid pain medications such as gabapentin and pregabalin.”
Gabapentin’s brand name is Neurontin, made by Pfizer. (It is also available as a generic.) Jena disclosed nearly $4,000 in payments from Pfizer in 2015 among other drug industry payments.
I will reiterate that there are many excellent journalists who write for STAT and whose work we praise on a regular basis. Their stories meet or exceed the highest health care journalism standards and are a model for the industry. The problems we shine a spotlight on may reflect poorly on some aspects of STAT’s operation, but it does nothing to tarnish the first-rate work that these journalists produce on a daily basis. We are not alone in calling for STAT to acknowledge and address the problems that we and others have identified and that have gone unaddressed publicly until now. Our Twitter timeline is filled with messages like this one that call for STAT to take a deeper look.
— Sunil K Sahai MD (@DrSunilKSahai) September 10, 2017
NYU’s Seife agrees that STAT “needs to take the problem of ghostwriting seriously.”
“At a minimum, I think they should delineate what they do and don’t find acceptable when it comes to an author’s conflicts of interest — as well as what must be disclosed and what need not be. And they should figure out precisely what needs to be done when those lines are crossed.”
Bioethicist Elliott added that STAT needs to call attention to problems with the Dushane op-ed. “One argument for not retracting would be that you want something like this to stand as a warning sign, not to disappear. But whether or not it is retracted, it has to be flagged. And STAT has a lot of explaining to do. That’s what I want to see more than anything. It bothered me that they never explained that the other editorial was ghostwritten by a PR company.”
HealthNewsReview.org is a small operation that simply doesn’t have the resources to investigate all of STAT’s prodigious output. This is STAT’s problem to address. Readers and patients who count on STAT for balanced and accurate reporting are likely to be misled by this deceptive content and it’s unethical to let this continue.
Addendum 9/14/17: On September 13, 2017, a day after this post raised concerns about the provenance of a STAT op-ed that highlights the value of television commercials for hepatitis C medications, STAT updated the post to include a disclosure about the author’s ties to drug company Gilead. Here is the revised disclosure:
Deborah Clark Dushane, a retired educator, is enjoying a hepatitis-free retirement in Temperance, Mich. This article originated as a “thank you” letter she wrote in December 2015 to Gilead Sciences, a pharmaceutical company that makes drugs to fight hepatitis C. She was asked to turn it into an op-ed by W20, a PR firm for Gilead. Dushane wrote the article, which she said was lightly edited for grammar by W2O. She received no compensation for the piece. After it was published, she appeared on several local TV stations. Gilead then paid for her to fly to California to learn more about the company and its products.