Tone deaf again on pharma conflict of interest: STAT piece praising drug reps fails to disclose industry payments

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Conflicts of interest in healthcare[Editor’s note: The STAT article that’s the subject of this post has now been retracted following our investigation showing that the physician listed as the author did not write the piece, and that the content of the article was initially crafted with the assistance of a public relations firm.]

I woke up this morning after a long holiday weekend thinking that STAT, the well-regarded science and health news outlet, would surely have addressed this article that it published on the Friday morning before Labor Day.

The opinion piece was headlined  “How pharma sales reps help me be a more up-to-date doctor,” and it was written by Robert Yapundich, MD, described as a “neurologist in practice for more than 20 years.”

Yapundich praised drug salespeople for providing doctors with “vital nuggets of information on the latest treatments.”

But he failed to provide this vital nugget about himself: He’s been paid well over $200,000 from drug companies since 2015, according to the federal government’s open payments database.

Yapundich is certainly entitled to his opinion as to the merits of drug detailing, and STAT is entitled to publish them. But they’re both obligated to disclose that he’s being paid directly by the industry which profits from physician-sales rep interactions. That’s a strong conflict of interest — something we think is a growing problem in health care and health care journalism.

We were not the first to notice this problem, which was widely shared on Twitter and discussed in the comments section of Yapundich’s post.

But since it’s now been four days since the article was posted and there’s been no update or clarification, I think we’re obligated to ask: What’s going on here?

Moreover, I think it’s important for STAT to address some other questions that were raised in the comments section of the post by Charles Seife, a professor of journalism at New York University. Seife wrote:

Could STAT please reconcile the following two statements?

a) The author had not heard of a drug for Parkinson’s Disease Psychosis (implied to be Nuplazid, the only drug approved for this condition) until a recent “lunch program” with a drug rep.

b) The author was paid $5,600 on 12/8/2016 (cash, in two payments) by Acadia Pharmaceuticals for “Consulting” regarding Nuplazid, as well as two more payments of $525 on 11/23/2016 (consulting; in-kind services) and $600 (consulting; in-kind services) also regarding that same drug.

(Source for B: CMS’ Open Payments system — https://openpaymentsdata.cms.gov/physician/110034/payment-information )

If STAT is not able to reconcile these statements, it should retract the article.

I reached out to Pat Skerrett, who edits the First Opinion section for STAT. He told me that he was unplugged over the holiday weekend and that this morning was the first he’d heard of the problems with Yapundich’s piece. He said that STAT’s author agreement requires disclosure of any financial conflicts of interest, and that Yapundich hadn’t declared any. He said he had emailed Yapundich for clarification this morning and was hoping to hear back soon.

“It disturbs me a lot,” Skerrett said, referring to Yapundich’s apparent failure to disclose significant conflicts of interest.

He said that he was especially concerned that there might be “dishonesty” in how Yapundich framed the anecdote about Nuplazid — something which he said “very well could lead” to STAT issuing some kind of clarification or correction on the piece.

We’ve written plenty about Nuplazid, and how the company PR and related news coverage tended to downplay the significant harms and high cost of the drug, and gloss over the skimpy supporting evidence.

In its own news coverage about the drug, STAT noted that “for every two patients who are expected to achieve ‘much improved’ status as a result of Nuplazid, one patient experiences a serious adverse event.”

What are the chances that company sales reps are going to fill doctors in about these messy details, which conflict with the optimistic anecdote that Yapundich shares about the drug in his essay?

My guess is that they’re not good. That’s one reason why some academic medical centers are restricting visits by pharmaceutical sales reps, and perhaps why those restrictions are associated with reduced prescribing of brand name drugs and higher use of generics.

STAT features plenty of first-rate journalism, and it regularly win plaudits from us in our story reviews and 5-Star Friday feature (see this example which called attention to three STAT standouts).

But we’ve also criticized its practice of accepting sponsorship from PhRMA (the Pharmaceutical Research and Manufacturers of America) for its Morning Rounds email — as well as other drug industry funding.

We think that such arrangements represent a serious conflict of interest. They are tone deaf and should raise questions in the minds of readers about how their news gets made and whose interests are being represented.

Those questions become even more relevant in the wake of an article like this one.

Update 9/6/17:

STAT has revised the bio at the end of Dr. Yapundich’s article to include relevant financial disclosures (see below). We are working on a follow-up post that will address this and other issues related to the op-ed.

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.

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Carolyn Thomas

September 5, 2017 at 2:51 pm

Thanks for this, Kevin. I see that STAT’s now added a conflict of interest disclosure to Yapundich’s essay (but the dollar amount is bigger than we thought, and the extent of his conflict of interest even more distasteful, e.g “Robert Yapundich, M.D.,… is 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.”

No discussion of his preposterous claim that, were it not for that super-helpful drug rep, he’d never have heard about Nuplazid, and no answers yet to Charles Seife’s excellent questions, and, far worse, no decision to retract the article in the first place.

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Charles L Carter

September 5, 2017 at 9:06 pm

I saw this on STAT and posted my own criticism of both the author and STAT. I recalled mention here of STAT’s COI in accepting financial support from the pharmaceutical industry. All but one respondent among the comments was highly critical of Yapundich and his piece. The sole exception wrongly inferred that being influenced by reps equates to gullibility and that doctors are too intelligent for that.
STAT’s articles generally seem to be in the public interest but Yapundich’s piece, without financial disclosure, raises serious questions about their editorial policies and credibility.

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Jason Barritt

September 5, 2017 at 11:22 pm

This is not a growing problem its been like this for decades. So have the opiate problem. Were you people sleeping since the 90s

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