‘Ethical bordellos:’ Op-eds don’t always disclose Big Pharma conflicts of interest

Mary Chris Jaklevic is a freelance health care reporter and regular contributor to this blog. She tweets as @mcjaklevic.

Drug companies have been promoting their views on the nation’s op-ed pages via commentary writers who come across as neutral-sounding experts, and editors don’t always call out these industry mouthpieces for what they are.

pharma op-edsPharma-friendly guest columns have appeared on editorial pages around the country without disclosure of the authors’ drug industry ties, including the Philadelphia Inquirer, Austin American-Statesman, and USA TODAY Network, HealthNewsReview.org found.

Last month STAT News retracted a commentary praising drug industry sales reps after the physician whose byline it contained was found to be on the pharma payroll. The physician, a board member of the industry-funded Alliance for Patient Access (AfPA), also admitted to HealthNewsReview.org that it was ghostwritten. Another commentary in STAT, which praised drug ads, was written by a patient who said a PR firm employed by a drug company helped her write it.

Op-eds disclosures contrast sharply with news reporting

But while STAT has taken a lot of heat for the lack of transparency, it’s clear other publications aren’t informing readers about conflicts of interest on their op-ed pages.

We found a dozen examples with some connection to the little-known AfPA, which HealthNewsReview.org recently profiled in detail. A writer’s affiliation was sometimes disclosed, but with no mention of the organization’s financial backing. In some cases, physician writers had personally accepted pharmaceutical money that was not disclosed.

‘Ethical bordellos’

This is a sharp contrast to transparency standards for news reporting. Edward Wasserman, dean of the Graduate School of Journalism at the University of California at Berkeley, goes so far as to describe op-ed pages as “ethical bordellos,” where editors in need of content are sometimes complicit in concealing the connections between a writer and the subject of a column.

“The kinds of disclosures that would be routine in news coverage —  by which I mean when you’re quoting somebody, if that person has a connection to the subject that isn’t clear from the context in the story then you need to disclose it to your readers — those standards have rarely been applied to op-ed contributors,” Wasserman said.

Not everyone’s assessment is as harsh. “I think there’s a bit of naivete on the part of editors,” said Sharon Batt, author of the book “Health Advocacy, Inc.” She noted heightened skepticism among some journalists that’s led to more critical reporting of pharma-funded advocacy groups in recent years, while op-ed editors in the same newsrooms don’t seem to be asking questions about where advocacy groups get their money.

Three pharma-friendly commentaries in 2017

Just this year:

  • The USA TODAY Network, an online amalgam of content from Gannett publications nationwide, ran a column entitled “Insurance companies block heart disease treatments,” by Craig Davis, who’s identified as a “an Orlando resident” and “volunteer patient advocate for the Global Healthy Living Foundation.” The column cites data from the Institute for Patient Access, a sister organization of the AfPA, showing that “thousands” may have been denied access to an expensive cardiac drug, a PCSK9 inhibitor, and urges readers to sign an online petition to “ask the National Association of Insurance Commissioners to help address the alarming rejection rates that qualifying patients across the country face in accessing new, groundbreaking, cholesterol-lowering medications.” The piece didn’t mention that both the institute and the foundation are funded by companies that have invested in that drug. After HealthNewsReview.org inquired, its tagline was expanded to identify Davis as “a volunteer patient advocate for the Global Healthy Living Foundation, a national non-profit organization, which advocates for improved quality of life for people with chronic disease. GHLF is supported by various pharmaceutical and biomedical companies and university and college institutions.”  
  • The Austin American-Statesman ran a piece entitled “Protect patients from nonmedical prescription switching,” by Joshua Stolow, M.D., who is identified as a board member of the Coalition of State Rheumatology Organizations and a member of the Alliance for Patient Access. The commentary advocated pending Texas legislation that would block health plans from ever switching patients to cheaper but similarly effective drugs once a patient has a prescription. The paper didn’t note that both groups Stolow is affiliated with are funded by drug companies, and that Stolow received $7,650 in drug company payments from August 2013 through 2015, according to ProPublica’s Dollars for Docs.
  • The Philadelphia Inquirer ran a commentary by AfPA executive director Brian Kennedy, titled “Insurers make troubling decisions on new treatments,” which argued that health plans’ decisions to deny coverage for a newly approved $300,000-a-year medication for Duchenne muscular dystrophy “set a dangerous precedent.” In okaying the drug for sale last year, the FDA said there was insufficient data to show the drug, Exondys 51, helps patients. The paper identified Kennedy’s affiliation, but did not mention how the AfPA, which he runs, is funded.

Editors aren’t always open about their practices

pharma op-edsEfforts to find out how these commentaries ran without mention of the drug industry ties of their authors met with limited success.

Gannett spokeswoman Chrissy Terrell emailed this response: “Our Network newsrooms follow ethical principles, which are posted on the home page of our websites.” She provided a link to their guidelines, which call for opinion pieces to adhere to “the same standards of accuracy as news stories” but don’t require opinion writers to meet transparency standards, as Gannett journalists do.

Terrell added: “The original version of the opinion piece left out information, which may have confused some readers, and The (Fort Myers, Fla.) News-Press staff addressed (this) by including more in the tag line.”

American-Statesman Editor Debbie Hiott thanked us for asking about her paper’s disclosure policies, but she didn’t give details about the paper’s process. Hiott said in an email: “We do have an expectation that writers divulge conflict of interest. We’ll go back and review this case and our procedures to make sure we are handling it as we should, and I look forward to seeing the suggestions in your article.”

The Philadelphia Inquirer’s editorial page editor, Harold Jackson, indicated it’s up to readers to discern potential conflicts. He wrote in an email:

“Our policy in publishing commentary by outside sources is to identify the organization the person represents in expressing an opinion and, with that person’s permission, publish his email address so readers may directly contact the writer with any questions or observations they may have. We believe that provides readers with enough information to do their own research about the writer’s affiliations. If there are occasions when we believe more information should be published, we do our best to provide it.”

Sandra Shea, managing editor in charge of opinion for the Philadelphia Media Network, which owns the Inquirer, added:

“These are opinion [emphasis by Shea] pages. We assume that readers are intelligent enough to understand that opinion writers may have agendas. They are not news stories, and are by nature subjective. The expectation that we would report on sources of funding for an organization or individual submitting an opinion is not realistic, and I can’t imagine any publication would contemplate such a policy.”

But is it realistic to expect every reader to contact the writer to inquire about potential conflicts? And while identifying a writer’s affiliation might be adequate if it’s a well-known group, such as Blue Cross Blue Shield or the American Hospital Association, most readers wouldn’t be familiar with the AfPA or the GHLF. Shouldn’t editors offer some information about little-known groups to help readers evaluate arguments they put forth?

Charles Seife, a journalism professor at New York University who’s sued the FDA to obtain information about the approval process for Exondys 51, the drug cited in the Inquirer column, said it boils down to whether a typical reader would be deceived.

“I think it’s deceptive to portray a PR guy paid by pharma to do their bidding as some kind of patient advocate, so yes, I think the description at the end of the (Inquirer) piece is inadequate,” he wrote. “It would have been nice had the Inky caught the issue with just a bit of background research — simply wondering ‘who are these guys?’ would have helped. But, frankly, it’s not easy to make a hard distinction between outright front groups and industry-backed fellow-travelers and think tanks — and what difference it should make if one could make that distinction.”

Some publications do ask writers to divulge their ties. In the past at least, the New York Times has required op-ed writers to sign an agreement to disclose financial interests in the topic they’re writing about to Times editors.

USA Today includes this sentence in its commentary submissions guidelines: “If you or a business, trade group or other institution with which you are associated stands to gain financially or in any other way from your column, you should disclose that information to us in detail. In most cases, it should also be included in the body of the piece or in the author’s biographical information.”

The Washington Post asks that op-ed writers “disclose any personal or financial interest in the subject at hand.”

“It’s important to disclose anything that may amount to a conflict of interest,” Post media columnist Margaret Sullivan said in an email. “This can be done by describing affiliation in an identification line or in any editor’s note. The more that readers can understand about where a writer is coming from, the better.”

Publications have limited incentive to promote disclosure

Unfortunately, there’s not always an incentive for editors to probe. Commentaries by outside writers constitute free content and fulfill the mission of providing diverse voices. With media organizations cutting editorial staffs, special-interest groups are happy to step in and fill the content void. “If the publication isn’t paying, then somebody is,” Wasserman noted. He said newspaper opinion sections “have always been the recipient of largesse subsidized by undisclosed sources.”

More problematic op-eds

Internet searches and a perusal of the AfPA web site turned up 12 op-eds with AfPA connections published since 2011. None disclosed drug industry ties. HealthNewsReview.org did not search for op-eds connected to other pharma-backed groups. Among those we found:

  • To curb opioid addiction, give patients and doctors more choices for pain, in The Hill, by Roy Soto, M.D. Soto is identified as a member of the Alliance for Patient Access. Not mentioned is that the alliance is funded by two companies that make opioid alternatives, Pfizer and Purdue Pharma. Soto received $118,000 from drug companies in 2015, mostly from Mallinckrodt, maker of Ofirmev, an injectable acetaminophen that is considered an opioid alternative.
  • Keep Physician-Patient Relationships Healthy in 2015, in the Chattanooga Times Free Press by Joseph Huffstutter, M.D. The piece supports state legislation to “require pharmacists to communicate to physicians which biological product they dispensed” to patients. Huffstutter’s identified as “a Chattanooga rheumatologist and serves on the National Physicians Biologics Working Group with the Alliance for Patient Access.” Huffstutter received $404,135 from drugmakers from August 2013 to the end of 2015, with large payouts coming from the makers of brand-name biologics such as Stelara and Simponi. 
  • Over-regulation of drugs not the right prescription in the Columbia (Mo.) Daily Tribune, by AfPA board member Srinivas Nalamachu, M.D. Nalamachu, who argues for an end to “onerous” regulations of pain medication, received more than $800,000 from drug companies between 2013 and 2015, according to Dollars for Docs. The publications gives no background information about the writer.

Editors might believe the op-ed label relieves them of responsibility. “They can post (submissions) with very little scrutiny as an op-ed,” said Lisa Graves, executive director of the Center for Media and Democracy, a corporate watchdog group. “It’s happened with a lot of papers. It’s a nod to the blog world.”

Pharma is following the playbook of other industries

Op-ed opacity isn’t a new issue. In 2011, a corporate watchdog focused on energy policy, the Checks and Balances Project, campaigned to increase transparency on the Times op-ed page, citing a Times op-ed by Robert Bryce, a senior fellow at Manhattan Institute, which didn’t mention of the institute’s ties to the petroleum industry.

“We see The New York Times as the standard bearer of journalism, the nation’s paper of record,” Gabe Elsner, leader of the project, told the Columbia Journalism Review. “We think that they can set the standard and everyone else would likely follow. It’s a common sense practice that if there are people putting out opinions, readers should know who they are and where they’re coming from.”

Of course, not everyone agrees what constitutes adequate disclosure, and standards may be different in print due to space and technical constraints.

Former Times’ public editor Arthur Brisbane — whose old position incidentally was eliminated this year — grappled with that issue in a 2011 column, suggesting print editions include a writer’s current paid role while web versions include links to a writer’s organization and a document listing current paid positions.

Brisbane concluded: “These steps aren’t as simple as perhaps they sound, and, even if done well, some readers will ask for more.”

It seems clear more scrutiny is needed at a time when op-ed pages are being used as covert PR tools. “This is an instance where the editor needs to be the proxy for the reader, which really is the editor’s job,” Wasserman said. “If the editors aren’t doing that, then the reader is really up a creek.”

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