Mary Chris Jaklevic is a freelance health care reporter and frequent contributor to HealthNewsReview.org. She tweets as @mcjaklevic.
Kevin Lomangino is the managing editor. He tweets as @KLomangino.
On November 8, MedPage Today, one of the nation’s most widely read physician news sites, published a scathing critique of insurance industry functionaries headlined “Who is actually reviewing all those pre-authorization requests?”
The post was the most popular article on the site for more than a week.
While many readers praised the piece for exposing what they described as unethical practices in the health care payment system, others questioned the article’s accuracy and its characterization of the preauthorization process, which is a special approval insurers require before they’ll pay for certain (often costly) treatments. The piece made no mention of the author’s sizeable income from the pharmaceutical industry.
HealthNewsReview.org began looking into those questions after a reader brought them to our attention on Twitter. In response to concerns we and others raised, MedPage Today Editor-in-Chief Peggy Peck wrote a column headlined “If It’s a Blog, Is It Journalism?” where she argued that blog posts like the one in question should not be held to journalistic standards for accuracy.
She said that MedPage Today readers know not to mistake its blog content for “news” or “facts,” and that unsubstantiated stories and missing financial disclosures are “par for the course in the blogosphere.” She added:
blogs are not news articles, not editorials, not op-ed pieces, not analysis. Blogs are simply musings and opinions by the individual authors. They are stories shared about the dinner table.
We couldn’t disagree more.
As bloggers and journalists who care about the quality of health care information presented to professionals and the public, we think it’s irresponsible for a news organization to present unvetted, unsubstantiated “dinner table” stories without better explanation of what readers are being served.
And we think it’s wrong to believe that readers understand Peck’s distinction between blog posts and journalism and the differing standards that MedPage Today applies.
MedPage Today, after all, isn’t clear on that distinction itself.
While Peck claims that blogs are not to be confused with “news,” the publication’s “Blogs and Columns” appear under the “News” tab on the MedPage Today site. This blog content looks the same to readers as any other MedPage Today article written by its journalists and op-ed contributors.
Peck further states that a “column” is different from a “blog” because it has “a timeline established and sources clearly identified.” But the blog that’s the focus of this debate – “Revolution and Revelation” — is promoted to MedPage Today readers as a “popular column.”
Moreover, a section called “About this content,” which seemingly applies to all content on MedPage Today, would lead readers to believe that blog posts are edited for accuracy, objectivity, and balance. It reads:
Content on this page was created or selected by the Everyday Health Media team and is funded by an advertising sponsor. The content conforms to Everyday Health Media’s editorial standards for accuracy, objectivity, and balance. The sponsor may select the topic but does not edit the content. [Everyday Health is the digital media company that owns MedPage Today; our emphasis added to the quote.]
In fact, there’s no universal definition of what a blog is or isn’t. (There are some interesting ideas about that here.) Peck argues that there’s an obvious distinction between blog content and journalism, and she told us that there’s nothing she can do “if people are stupid enough” to mistake a blog for actual reporting.
But some blogs feature journalism. And many journalists have written blogs. Some news organizations have started blogs that have morphed into something else. For example, the New York Times previously called its Well personal health column a “blog.” Similarly, NPR used the term “blog” for its Shots health news coverage. Now they both use the word “section.”
It’s hard to keep up with the changes. And average readers who live in the clinical and research world could be excused for not understanding a distinction that Peck – a journalism professional — thinks is so clear.
The piece that sparked this discussion, written by veteran cardiologist Milton Packer, MD, is a good example of a blog post that would have benefited from more editorial oversight.
The post describes an exchange Packer said he had with retired physicians who are employed by health plans to make coverage determinations for drugs. He said the doctors had just listened to him deliver a talk on heart failure drugs.
Without naming his sources, Packer wrote that the doctors told him they typically deny payment requests for life-extending medications because those drugs are “too expensive,” and one said “if I approve too many expensive drugs, I won’t get my bonus at the end of the month.”
Many people commenting online and in interviews with HealthNewsReview.org said the post conveyed multiple misconceptions about how health plans actually work.
Yet the piece drew more than 100 comments, many of which said Packer’s account affirmed a view of insurers as unscrupulous behemoths. Nine days after the post debuted it was still the most popular article on the site. Commenters called it “sad,” “disheartening” and “horrifying.” One lamented “across the board ridiculous profits of [insurance companies]. Shareholder profits are the priority, not the healthcare of policyholders.”
But most of those commenters and the presumably thousands of others who read the piece missed some important context: Packer has received more than $400,000 from drugmakers since 2013, including companies whose costly medicines are subject to pre-authorization. His financial ties weren’t disclosed on the blog until a week later, four days after the omission was flagged on Twitter and a day after HealthNewsReview.org asked about it.
Peck told HealthNewsReview.org that the missing disclosure was the result of an editing error and that it has run with his previous columns. An archived version of Packer’s Nov. 1 post, another jab at the insurance industry headlined “Are Payers the Leading Cause of Death in the United States?” suggests it initially ran without disclosure as well.
MedPage Today appears to do an admirable job generally of disclosing financial relationships of its writers and sources as well as the funding sources of studies. Peck said she pioneered the idea of calling out those relationships in a colored box at the end of each story. This is commendable.
But missing disclosure wasn’t the only concern with Packer’s piece, which implies that health plan employees routinely deny claims not based on medical necessity but to protect monthly bonuses. Those claims should be supported.
We’ve tried to track down the source of the account – apparently an attendee at Packer’s talk — because we agree that Packer’s depiction, if verified, is shocking and should be investigated. In an email on November 17, Packer said he was traveling and could not provide the names of either the person who invited him to speak at the meeting or any of the attendees. He said he would look up this information when he returned to his office and added, “The story occurred exactly as I said it did.”
Tom James, MD, senior medical director for medical policy and quality at Pittsburgh-based Highmark, who has 38 years of experience working for health plans, told HealthNewsReview.org that Packer’s blog depicts a “stereotype” of pre-authorization. “This is not the way the world works today,” James said.
While time-consuming for doctors, pre-authorizations do effectively limit spending on pricey drugs. But James said simply handing out bonuses based on coverage denials would violate ethical guidelines and state laws.
Some MedPage Today commenters tried to provide the context that was missing from Packer’s story. For example, a woman who identified herself as a pharmacist working in managed care pointed out that insurers can’t easily boost profits by denying coverage for medically necessary treatment, as the piece implies. That’s in part because the Affordable Care Act requires health plans to spend at least 80 percent of premiums on medical claims and quality improvement, or at least 85 percent for large group plans.
Cindy Thomas, PhD, a professor and associate dean for research at the Brandeis University Schneider Institute for Health Policy, said that payers should be more transparent about how they decide which treatments need pre-authorization and which patients get approvals, as well as how much they pay for drugs.
However, if Packer’s account reflects widespread practice in the insurance industry, Thomas said, there should be some evidence of that. If health plans are paying bonuses for payment denials, “someone should come forward and reveal specifics of the arrangements,” she added.
No doubt many MedPage Today readers would agree with Thomas’s call for more investigation. But that’s difficult without specific information, including names and dates
, which Packer doesn’t provide.
It’s clear that many commenters didn’t realize this blog post was, in Peck’s terms, a mere musing and that it didn’t portray facts. They were disturbed by the portrait of corruption that Packer painted.
As a commenter who identified himself as Ronald Levy wrote in response to Peck’s editorial:
Dr. Packer’s reports are a LOT more than musings and opinions. He makes factual revelations, like his first hand reports of how preauthorization requests are casually turned down (perhaps unlawfully in some cases although he didn’t say this) that can be of life-and-death importance to thousands of patients, perhaps millions.
To clear up any confusion about the editorial standards that apply, we encourage Peck to make her “dinner table” story disclaimer more visible on Packer’s post itself. Surprisingly, that post doesn’t currently link to her editorial that supposedly clarifies its purpose.
Ideally, MedPage Today should insist that its opinion writers back up assertions on matters of public debate with verifiable sources whenever possible. That’s something HealthNewsReview.org, with its comparably tiny staff, is always careful to do with blog posts and especially with outside contributions.
While we’re not perfect and we may miss some things, our starting and ending point is the assumption of a responsibility to verify. We would never allow unsubstantiated statements to be published without editorial scrutiny merely because they are opinions.
At the very least, we recommend that a disclaimer run on all of MedPage Today’s unvetted blog content, which should clearly be marked “commentary” with an explanation of what editorial standards apply to the content and which ones do not.
MedPage Today bills itself as “a trusted and reliable source for clinical and policy coverage that directly affects the lives and practices of health care professionals.” We think that’s generally true of the site’s high-quality journalist-written news content.
But is some of MedPage Today’s most popular content “trusted and reliable” when the organization admits it does little to vet such material?
Peck seems to think this is justified because, as she told us, it’s her job “to run the kind of content that drives traffic to the site.” And according to that metric, apparently, Packer’s blog qualifies as “a success.”
A news organization ought to measure success by more than clicks, or even the number of comments an article generates. It’s easy to get people to read and share provocative opinions that reinforce what they already believe, or want to believe. It’s harder and more important to get them to read something that deepens understanding of a complex issue.