Is journalism the drug industry’s new dance partner?BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d6978 (Published 02 November 2011) Cite this as: BMJ 2011;343:d6978
All rapid responses
Clive Mathieson, Editor, The Australian
Adam Cresswell, Health editor, The Australian
In his recent critique of the Health of the Nation series published by Australia’s national daily newspaper, The Australian, Ray Moynihan concludes with a plea that reporting of new drugs or pharmaceutical company views be done “fairly and accurately”.
We agree, and wish he and fellow critic Melissa Sweet had held themselves to the same standards.
To refresh BMJ readers’ memories, both Ms Sweet (Sweet M. Experts criticise industry sponsorship of articles on health policy in Australian newspaper. BMJ 2011;343:d6903) and Mr Moynihan (Is journalism the drug industry’s new dance partner? BMJ 2011;343:d6978) took issue with The Australian’s Health of the Nation series, which was sponsored by the Australian pharmaceutical industry’s umbrella body, Medicines Australia.
Both suggested the arrangement would allow drug makers, now or in the future, to exert inappropriate influence over editorial content. Sweet quoted Gary Schwitzer, publisher of the US-based HealthNewsReview website, as saying the deal amounted to the “drug industry influencing public discussions in one more infectious way”.
For his part, Moynihan claimed one of the deal’s “most insidious effects will be self-censorship – invisible, immeasurable, but chilling in its effect on the free flow of public debate”.
Not a shred of evidence was offered to support such assertions, which is not surprising, because they are not true.
There are two separate issues to consider. One is whether the HOTN series was compromised by the source of its funding, and pandered to drug industry interests; the second, whether such deals impair a newspaper’s ability to scrutinise the drug industry in future.
You would think any fair-minded look at the first question would start with an account of what was printed as part of the series. Yet, remarkably, neither Sweet nor Moynihan attempted this. Indeed, it remains unclear how much of it they, or those they interviewed, have read: Sweet wrongly states the series appeared on 15 October, by which date nearly 25,000 words had in fact already been published under the HOTN banner, in 23 separate articles.
For the record: 12 pages of material were published in the Inquirer section of The Weekend Australian for the HOTN series between July 30 and October 15. (Selected elements of this coverage were later reprinted in a one-off Health of the Nation magazine, which appeared on 22 October.)
Of these, just one page (published on 27 August) addressed medicines policy. It contained an even-handed account of the affordability challenges created by expensive new drugs that, for all the hope they offered patients, often translated into very slender improvements in patient outcomes.
This article was accompanied by a comment piece from an independent expert from the University of Sydney, chosen by The Australian’s journalists, who argued taxpayers should be paying much less than current practice for a range of generic drugs on the publicly-funded drug subsidy program, the Pharmaceutical Benefits Scheme – a notion that is anathema to Medicines Australia, the series sponsor.
And as far as pharmaceuticals and taxpayer-funded public drug subsidies are concerned, that was about it.
Direct-to-consumer advertising of prescription drugs is banned in Australia, and none of the advertisements accompanying the editorial named let alone advertised any drugs, or included branding specific to individual drug companies.
The other elements of the series, which all carried a declaration of the sponsorship, addressed various systemic strains. We reported on the growing problem of out-of-pocket costs, including the case of one cancer patient who had to find $17,000 to pay for her cancer surgery and other treatment despite having top-level private insurance. Other issues included the rise of chronic disease and the altered balance of hospital and community care required to cope with this; areas such as mental and dental care that are currently not well provided for, and the challenges faced in the introduction of electronic health records.
None of these stories gave a free kick to the drug industry’s commercial agenda, yet by omitting these details Sweet and Moynihan suggest the reverse.
As for the second issue, whether future coverage will be compromised, Sweet and Moynihan both implied the arrangement will see The Australian cowed into taking a more industry-friendly line.
Yet on this point, too, the evidence points the other way, as The Australian has reported critically on the pharmaceutical industry at least as much, if not more, than rival papers.
To take just two examples: on 30 July, when the HOTN series was already in train, the paper ran a story that Pfizer was paying pharmacists $7 a time “to enrol patients in support programs in an effort to ensure they keep taking the pills the drug company makes” – potentially earning pharmacists $8000 a year. And on Monday October 10, two days after the series ended, The Australian reported the drug industry had been “paying specialists up to $1500 to sell the benefits of new products to their peers… raising questions about the independence of the medical profession”.
Not only is it wrong to claim scrutiny will be lessened, it betrays a misunderstanding of how newsrooms operate that is so fundamental, it is hard to believe Sweet and Moynihan both once worked in them.
Sweet quotes Gary Schwitzer as claiming journalists should not be “party” to such sponsorship deals, while Moynihan claims that the “next time there’s a call to the editor’s office from a drug company, it’s not just another promotional player on the line, it’s a co-sponsor of the paper’s journalism”.
Both these comments overlook the obvious point that advertising deals are strictly between advertisers and advertising departments. Journalists are never “party” to them, and neither are they party to any “relationships… friendships, alliances and back channels” such deals might create. To non-journalists, this will sound like hair-splitting; in fact, it is a crucial distinction on which all journalists at commercial organisations rely, every single day.
Every day, advertisements appear in major newspapers for supermarkets, banks, liquor chains, airlines and other clients as part of long-term advertising deals that are worth far more than the HOTN sponsorship. The idea that those companies are buying fawning coverage in placing these ads is absurd. The HOTN deal is no different.
Potential conflicts of interest are ubiquitous, and are not unique to media sponsorship deals. We argue almost all such conflicts can be managed, ethically and successfully. For reassurance that is the case, we need look no further than the BMJ, which (as declared at the end of Ray Moynihan’s article) runs an annual awards scheme itself partly funded by pharma sponsorship. Likewise, Ms Sweet has also for many years accepted regular freelance income from professional medical publications that are largely funded by pharma company advertising promoting specific prescription drugs -- which again suggests the source of funding does not invariably contaminate editorial content.
Many researchers, academics, clinicians and others find that commercial realities require them to seek industry funding for their activities. Some, at least, are growing tired of the implication that such links are “tantamount to malpractice” (Comment on Croakey blog http://blogs.crikey.com.au/croakey/2011/10/28/adam-cresswell-responds-to...). It is time to ask if a more nuanced -- and evidence-based -- debate over conflicts of interest in health is now overdue.
Competing interests: No competing interests
For years, healthcare professionals have debated the merits of
industry involvement in research, academia and clinical practice.
Gradually, this debate seems to be settling on a consensus: more and more
doctors see close relationships with the pharmaceutical industry as a
conflict of interest that has negative effects on patient care.
This should be considered a success for all of us who have campaigned
to reduce the influence of industry on medical practice. But Ray
Moynihan's article highlights the adaptability of Big Pharma, and suggests
that the struggle is moving into a new arena. The old tried-and-tested
methods, once so dependable within the medical profession, are being
transferred to the world of journalism.
This is not a surprising move. After all, if the industry has failed
to halt independence within the medical profession, the natural next step
would be to ensure that the debate does not become a public one. One way
to do that is to get cosy with the people who orchestrate public debate.
As doctors we should be clear about the public health implications of
this "dance" with journalism. A media tainted by the influence of Big
Pharma cannot be trusted to hold them to account. Let's stop the music
before this dance hurts us all.
Competing interests: No competing interests