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Concerns raised about pharma-sponsored health journalism at The Australian

(Additional comments are being added to the bottom of this post as they land)

As you may have seen, The Australian has been running articles and video clips about health policy in a series called “Health of the Nation”, sponsored by The Australian Medicines Industry, an initiative of Medicines Australia.

The series culminated in a glossy, 24-page magazine published on the weekend that included feature articles, and advertorials and advertisements for the pharma industry.

I have written a news story for the BMJ raising concerns about the project (subscriber access only, let me know if you’d like a copy), and also a piece for today’s Crikey bulletin.

Below are comments on the arrangement from Medicines Australia, leaders in health journalism, researchers, and others.

***

Statement from Medicines Australia (provided for the BMJ story)

It’s important that the Australian public understands the contribution The Australian Medicines Industry makes to the health and wealth of the nation. Many Australians aren’t yet aware of that contribution.

That is why we want to have a conversation with the community and introduce ourselves as The Australian Medicines Industry.

This initiative is to ensure the Australian public has a better understanding of The Australian Medicines Industry and our contribution to the health and wealth of the nation, as a major employer, exporter and investor in local R&D.

Medicines Australia has a commercial agreement with News Ltd. The value of that agreement is commercial in confidence. The commercial agreement does not extend to any control or influence whatsoever over editorial generated by News Ltd journalists.

The agreement arose out of meetings between News Ltd and Medicines Australia which recognised common interests.  

News was interested in creating a ‘Health of the Nation’ series and vehicle to stimulate consideration, discussion and debate about health issues in Australia with its readership. Medicines Australia was interested in a communication platform to increase awareness of The Australian Medicines Industry as ‘supporting Australia’s health’ and get Australians thinking about the industry.

We continue to consider different options for how we can get Australia thinking about The Australian Medicines Industry and the contribution it makes to the health and wealth of the nation.

Q from MS: When you say, the agreement arose out of meetings between NL and MA – did the meetings involve the editorial staff of NL or advertising/marketing staff of News?

The meetings were between Medicines Australia’s advertising agency and News Limited’s promotions and advertising teams.

Q from MS: Are you planning any other such arrangements with other media organisations?

We don’t have any specific plans at the moment to engage in similar relationships with other news organisations.

***

Gary Schwitzer, publisher of HealthNewsReview.org

The Association of Health Care Journalists Statement of Principles includes a clause that states that journalists must “Preserve a dispassionate relationship with sources, avoiding conflicts of interest, real or perceived.”

Another clause states “Deny favored treatment to advertisers and special interests and resist their pressure to influence news coverage. ”

Is this a dispassionate relationship?  I don’t think so.  It’s courting financial deals with the subjects of news stories. That’s pretty passionate.

In expectation of all of the claims by both parties that the relationship is “clean” and that the conflict is not real, it doesn’t make much for one to perceive a conflict.

And therein you’ve introduced a doubt in the public’s mind about the integrity of editorial decision-making – if not now on this project, then in the future.   If the paper doesn’t aggressively report on future drug industry issues, how will the public know what to think of it?  The seed of doubt will have been planted.  Journalism can’t afford that.

Is this favored treatment?  You bet it is – if you believe, as I do, that the job of journalism is to “Comfort the afflicted and afflict the comfortable.”  How do those without deep pockets gain access to the pages of the paper in like manner?  If they don’t, then this is favored treatment – isn’t this simply checkbook journalism?  News for hire?

Since when do journalists partner with/collaborate with/have commercial agreements with (you name the correct term for this alliance) the drug industry they must cover?

I’m sure that the newspaper will say that they retain complete editorial control over the content.  I’ve heard that before from American news organizations that take money in similar ethically challenged deals.  But think about this:  even by entering into this arrangement, the newspaper has agreed to publish content that they otherwise would not have published.  No matter what that content is, the money on the table has influenced editorial decision-making.  If not, why didn’t the newspaper publish the material without being paid to do so?

No matter how you spin it, this is the drug industry influencing public discussions in one more infectious way.

Journalists should be sniffing out and exposing such deals – not being party to them.

• Schwitzer added that he resigned from CNN in 1990 due in large part to ethical concerns over drug company sponsorship of the network’s health/medical news coverage. He says: “So I don’t just talk the talk, I walk the walk and put my career on the line over it”.

***

Charles Ornstein, president of the Association of Health Care Journalists, and Senior Reporter, ProPublica

It’s hard to pass judgment on the stories or to question the integrity of the reporters and editors at The Australian without reading the articles. That said, if the newspaper is writing about pharma in this sponsored space, that would be a source of concern. The potential for conflicts, both real and perceived, is great.

News organizations have traditionally had a bright line between advertising and editorial content. Reporters didn’t know which advertisers would appear alongside their stories, and advertising sales reps didn’t know what stories would appear in the paper. This arrangement preserved the credibility of news organizations and advertisers.

More to the point, whenever ideas for news coverage are generated from the marketing or advertising departments—not from the newsroom–one must question whether it was simply because an advertiser desired it. Either the public needs more news and information on a given topic or it doesn’t. Letting outside commercial interests decide that rather than the newsroom is always a slippery slope.

I would note, however, that this is somewhat different from other situations in which we have opined. In one case, a television station allowed a local hospital to sponsor health segments and ensure that its experts were quoted. In another, a local newspaper turned over its health section to a hospital. Those are more egregious on their face.

***

Dr Amanda Wilson,  School of Medicine and Public Health, University of Newcastle, and Media Doctor Australia

It is an unusual arrangement and more in line with the kind of advertising supplement you see for tourism or fashion.

I suspect there will be no header of ‘this is an advertising/promotional supplement’ although you’d think there should be.  Coming on top of the fiasco of the Blackmore’s – ‘would you like vitamins with that?’ pharmacy deal, this looks like industry needing to make its mark on the common man.

Is it just another way to get around the legislation on direct to consumer advertising? And what does it say about the state of newspapers with such a reputable paper needing to take on this type of advertising?  And by having a health news journalist write it, it blurs the line between news and opinion.

Using someone like Adam Cresswell, who is undoubtedly one of Australia’s best health journalists, will give it a veneer of respectability and makes you want to believe this would be independent editorial.

Until you stop to consider that Adam is an employee of The Australian and probably has no choice.  But he will be risking his journalistic reputation by putting his name to this.

***

Dr Wendy Lipworth, NH&MRC Postdoctoral Research Fellow, Centre for Clinical Governance Research in Health, Australian Institute of Health Innovation, University of New South Wales

From my perspective, this gets right to the heart of the issues of industry-media relationships and the effects of even indirect financial ties on the content and tone of reporting.

I would, therefore, be worried not so much about the content of reports in this particular series (which I am sure will be very carefully balanced if they discuss industry issues), but rather about the effect of  the industry support for this series on subsequent reporting of industry-related issues.

I also wonder about the effect of having a declaration of funding on the same page as an advertisement.

While such declarations are usually seen as distancing mechanisms, I wonder whether the combination would give some readers the impression that the newspaper endorses the advertisement and industry more generally.

***

Carol Bennett, CEO of the Consumers Health Forum (who was asked by The Australian’s health editor, Adam Cresswell, to take part in the roundtable meeting convened as part of the series)

The way I look at this is that Medicines Australia are going to want to promote themselves. The Australian is a business and trying to increase circulation. So they do have some mutual commercial interests.

What would make the arrangement questionable is if it isn’t transparent. If it’s fully disclosed, then there is minimal risk of concern.

To my mind, there was absolutely no interference with editorial content.

There is absolutely no way any of those seven people on the panel would have been influenced by the medicines industry. Most of us would have been critical of them at one point or another. In fact I’m a critic at the moment as a result of the Pfizer deal.

I was approached by Adam Cresswell. Adam is a squeaky clean journalist who is very much focused on checking facts and making sure everything stacks up. He’s always been very rigorous.

He said he was convening a panel of health experts. I can’t remember if he mentioned Medicines Australia funding. He may well have, but if he did, I can’t recall it.

The roundtable was on 14 or 15 Sept.

It became clear to me that there was a link when the ads started to run. I didn’t have a problem with it because I was never asked or given any material.

At the panel discussion we were supposed to discuss the PBS and I was disappointed we didn’t get to it. They were very broad questions, it was a free flowing discussion, all recorded. There was no sense in which there was any intent to influence or focus the discussion or I wouldn’t have been part of it.

To me the publication was about giving the public the information. It was substantial space, and it’s hard to see how they would get that space to do a health series. Health often doesn’t get the attention it deserves. It was a welcome opportunity to highlight some of the challenges we’re facing in health reform.

I wouldn’t have been part of it if I had thought there was any concern about editorial content.

Media is a business and if you don’t get advertiser support, then issues wont get the space.

It was transparent. It was sponsored by the industry but the people involved, the editorial content were all completely free flowing. There was no influence or attempt at any time to influence the content of the material;

Sometimes you have to weigh up the pros and cons. In this instance it let us get out messages, more complex messages that wouldn’t otherwise be out there in the public domain.

This is a worthwhile discussion to be having (re the funding arrangement). We all should be held to scrutiny on these issues because it maintains the rigour. It can slip if we don’t maintain high levels of transparency and focus.

***

Dr Christopher Jordens, Senior Lecturer in Bioethics Clinical Research Fellow, Centre for Values, Ethics & Law in Medicine, University of Sydney

It’s disturbing that The Australian is willing to accept drug industry funding to underwrite its health journalism content.

The ‘Health of the Nation’ series is described as an as a ‘consumer initiative’ and as and ‘independent project’. ‘Consumer initiative’ usually means something initiated by consumers. This series was nothing of the sort. It’s an initiative to target consumers with the drug industry PR that covers a third of its surface area.

The claim that it is an ‘independent project’ is presumably there to allay readers’ suspicions about the fact that the series is funded by Australia’s drug industry peak body.

Readers usually expect journalists to disclose when their reporting is not independent (i.e. when they have a conflict of interest).

Apparently, journalists at The Australian now feel they have to disclose when the journalism is independent, as if this were something exceptional.  But how independent is it really? How much influence did the drug industry PR people have on the final product? If it’s difficult for readers to know, it will be difficult for us to trust what we are reading.

Presumably, ‘independent’ means that industry PR people didn’t tell the journalists what to write. But they don’t really have to, do they? Journalists can be relied on to tell the same old story that Australia’s public health system is in “crisis”. And this provides an ideal backdrop for drug industry PR.

The health editor at The Australian is so reliable in this respect that he’s willing to tell that story even though the results of the Newspoll survey tell a different story if you view the figures differently. Consider the following, which are the same percentages with the emphasis reversed:

·        85% of respondents normally make an appointment to see their GP
·        77% find the waiting time to be very or quite reasonable
·        two thirds say that the waiting time has become no worse during the last 5 years
·        89% said they are very or somewhat confident that they will receive high quality care
·        almost 80% were confident they could afford it

Does this sound like a system in crisis?

The leading article also highlights the fact that Australians are not seeking dental care in order to save money. This is disturbing, but it’s not evidence that the existing system is in crisis. On the contrary, it suggests that the existing system should be extended to cover dental care, and about two thirds of the survey respondents supported this idea.

But in the end, the content of the arguments doesn’t really matter.

The drug industry knows that readers are more likely to attend to its promotional hype if it’s presented in the context of “serious” journalism, and the Australian is willing to make deals accordingly.

Health journalism is thus reduced to mere wallpaper against which to display the main product – industry PR.

****

Dr Peter Mansfield, GP, Director, Healthy Skepticism Inc

The true effects of drugs are usually impossible to measure in individuals and are estimated only approximately by clinical trials.

Consequently pharma profits are based not on the realities of their products but on perceptions. Consequently pharma is obsessed with influencing every information channel lest the bubble be burst by sharp reality.

To the extent that journalists are civilised humans, sponsorship will make them feel subconsciously uncomfortable about biting the hand that feeds them, let alone fulfilling their role to speak truth to power.

***

Update 1:

The Australian’s editor, Clive Mathieson, is quoted in the BMJ and Crikey stories arguing that editorial independence has been maintained. “There is no way The Australian would have agreed to any commercial relationship that compromised its editorial independence and integrity,” he said.

Adam Cresswell and others involved in producing the Health of the Nation series are welcome to respond to the issues raised above.

***
Update 2:

Philip Davies, Professor of Health Systems and Policy, University of Queensland

As a fellow participant at the Australian’s ‘Health of the Nation’ panel discussion I wholeheartedly echo Carol Bennett’s comments.

I was asked by Adam Cresswell in July to contribute to what appeared at the time (and, I believe, proved to be) a worthwhile contribution to the debate on Australia’s health sector.  He did not, at that point, mention the involvement of Medicines Australia; and I do consider that to have been something of an oversight on his part.

When the first article in the series appeared with details of Medicines Australia’s involvement, however, I immediately contacted Adam and sought his reassurance that they would have no influence over the content.  His reply, which I believe merits quoting at length was as follows:-

Re the Medicines Australia link — can I assure you that they have had, and will continue to have, absolutely zero input or influence on the content of the series, or anything to do with that. Their involvement has created the editorial space, but that’s it. The same goes for another Big Pharma or other external interest (ie no-one else is pulling any strings). I didn’t mention their involvement because it has no impact on how I am going about this — all the decisions are being taken in the normal way between my editors and myself, as would happen with any story.

We are doing a poll, but Medicines Australia have no opportunity to shape the questions. (They are asking three questions of their own, but that is a semi-detached bit of the poll and we will review what those questions are, and whether the results tell us anything interesting or useful, before we decide if we will even include those three questions and answers in our coverage.)

As for the panel, Medicines Australia have not sought, and are not being given an opportunity to nominate panel guests, and yes I can assure you there will be absolutely no taboos on what can be raised or discussed.

I can assure Croakey (and Crikey) readers that at no time was the panel put under any pressure to discuss, or avoid discussing, any specific topic.  Had we done so, and knowing the other panellists as I do, I am confident that the result would have been an immediate termination of the discussion followed by a mass walkout.  Indeed, in one of the video clips featured on the Australian web-site I am quite clearly critical of the prices paid for some prescription medicines in Australia.

Finally, the article raises some concerns about Croakey’s own standards of journalistic balance.  Six of the eight quotes are from commentators who might be considered to hold particular views on the issue of pharmaceutical sponsorship.  Among those six one (Charles Ornstein) explains that he has not actually read the Australian’s material while two (Drs Wilson and Lipworth) both refer to it using the future tense which suggests their comments may not themselves be wholly evidence-based!

In contrast only one member of the Australian’s panel is quoted and I, for one, was not invited to comment, despite the fact that Croakey knew of my involvement and has my contact details. I would be interested to know how many, if any, of the other participants were contacted by Croakey and invited to offer their side of the story before the article was published.

I am pleased that Croakey chose to highlight the issues surrounding the Australian’s initiative and I do agree that they should be debated in an open and constructive manner.

For my part, however, I am not convinced that the pharmaceutical industry (or, indeed, any other private sector body) should automatically be afforded pariah status when it comes to supporting independent, expert debate on matters of national significance.

And nor should those of us who make an informed and considered decision to participate in such initiatives.

***

Response from Croakey:

Yes, anyone who is familiar with my work would know that I think the evidence suggests that we all – whether researchers, clinicians, policymakers or journalists and media outlets – should approach entanglement with powerful interests, including the pharma, food and alcohol industries (for example) with caution. For more on this, see The Crikey Register of Influence and the Croakey Register of Influencers in Public Health.

Professional and bureaucratic interests also deserve to be approached with care. Personally, I agonise over conflict of interest issues as a freelance journalist, and often turn down work as a result. Just for the record, I take no pleasure in doing stories like this, particularly as I have some appreciation of the pressures upon journalists and the newspaper business more broadly.

I had always intended to seek wider comment on this story; the tradition at Croakey is to use posts or stories as a catalyst for wider debate, whether as comments or in follow-on blogs.

Personally, I don’t think the content of the roundtable discussions or of the stories themselves are the central issues here (as has already been argued by Schwitzer and Ornstein above).

The value of that glossy supplement to Medicines Australia – thanks to its close association therein with leading health journalists and policy experts – far exceeds the hundreds of thousands of dollars the deal has presumably cost.

But no doubt others have different views? Presumably the views about conflicts of interest and the media are just as diverse as those within the healthcare industry…

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  • 1
    James Gillespie
    Posted October 27, 2011 at 2:41 pm | Permalink

    It would be helpful if someone could point to something in the articles that constituted a conflict of interest. It is notable that Phillip Clarke’s astringent attack on current funding arrangements for generics was included in the liftout. If implemented, his proposals would remove hundreds of millions from the PBS bill and the profits of members of Medicines Australia. Its inclusion suggests – in the absence of contrary evidence from elsewhere in the supplement – that in practice, standards of independence were maintained.
    Blanket bans on fully declared industry sponsorship of – in this case – serious research may muddy attempts to expose covert attempts to influence news and research agendas. I would be interested if anyone can show that the survey questions or choice of topics seem influenced by such manipulation.

    James Gillespie, Menzies Centre for Health Policy, University of Sydney

  • 2
    Melissa Sweet
    Posted October 28, 2011 at 9:41 am | Permalink

    Jim, as I mentioned briefly above, I think it is a distraction to focus on the content of the articles. Knowing the journalists involved, I am aware of their commitment to independent reporting. But that is exactly what makes the magazine such an excellent investment for Medicines Australia, which now has an attractive publication clearly branded by MA, and featuring work by leading health journalists and also featuring prominent health policy experts. This is a far more valuable product, from a marketing point of view, than if the magazine simply featured soft journalism or material written by PR people. If I was working in marketing for Medicines Australia, I would regard this outcome as quite a coup. In many ways, it is a similar argument as when health or medical reports are funded by industry but independently written by experts. It is just this arrangement which gives the credibility and the connections that the industry seeks.

  • 3
    James Gillespie
    Posted October 28, 2011 at 12:28 pm | Permalink

    Melissa, My problem is in seeing what is wrong with this, if it is all transparent. If there had been secret funding, and if the survey had triumphantly supported some cause championed by Medicines Australia (rather like the fake articles and journals both Pharma and Tobacco have secretly sponsored or ghost written) there would be a major problem. But this is a serious piece of research with no evidence of manipulation by industry interests and advertising that is clearly demarcated from the main text. And, as i pointed out, at least one piece that clearly attacks the industry’s interests.
    Every medical journal I know is subsidized by advertising and less open subsidies, such as purchase of off prints, but this does not immediately cast automatic doubt over their independence. It qactually blurs the case against real transgression if the bow is drawn so wide.

  • 4
    Melissa Sweet
    Posted October 28, 2011 at 2:21 pm | Permalink

    Jim, some quick points in response:

    1. Perhaps people outside the media don’t fully appreciate the industry’s tradition of not linking editorial to specific advertisements (at least outside of advertising supplements, lifestyle publications etc). As Charles Ornstein, president of the Association of Health Care Journalists, commented: “News organizations have traditionally had a bright line between advertising and editorial content. Reporters didn’t know which advertisers would appear alongside their stories, and advertising sales reps didn’t know what stories would appear in the paper. This arrangement preserved the credibility of news organizations and advertisers.”

    2. Transparency is important but not necessarily a solution in itself. Indeed, some people (like Peter Mansfield) have argued that encouraging transparency as a solution may even be counterproductive (the reference here: http://www.australianprescriber.com/magazine/33/5/136/7
    My own view/practice is that sometimes saying “no” is a better option.

    3. You could have a whole other debate about the merits of holding up medical journals as yardsticks. Richard Smith, former editor of the BMJ, and other journal editors have themselves raised questions raised about the role of medical journals in pharma marketing: eg: Medical Journals Are an Extension of the Marketing Arm of Pharmaceutical Companies
    http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0020138

    4. I don’t think there is a perfect way of funding journalism; just about every option has some flaws. But direct advertiser-funding of related journalism is a noteworthy and worrying development – and not only for health journalism. If you saw the comments from The Australian’s editor, a number of these “commercial arrangements” are planned. I will soon post more details about the particular arrangement with Medicines Australia.

  • 5
    Melissa Sweet
    Posted October 30, 2011 at 2:09 pm | Permalink

    Further to the above, it is worth noting that the medical press (which are largely funded by pharma advertising) do not, as I understand it, generally link print news editorial to specific advertisers.

    Also, it’s worth pointing out that my comments about the media not traditionally linking specific advertisements to editorial apply very much to the traditions of newspapers. It’s likely that online publishing is breaking down some of the demarcation between editorial and advertising – and that online news stories may be linked to specific advertisements.

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  1. ...] her blog, Sweet also published more detailed concerns raised by a number of observers, including what I wrote to her in an email [...

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