Although Jeanne Lenzer’s article about stealth marketing in Reporting On Health is actually meant for other journalists, it reminds me that we consumers should all be more savvy when it comes to evaluating medical news. Before my own heart attack, for example, I pretty well swallowed any medical miracle breakthrough news without question.
But because I now take a fistful of powerful cardiac medications everyday, I have become gradually both aware of and alarmed by Big Pharma marketing, and especially about what Dr. Marcia Angell herself (for over 20 years the Editor-in-Chief at the prestigious New England Journal of Medicine) calls “… its pervasive conflicts of interest that corrupt the medical profession.”
In fact, I have absolutely no way of knowing which of my cardiac meds were prescribed for me based on flawed research or tainted medical journal articles that were funded and ghostwritten by the very drug companies who stand to gain by paying for positive outcomes. And, worse, neither do my doctors. This is allowed to happen in part because of what we now know as “stealth marketing“.
Jeanne Lenzer explains that stealth marketing is frequently used by the health care industry whenever it puts its marketing messages into the mouths of seemingly independent third parties. In this way, the third party – usually an academic researcher, a medical school teacher, a professional association, or a patient group – lends credibility to the marketing message while disguising its hidden origin as the paid mouthpiece of commerce, not science.
Medical ghostwriting is one example of this – in which a drug/device company pays a professional communications firm or its own staff to write flattering articles about its products, and then gets a well-known academic to pretend to be the real author so these articles can be submitted to medical journals for publication.
Instant credibility – while disguising hidden industry origins.
With so many physicians and academics on the take from major pharmaceutical companies and medical device manufacturers (some even in unapologetic violation of established professional conflict of interest guidelines), it can be downright impossible to ferret out frequently undisclosed financial conflicts of interest.
As New Hampshire physician Dr. Kevin Pho writes in his blog KevinMD, there is a type of pharmaceutical sales rep whose actions remain completely unregulated.
“These reps have unfettered access to the top academics of all fields of medicine, are invited by medical societies to give keynote addresses, routinely publish articles in the best journals, and offer advice about medications that is accepted as gospel by doctors everywhere. These reps have medical degrees, and some have become millionaires by taking fat payments from drug companies. The are “the hired guns of medicine”.
How can journalists ferret out hidden financial conflicts of interest? Jeanne Lenzer teaches health journalists this strategy:
“Ask every source in your article about any financial conflicts of interest they might have – but only after you’ve done your homework. Make your question broad and inclusive. Don’t ask a physician: ‘Are you receiving money from Pfizer?’ Instead ask: “Have you received in the past five years, or are you now receiving, any sort of payments, grants, expense reimbursements, or any form of consideration from a drug or medical device company or do you hold any stock or stock options in one?”
Lenzer tells a compelling story to illustrate this point:
“While reporting one story, I was told by two doctors that they had no financial ties to Genentech, the maker of the cardiovascular clot buster drug called tPA. Both doctors, while serving as experts on an American Heart Association panel, had voted to make tPA a “highly recommended” treatment for acute stroke.
“One doctor was the lead researcher on a Genentech-sponsored study published in the Journal of the American Medical Association. Confronted with a copy of the JAMA article, the doctor said he “didn’t realize” he was listed as the principal investigator. The other doctor, who was on Genentech’s Speakers Bureau, said: “I didn’t realize I was officially on the Speakers Bureau.”
This kind of admission seems appallingly insulting. An expert who “didn’t realize” that he was receiving money from drug companies for being one of their so-called “thought leaders” speaking to his medical peers, or “didn’t realize” he was listed as lead author of published research that was bought and paid for by the drug company that makes the drug he likes?
Since publishing (not teaching) is the raison d’être of academia, it is simply impossible to believe that every physician or researcher teaching in every medical school cannot rattle off every title published. Can they honestly expect that we might believe otherwise?
And would you trust experts who were actually this stupid?
Here are more of Jeanne Lenzer’s recommendations to her journalism students – and to any concerned patient who’s interested in becoming a more informed consumer:
- Do a PubMedsearch of an expert’s journal articles. Look in the disclosures section by searching his or her name in the article. Remember, just because an expert doesn’t declare a financial conflict doesn’t mean he doesn’t have one.
- Go to the subject’s or source’s website. Many universities and hospitals include the curriculum vitae (CV) and even the research history of physicians online. Look for research grants, employment history and other clues to industry ties. If the CV is not available online, request it from the doctor’s secretary. You can say that you want to learn as much as you can in preparation for an interview.
- Use a standard search engine like Google and search under the expert’s name. If you suspect a tie to a certain drug company, add the company name as a search term. This will often draw up irrelevant webpages, but occasionally can reveal that your expert gave a company-sponsored talk or received cash from that company.
- Check for known funding issues and conflicts of interest at the Center for Media and Democracy’s SourceWatch project and the Integrity in Science database of the Center for Science in the Public Interest (CSPI). SourceWatch is a superb website, says Lenzer – “one of my most trusted sources of information.” However, it lists only people of significant stature or exposure. CSPI, on the other hand, maintains a database without regard to stature, but it is far from exhaustive and relies on past reports from journalists and others.
- Check with critics of your source. Lenzer adds that her tip about the doctor being paid to work on the Genentech Speakers Bureau came from a critic. “I was able to confirm the tie before I spoke with the doctor.”
See also Dr. Marcia Angell’s article in NEJM Editor: “No Longer Possible To Believe Most Clinical Research Published” or more articles on the disturbing subject of medical ghostwriting.