Conflicts of interest: Time for world’s top health journalism organization to reconsider fundraising practices. Part 2 of 3

Perhaps few journalism organizations have tried harder to minimize conflicts of interest than the Association of Health Care Journalists (AHCJ), the leading professional organization for journalists who report on health care.

The two of us know AHCJ well, having been members almost since its launch 20 years ago. We’ve both served on AHCJ’s board, attended most of its 18 annual conferences, and served on many panels as speakers or moderators over the years. Gary wrote the AHCJ’s Statement of Principles, which was adopted by the Board in 2004.

AHCJ states that its educational arm, the Center for Excellence in Health Care Journalism, won’t take money from pharmaceutical companies, device makers, insurers or even most advocacy groups such as the American Cancer Society. That strict standard distinguishes AHCJ from some other journalism training organizations, which have no qualms about accepting money from companies that journalists routinely report on.

In fact, when AHCJ agreed to collaborate with the World Conference of Science Journalists (WCSJ), which meets in San Francisco this fall, it raised its own money for a health care track “because the broader funding of the conference includes funders that we would not take money from,” AHCJ Executive Director Len Bruzzese told us. As noted in part one of this series, WCSJ accepted $400,000 in support from drug company Johnson & Johnson and another $50,000 from drug company Bayer. Each of the funders that AHCJ lists for its track at WCSJ is a philanthropic foundation. Bruzzese added: “There is easier money out there if you’re willing to take it from other organizations that may want to have more influence than we believe they should have on journalists.”

Conflicts of interest in health care journalism. Who’s watching the watchdogs? We are. Part 1 of 3

Ben Harder, a journalist with US News & World Report, recently tweeted, “Pharma ads subsidize many health reporters’ salaries.”

Elisabeth Rosenthal, who now heads Kaiser Health News after a long career with the New York Times, tweeted in that same discussion, “Many of my articles in the NYT carried pop-up ads for pharma. Infuriating.”

Many journalists are aware of the drug industry’s attempts to gain positive attention by buying placement within the nation’s health care news.  A few occasionally write or talk about it, as Harder and Rosenthal did publicly.

But I don’t think we talk often enough about why it matters if health care industry entities are allowed to advertise within, or sponsor, health care journalism content.  Americans spend more than $3 trillion on health care. Conflicts of interest in health care and research are rampant. The Journal of the American Medical Association (JAMA) last month published a special edition all about health care conflicts of interest.  JAMA included a Viewpoint article entitled, “Conflict of Interest:  Why Does it Matter?”  The first line:  “Preservation of trust is the essential purpose of policies about conflict of interest.”

But who talks about conflicts of interest in health care journalism? In a Gallup poll, “Honesty/Ethics in Professions,” respondents rated journalists’ honesty and ethical standards below psychiatrists, chiropractors and bankers….and just above lawyers.

There is great potential harm in a further erosion of trust in journalism and in health care.  There is a great potential harm in journalists – and the audience they serve – becoming numb to the presence of and influence of drug companies and other industry entities in the news and information disseminated to the public.  There is, as we have begun to point out repeatedly in our review of news stories and PR news releases, advertising and marketing messages, often a polluted stream of contaminated information reaching the public.  Often vested interests pollute that stream.  (We will discuss these potential harms in more detail in part 3 of this series.)

That’s why I think that this issue demands and deserves a deeper dive. Why now?  Because, as outlined in this series, there are a growing number of questionable alliances between a growing number of news organizations and health care industry sponsors. Money is exchanging hands and I ask “Why? Why do news organizations enter into these arrangements?  Why do they feel they need to?  Have they exhausted all other options?”  I want to shine a light on a collection of news organization practices.  I’m raising the same types of questions that journalists often raise as they report on various issues.  But I’m asking them because I don’t see enough journalists talking about it when their own organizations accept industry money.

With Spotlight on Obamacare, Public’s Opinion of Drugmakers Softens

Consumer perceptions of several major pharmaceutical companies have softened in recent months amid an industry push to counter public uproar over high drug prices, Morning Consult Brand Intelligence data show.

Large drugmakers this spring have seen a decline in the the percentage of Americans who view them unfavorably, according to weekly national surveys of thousands of U.S. adults.

The Pharmaceutical Research and Manufacturers of America, the industry’s largest trade group, took action in January to revamp its public image by rolling out a multiyear ad campaign that promotes breakthrough medicines. The drug lobby, which consistently outspends other industries in an effort to exert influence on Capitol Hill, spent $245 million last year, an increase of more than $18 million since 2013, according to the Center for Responsive Politics.

The shift in public opinion has occurred amid GOP efforts to overhaul the nation’s health insurance system and the high-profile battle over the Affordable Care Act. The White House has prioritized replacing the 2010 ACA over lowering drug prices, though newly installed Food and Drug Administration Commissioner Scott Gottlieb announced last month that his agency is looking for ways to reduce some costs to consumers.

Since the House GOP health care legislative effort began in earnest in March, some of the most unpopular drugmakers have seen declines in the percentage of Americans who view them unfavorably. Still, favorability rankings for drugmakers have not improved significantly.

Some of the most-liked drugmakers include Johnson & Johnson and Bayer — the most well-known drug manufacturers among U.S. consumers.

Results are based on online surveys, with a nationally representative sample of adults, that ask participants if they have a favorable or unfavorable impression of certain companies.

Pfizer, which last year killed a proposed $160 billion merger with Allergan after the Obama administration announced new rules on tax inversions, had the highest unfavorability percentage among drugmakers tracked in March, at 29 percent. As of June 5, that figure had fallen to 12 percent.

Another drugmaker – Bristol-Myers Squibb – saw its unfavorability decline 13 percentage points during the same time period, from 23 percent in March to 10 percent in June. Merck had its unfavorable views peak at 25 percent in March before falling to 12 percent in June.

Mylan Sued by Consumers claiming PBM Rebates Are Just Kickbacks

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Three consumers filed a lawsuit accusing Mylan Pharmaceuticals of paying kickbacks to pharmacy benefits managers in order to boost EpiPen sales, which caused them to unfairly overpay for the allergy-reaction device that has been at the center of the national debate over the high cost of medicines.

Their allegations take aim at the convoluted interplay between drug makers and pharmacy benefit managers, which are middlemen that negotiate favorable insurance coverage for medicines on behalf of insurers. The PBMs attempt to extract the best prices from drug makers and, for their trouble receive rebates, some of which are held back as fees.

The lawsuit, which charges Mylan engaged in racketeering, seeks class action status and claims that Mylan “gamed the system” and pretended to blame PBMs for demanding ever-higher rebates for its decisions to regularly raise the price for EpiPen.

The consumers maintain that Mylan paid continually higher rebates in order to book larger sales and ensure favorable insurance coverage, especially as competition to EpiPen arrived. The lawsuit, however, argued that the rising rebates “saddled” consumers who either did not have insurance or have high-deductible plans with “crushing out-of-pocket expenses.”

One of the women who brought the suit, Lisa Vogel of Takoma Park, Md., purchased EpiPen Jr. two-packs several time for her son, who is allergic to peanuts and amoxicillin, according to the lawsuit. Her family has a high-deductible plan from Aetna and, on June 13, 2014, her out-of-pocket cost was $351.73. A year later, on June 22, 2015, her share of the cost $453.49, the lawsuit stated.

The lawsuit also pointed to recent research in the Journal of the American Medical Association that found between January 2007 and December 2014, out-of-pocket spending for each EpiPen patient rose nearly 124 percent, to $75.50 from $33.80. “Mylan’s list price has become an artificial and phony price established and driven up as part of a kickback scheme from Mylan to the PBMs,” the lawsuit argued.

“Mylan is no victim,” the lawsuit continued. “Instead, Mylan participated in and benefited from the high list price scheme and from paying high rebates or kickbacks to PBMs to ensure EpiPen’s market dominance. In fact, from at least 2008 until 2011, when Mylan stopped reporting this information, EpiPen had a 95 percent market share” for auto-injector allergy devices.

There are no PBMs named as defendants. A Mylan spokeswoman declined to comment.


Editor’s Corner: Why are we still letting pharma pay physicians?

Close-up of a doctor's white coat

Last month, W. Carl Reichel was acquitted of charges that he oversaw a kickback scheme designed to induce physicians to prescribe certain drugs manufactured by Warner Chilcott LLC.

The president and CEO of the pharmaceutical company was acquitted of those charges despite the fact that the company itself pleaded guilty to “knowingly and willfully” paying off physicians in the form of sham speaking fees and meals at high-end restaurants, and agreed to pay the government $125 million in civil and criminal fines.

He was acquitted even though prosecutors trotted out nearly a dozen witnesses who worked under Reichel to testify against him, some of whom admitted to participating in the scheme that used “medical education” events–including barbecues, picnics, parties and trips to a casino–to improve physician prescribing rates. The government also alleged that Reichel oversaw the whole thing by demanding sales reps engage in “business conversations” about “clinical experience,” which was code for a physician’s prescribing rate.

But most importantly, he was acquitted because his attorneys never denied that he oversaw any of these payments, or that he instructed sales staff to take physicians out “at least twice a week.” They merely argued that “relationship building” is “widely accepted conduct” in the medical community.

They aren’t lying–allowing pharmaceutical companies to pay physicians large sums of money is a widely accepted practice. The question we should be asking ourselves is, why?


83% of patient advocacy groups accept payouts from pharma


drug and healthcare costs, a significant majority accept payouts from the pharmaceutical industry, according to a new study.

Researchers at the University of Pennsylvania found that 83% of patient advocacy groups accepted donations from drug or medical device makers.

The study, published in the New England Journal of Medicine, also found that in close to 40% of cases, executives in the pharmaceutical industry sit on governing boards of patient groups. For some groups in the study, donations from the industry make up more than half of their annual income.

The study examined financial data for the top 104 patient advocacy groups that reported more than $7.5 million in revenue per year. Ezekiel Emanuel, M.D., vice provost at the University of Pennsylvania and one of the study’s authors, told The New York Times that these patient advocacy groups “wrap themselves in white as if they’re pure.”

He told the publication that these groups should have to disclose ties to industry in the same way as medical researchers, who are pushed to reveal connections to industry groups as they perform research and speak in public.

Some patient advocacy groups are taking aim at the study’s findings. For instance, National Health Council CEO Marc Boutin, said in a statement (PDF) that the organizations under its umbrella adhere to 38 standards, about 16 of which are designed to ensure that the group’s mission is kept separate from donations.

“Patient advocacy organizations are driven by their missions—putting patients first,” Boutin said. “To say otherwise negates the extraordinary work achieved by these organizations on behalf of their patients.”

Where Are All the New Diabetes Drugs?

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As oncologists race forward with new treatments verging on science fiction and biotech companies press on with drugs for once-hopeless rare disorders, one of the world’s most pervasive diseases looks like it’s been left behind.

There are few new drugs on the horizon for diabetes, which affects about 29 million Americans. Most of the treatments in late-stage development are simply improved versions of what’s out there — taken weekly versus daily, or orally instead of by injection.

So has pharma run out of ideas in diabetes?