Thursday, January 15, 2009

Are newspapers under the financial gun getting sloppy with health coverage?

We've all heard the ominous reports about newspapers: as their print advertising disappears under the double whammy of the Internet (craiglist etc) and the recession, metropolitan newspapers are being forced to downsize, lay off veteran writers and cut back on coverage. Over the last few years, these financial woes have had a direct effect on the dwindling resources that newspapers like The Boston Globe can devote to investigative and enterprise reporting. And now, alas, the belt-tightening seem to be cutting into the very bone of news coverage and analysis -- at least at The Globe (where I worked for 13 years).

Consider these two examples. On Saturday, The Globe ran an opinion piece on its op-ed page about Massachusetts' proposed regulations requiring disclosure of financial ties between doctors and the pharmaceutical industry. The piece was written by Peter J. Pitts, who identified himself as president of the Center for Medicine in the Public Interest and a former associate commissioner of the FDA. Pitts neglected to mention that he is also senior vice president for global health affairs at the PR firm Manning Selvage & Lee, which represents Eli Lilly, GlaxoSmithKline, Pfizer and more than a dozen other pharmaceutical companies. In addition, the Center for Medicine in the Public Interest (which Pitts founded) receives the bulk of its funding from the pharmaceutical industry. Indeed, the fact that Pitts’ close ties to the drug industry went undisclosed when he was a guest on Fred Goodwin’s Infinite Mind show (which runs on several NPR affiliate stations) was a big part of the controversy that erupted over this NPR show last fall, according to Slate.

In his op-ed piece, Pitts said he favored limiting disclosure of financial conflicts to the industry's "marketing efforts," which would mean that drug and medical device companies would not have to disclose payments to medical researchers for consulting, speaking or anything to do with the research of their products. And, in fact, the regulations, as currently written, do not cover "bona fide services" for drug and medical device manufacturers such as consulting services, research, participation on advisory boards, company-sponsored presentations and education (back story). In other words, the regulations exempt much of the payments to doctors that create the conflicts of interest that health advocates worry about most.

As a shill for Pharma, Pitts is entitled to his opinion. The question in my mind is why The Globe's editorial page ran his piece without vetting Pitts' conflicts and making readers aware of them. I can only speculate that this kind of sloppiness might not have happened with a more fully staffed board of veteran editorial writers.

I draw my second example from a news story published today in, again, The Globe about new evidence that atypical antipsychotics -- drugs like Zyprexa, Risperdal and Seroquel -- have the same level of heart risks as older antipsychotics do. As The New York Times reported, the finding (published yesterday in The New England Journal of Medicine) is the latest in a string of reports contradicting the long-held assumption that these new antipsychotics are safer than the older and much less expensive drugs that they replaced. As it turns out, the new atypical antipsychotics, which have become blockbuster drugs prescribed for all kinds of off-label uses, double the risk of sudden cardiac death in patients.

The Globe article (written by a correspondent, not one of newspaper's regular medical writers) failed to put the latest finding in the context of the growing controversy over these drugs. For example, there is no mention in the article about earlier findings that drugs like Zyprexa, Seroquel and Risperdal are no more effective than the older antipsychotics in treating schizophrenia or dementia-related psychosis in elderly people. Or that the makers of these drugs are under investigation for illegally marketing these drugs for off-label uses to vulnerable patients (such as children and the elderly) in whom the previously known side effects (excessive weight gain and diabetes) are particularly risky.

Ironically, readers had to plow through to the Business section of The Globe to find that Eli Lilly, the maker of Zyprexa, is about to announce a $1.4 billion settlement with federal and state investigators over allegations that the drug company knew about the drug's dangerous side effects but launched an aggressive campaign to market Zyprexa for myriad off-label uses anyway.

In an earlier, less financially constrained, era, would a veteran medical writer or editor have thought to put these two pieces of news together in one place to give readers a fuller picture of the story? One can't help but wonder.

1 comment:

shaun said...

This is a serious problem in and out of medicine. However, I am not convinced it is sloppyness. The Globe may be more interested in presenting the side of concentrated power than in presenting reality. That is sloppyness may be a cover for complicity.