Australia lagging in conflict-of-interest disclosures
Filed under: Conflicts of interest, Health journalism
When a country is holding up the United States as a model of progress on medical conflict of interest issues, you might suspect there are some serious systemic issues there. Such seems to be the case in Australia, based on Melissa Sweet’s recent post on the Croakey blog. At present, there’s little baseline research into industry funding and influence in Australia, though what little there is seems to indicate a situation similar to what we’ve found in the United States. The lack of research seems to stem from a lack of awareness and perhaps even indifference.
Photo by acediscovery via FlickrThe catalyst for this post seems to be the Walkey Media Conference, a media industry confab sponsored by the national journalists’ union that generated a bit of controversy thanks to a sponsorship from Exxon Mobil.
Sweet found a University of Sydney seminar in July that was to look at conflicts of interest to be less than packed, and inferred that Aussie “academics seem to regard (COI) as irrelevant, tedious or confronting.” Furthermore, she wrote, “Australian universities are dragging the chain in dealing with their staff’s conflicts of interest, at least compared with institutions in the US.”
The post makes a strong, well-researched case for COI disclosure and serves as a sort of roundabout compliment to the dogged American journalists (we’re looking at you, John Fauber) who are creating mainstream awareness of conflicts of interest.
Pfizer-funded workshop raises questions of ethics
Filed under: Conflicts of interest, Health journalism, Pharmaceuticals
Christopher Weaver, in a piece from Kaiser Health News and NPR, writes about a Pfizer-funded seminar for journalists. To attend the annual seminar about cancer, hosted by the National Press Foundation, 15 journalists get an all-expenses-paid trip to Washington, D.C.
Health care journalists, including HealthNewsReview.org’s Gary Schwitzer and AHCJ president Charles Ornstein, say reporters need to be careful and avoid even the appearance of a conflict of interest.
Foundation president Bob Myers says the pharmaceutical company does not have input on the meeting and an attendee of last year’s meeting, AHCJ member Joy Robertson, says she doesn’t remember Pfizer ever being mentioned at the event.
Commenters on the KHN/NPR include AHCJ members Ornstein; Andrew Holtz, M.P.H. (also a board member); Elaine Schattner, M.D.; and Schwitzer. Schattner, a licensed, non-practicing physician and medical educator, says “This is precisely how Pfizer and other companies try to influence physicians who, in their sometimes-arrogance, tend to think they’re “above” subtle persuasion. Are journalists any better?”
Journalist Merrill Goozner also has written about the seminar and says that that Pfizer has dictated the overall agenda:
Pfizer didn’t make an unrestricted grant to a journalism training organization. The money is being spent to train journalists in how to cover cancer.
Goozner points out, as does Holtz in his comment on the NPR/KHN piece, that “journalism spends less on training than almost any other profession” and that journalists have few opportunities to get out of the newsroom for professional education.
Covering Health wrote about this seminar and this issue last year. It’s worth noting, as we did then, that the Association of Health Care Journalists and the Center for Excellence in Health Care Journalism seek to minimize the possibility and appearance of inappropriate influence from outside parties. Pharmaceutical companies, insurance companies and medical device makers are examples of organizations with with AHCJ will not partner. Read AHCJ’s complete fundraising policies.
AHCJ’s Statement of Principles, which identifies challenges that health care reporters face and suggests how to meet those challenges, addresses the topic:
- Refuse gifts, favors, and special treatment. Refuse meals from drug companies and device manufacturers and refuse to accept unsolicited product samples sent in the mail.
- Weigh the potential benefits involved in accepting fees, honoraria, free travel, paid expenses from organizers of conferences or events against the desire to preserve our credibility with the audience and the need to avoid even the appearance of a conflict of interest.
- Also weigh the potential benefits of accepting awards from organizations sponsored by an entity with a vested interest in health care against our need for credibility.
- Weigh the potential conflict in accepting support from public, private, or foundation sources.
Conference walks back description of partnership with heart news website
A medical conference has retreated from a claim suggesting a trade website was being used to promote it and that supporters would be able to “reach new audiences” through a partnership between the conference and the website.
The 2010 Dallas-Leipzig International Valve conference has issued a correction after it came to light that it was promoting its partnership with theheart.org as a “highly influential source of publicity” and said theheart.org will “cover the benefits of attending DLIV 2010; it will forecast key aspects the meeting will offer; it will report on the highlights of the two-and-half day event - and more.”
Conference organizers have since posted the following note on its website (emphasis added):
Given the success of DLIV 2009 and its potential to grow in years to come, the meeting organizers have partnered with theheart.org to promote DLIV through their banner advertisements and e-blasts. [Correction: the previous material erroneously stated that industry would have the opportunity to gain exposure through theheart.org's news and editorial programs: this is incorrect, and the meeting organizers apologize for the error. theheart.org had no other involvement with DLIV's offers to industry.]
Shelley Wood, managing editor for Heartwire news and theheart.org, said, “There is a firm firewall between news activities and any advertising or sponsored content on theheart.org and at no point would outside parties be able to dictate the news or editorial content of theheart.org.” She pointed out theheart.org includes a staff of seven journalists.
Larry Husten, on his CardioBrief blog, pointed out details about sponsorships at the conference, including the opportunity for supporters to pay large amounts of money to meet with faculty members. He noted that its website linked to an Industry Prospectus, a document listing opportunities for exhibitors and sponsors. Sometime after he published the post with a link to the Industry Prospectus (now archived on Husten’s site), conference organizers removed it from the website.
In the prospectus the conference announced its partnership with theheart.org:
Given the success of DLIV 2009 and its potential to grow in years to come, theheart.org recognizes the impact the meeting has in the field of cardiac care. Through its website, online blog and print publications, theheart.org will cover the benefits of attending DLIV 2010; it will forecast key aspects the meeting will offer; it will report on the highlights of the two-and-half day event - and more.
With this highly influential source of publicity, DLIV 2010 offers to its supporters new benefits. By participating in DLIV 2010, you will not only reach the physician leaders who attend the meeting; you will also have the opportunity to make contact and establish relationships with a worldwide audience. Don’t miss out on the chance to reach new audiences, gain additional media benefits and connect your company with the specialty source for news and information.
Theheart.org’s editorial policy says it is committed to providing “balanced, accurate health information” and it “employs editorial professionals who are responsible for content selection, development and maintenance process.” It says it discloses “sources of funding and site contributors’ possible conflicts of interest.” It also says it complies with the HONcode standard for health information (more here).
It should be noted that Husten (aka @cardiobrief on Twitter) is the former editor of theheart.org, something he is quite open about.
Related
- AHCJ’s Statement of Principles
- Health on the Net Foundation’s Code of Conduct for medical and health Web sites
AAMC gives recommendations for clinical COI
After taking on continuing medical education and medical research, the Association of American Medical Colleges is now tackling conflicts of interest related to clinical care with its latest report, “In the Interest of Patients: Recommendations for Physician Financial Relationships and Clinical Decision Making” (46-page PDF). If you’re just looking for the Big Recommendations, the most salient of which are paraphrased below, fast forward to pages 24 and 25. Warning: They’re vague.
- Medical centers should compensate doctors in a way that promotes the patients’ best interests.
- Professional medical societies and medical institutions (such as teaching hospitals) need to take a long, hard look at their own relationships with the industry.
- Institutions should identify their physicians’ industry relationships, set thresholds for their disclosure, and identify situations in which disclosures should be made directly to the patient. These regulations should all have teeth.
- Centers and physicians should work with patients to figure out how best to disclose industry ties.
The AAMC committee that produced the report wrote that, while they focused on academic medicine, their recommendations could (and should) be applied to all of clinical medicine.
J-S settles records suit; docs rebel against COI rules
Filed under: Conflicts of interest, Health journalism, Hot Health Headline, Public records
As a result of the Milwaukee Journal Sentinel’s now-settled lawsuit against the University of Wisconsin, John Fauber was able to review newly public e-mails which show just how angry a segment of the faculty became when faced with the university’s new, stricter conflict of interest regulations. The regulations came, of course, in the wake of Fauber’s investigative reporting on the subject.
The newspaper’s lawsuit argued that the faculty comments were public records under Wisconsin law and sought a court order to obtain them. To settle the lawsuit, the newspaper agreed to accept the 41 e-mails with the names of the doctors blacked out. The foundation also provided a separate list with the names of the 28 doctors who wrote the e-mails.
The (UW Medical Foundation) also agreed to pay the newspaper’s attorneys’ fees of about $12,400.
The e-mails make for good reading, and Fauber wastes no time in deploying the liveliest phrases in his story.
For example, some physicians complained about the 18-month exemption for orthopedic surgeons and other implanters of medical devices, including one who said “Allowing our docs to shill for device companies is a complete perversion.” An orthopedic surgeon responded with a different take, saying it was “clearly ridiculous” to limit his hourly take from device makers to just $500.
For an explanation from Fauber on how he has been able to consistently produce groundbreaking stories on the conflict-of-interest beat, see the article he wrote for AHCJ.
U. of Michigan president sits on pharma board
On The New York Times Prescriptions blog, Duff Wilson reports that while her school has taken a lead in limiting conflicts of interest, University of Michigan President Mary Sue Coleman herself sits on the board of Johnson & Johnson, a post which earns her $229,978 each year. Her defense is that she’s openly disclosed the relationship, and that the world of pharma and that of university administration rarely intersect.
Responding to questions on Ms. Coleman’s behalf Monday, Kelly E. Cunningham, a spokeswoman for the university, said the president satisfied the policy by disclosing her outside work. Ms. Coleman has never had to recuse herself from any discussion or action at the university because medical purchasing and investment decisions are so remote from her, Ms. Cunningham said.
“The same is true at J&J,” she added. “There has never been a discussion or decision at the board level that involved something related to the UM. But, of course, if there were, she would recuse herself.”
It’s not uncommon for university presidents to sit on corporate boards, Wilson found, but it appears that pharmaceutical companies are a special case given the major role universities play in medical research and health care delivery.
Thomas Donaldson, a corporate governance expert and professor of business ethics at the Wharton School of the University of Pennsylvania, reviewed the case on Monday for The Times. He said many university presidents serve on corporate boards, but biomedical company boards pose special issues because of the possible ties to university research and medical schools.
“Because of the role of research and also the entrepreneurial interest that lies behind a lot of modern advances in medicine, this is a very difficult issue,” Professor Donaldson said in a telephone interview. “We’ve been aware for decades really that this potential for conflict of interest exists, but we haven’t as a moral community or even inside universities gotten our arms around it yet.”
PepsiCo sparks controversy on ScienceBlogs
A firestorm has erupted over at ScienceBlogs over its decision to allow PepsiCo to have a blog, called Food Frontiers, on its site.
In a post this morning, the “ScienceBlogs Overlords” say they didn’t do a good job communicating “what these sponsored blogs are for, give a proper explanation of what our relationship to Food Frontiers was going to be, or even properly explain what Food Frontiers is.”
They have added language that makes clear that what appears on the Food Frontier blog is written by PepsiCo’s scientists and that posts will include the scientists’ affiliation and conflicts of interest.
Sharon Astyk is taking a hiatus from the site “Until Science Blogs decides whether it wants to be a platform for science writers or a platform for corporations to buy credibility.”
The blogger known as Scicurious is taking some time to think over the situation and says she is “more than a bit uncomfortable.” Update: Scicurious has decided to leave ScienceBlogs.
Journalist and author David Dobbs is “dismayed” by the decision and has written a more lengthy post about the problems. He likens it to having Pfizer run continuing medical education and is moving his blog to Neuron Culture, and considering other venues.
A blogger and scientist who goes by GrrlScientist writes a strong post about credibility and the damage a PepsiCo-written blog will do to everyone associated with ScienceBlogs.
Science writer Brian Switek, who says he is “dumbfounded” over the move, points out that “A newspaper or magazine would not allow PepsiCo to write articles about global health or nutrition.” His blog also will be on hiatus. Update: Switek has decided to quit blogging at ScienceBlogs. He says he will keep blogging elsewhere.
For more on the controversy, see posts from PalMD, Abel, Isis, Janet, Zuska, Blake, Christie, Sharon, Jason, Greg, Orac, PZ, Mark, James H., and Alex Wild.
Update
Maryn McKenna, an AHCJ board member as well as author and journalist, weighs in on her blog on the ScienceBlogs site. She calls the move “spectacularly crass, naive, and dumb.”
Update (July 
ScienceBlogs reverses course, evicts Pepsi blog
ACCME reverses stand on industry presentations
The Accreditation Council for Continuing Medical Education has released new guidance that will allow industry scientists to present “product-related research at for-credit talks” as long as “provider controls ensure they have zero control over the content.”
Covering Health readers might remember that John Fauber of the Milwaukee Journal Sentinel recently reported on policy changes that would not allow industry representatives to make presentations at the American Health Association’s annual meeting and would likely block them from presentations to other medical associations.
Fauber reports the changes come after the ACCME said that “some accredited providers have an intensive process of peer review that ensures importance, accuracy, and validity and, therefore, the restriction was not needed.”
Marc Iskowitz of Medical Marketing and Media reports that the “guidance means other accredited providers, many of whom have been struggling with the same issue when planning meetings, can include new science that mentions therapeutic options or interventions.”
M.D. journalist suggests guidelines for dual roles
Filed under: Conflicts of interest, Health journalism
Tom Linden, M.D., looks at the role of physician reporters in covering disasters, particularly in light of the Haiti earthquake which saw a number of high-profile physician reporters cover the story and render care.
As Linden points out in the Electronic News journal, the networks promoted their reporters’ medical efforts and showed them providing care. He brings up a number of relevant questions about the duties of a physician reporter, whether network s or stations should promote them providing care, privacy of patients and more.
Beyond asking questions and discussing the implications of such coverage and promotion, Linden proposes a set of guidelines “to help clarify boundaries between medical and journalistic practices.”
In short, he says it’s bad journalism and inappropriate for physician reporters to report on themselves providing care.
When physician journalists become the story, medical reporting loses its way.
Linden, a professor of medical journalism in the School of Journalism and Mass Communication at the University of North Carolina at Chapel Hill and director of the medical and science journalism program, is no stranger to the subject, as he has worked as a medical journalist for CNBC and local news stations.
Related
- Press release about Linden’s piece
- Debate over M.D. reporters in Haiti continues
- Doctor or journalist? Roles become blurred in Haiti
APA’s new policy seeks collaboration with pharma
Filed under: Conflicts of interest, Hot Health Headline
The Wall Street Journal’s Shirley Wang looked beyond the American Psychiatric Association’s new conflict of interest guidelines to explore what the APA’s loosening of ties with major pharmaceutical manufacturers meant for their business model and future. The APA has lost 10 percent of its revenue – about $7.5 million – over the past year as pharma is spending less on advertising in their journals and sponsored symposia have been phased out of the APA annual meeting. That last move, Wang found, cost the organization about $2 million.
In an interesting twist, Wang says that while some of the decline in pharma advertising can be attributed to the recession and APA’s attention to COI, some of it comes “because the industry faces its own pressures to avoid potential conflicts of interest.” Overall, pharma’s ad spending in health care publications has slipped from $865 million in 2005 to $626 million in 2009.
Reactions to these tightening regulations and budgets among APA membership has been mixed, as Wang illustrates:
At the annual conference in 2008 in Washington, D.C., Dr. Scully recalled meeting a group of young residents and medical students at the bottom of an escalator who wanted to “express their outrage” at the industry influence at the meeting. At the top of the escalator ride, he encountered another group of doctors upset that there weren’t enough seats in the industry-sponsored symposia. “A number of members liked those [symposia] and they liked that they got fed,” said Dr. Scully.
In an accompanying blog post, Wang writes that the APA hopes its new guidelines will increase transparency, decrease conflict and still maintain a good, cooperative relationship with the pharmaceutical industry.
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