Tag Archives: conflict of interest

After 5-year FOIA fight, documents show ties between researchers, officials in Lyme wars

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

Documents obtained after a long FOIA battle reveal “behind-the-scenes maneuvers and long-standing connections between the scientists’ group and government officials” in the debate over whether Lyme disease can be chronic.

The debate, and the fight for the documents, are detailed by Mary Beth Pfeiffer in the Poughkeepsie (N.Y.) Journal and by documentary film maker Kris Newby on IRE’s Transparency Watch blog.

In 2007, in doing research for a film, Newby requested emails and resumes pertaining to three employees at the Center for Disease Control and Prevention. She writes that “For five years the agency strung me along with frivolous denials, mysterious delays, shifting explanations and false promises. In essence, the delays became an illegal, off-the-books FOIA denial.” Her account of how the CDC handled – or didn’t handle  her request is alarming.

Newby, whose film had been completed, provided the 3,000 pages of documents to Pfeiffer.

The documents show close connections between the government officials who set disease policy and researchers who have received government funds and written treatment guidelines. “As a result, physicians and scientists with opposing views on Lyme disease believe they have been marginalized in the debate.” This graphic provides a good overview of the connections and issues.

Reporters fall prey to back pain study’s shady PR push

Brenda Goodman

About Brenda Goodman

Brenda Goodman (@GoodmanBrenda), an Atlanta-based freelancer, is AHCJ’s topic leader on medical studies, curating related material at healthjournalism.org. She welcomes questions and suggestions on medical study resources and tip sheets at brenda@healthjournalism.org.

Photo by planetc1

If you follow me on Twitter, you may have noticed several 140-character conniptions I had last week over coverage of a Danish study that used antibiotics to treat low back pain.

I generally feel pretty protective of health reporters. I’m in the trenches with you. I have good days and bad days, too. Deadline reporting on medical studies is tough and sometimes undervalued for the work serious, balanced coverage requires. I’m with you.

Even so, I was dismayed by most of the stories I was reading.

Reporters were trumpeting the results of two studies published in the European Spine Journal, a less influential medical journal. Continue reading

Even in treatment guidelines, pharma conflicts abound

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

As part of the ongoing Milwaukee Journal Sentinel and MedPage Today series “Side Effects” John Fauber and Ellen Gabler “examined 20 clinical practice guidelines for conditions treated by the 25 top-selling drugs in the United States” and unearthed yet another tactic by which “pharmaceutical companies, with billions in sales at stake, exert a powerful but often unrecognized influence over the practice of American medicine.”

Issued by leading medical associations and government institutions, treatment guidelines are supposed to be based on rigorous science. But the committees that write them have been dominated by doctors who have worked as paid speakers, consultants or advisers for companies selling the recommended drugs.

In their investigation, the duo found:

  • Nine guidelines were written by panels where more than 80 percent of doctors had financial ties to drug companies.
  • Four panels did not require members to disclose any conflicts of interest. Of the 16 that did, 66 percent of doctors on the panels had ties to drug companies.
  • Some guidelines written by conflicted panels recommend drugs that have not been scientifically proven to safely treat conditions, leading to inappropriate or over prescribing. Medical experts have raised such questions about guidelines for anemia, chronic pain and asthma.

For extensive anecdotes and examples, dig into the full piece.

U. Iowa hospitals share patient data with fundraising organization

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

The Des Moines Register‘s Clark Kauffman opens his investigative report with a simple observation: “University of Iowa Hospitals is giving patient names and specific patient-treatment information to a fundraising organization that solicits donations through written appeals signed by physicians.” Then he backs it up.

Kauffman reports that while universities deny that the practice is questionable, “Patient advocates … say the fundraising seeks to take financial advantage of patients who feel indebted to their doctors for their medical treatment.”

“If people actually knew this sort of thing was going on, there would be a significant number of them disturbed by it,” said Dr. Michael Carome of Public Citizen, a national advocacy group with 80,000 members. “The fundamental practice is exploitative … and in my view there is no way to make this work in a way that would be ethical.”

Hospital spokesman Tom Moore said the fundraising campaign is legal and “completely ethical.” He said the university looked at “best practices” among its peers, and its fundraising practices are in line with those of other hospitals.

Kauffman found that, apparently, these “best practices” include sharing patient contact information, insurance status and appointment schedules with donors without their consent. It also includes routinely seeking patient permission to disclose more specific medical information. And the information flows the other way too, with doctors being notified if one of their upcoming patients is a major donor. Kauffman’s piece describes a fascinating hidden economy.

Network drives increase in painkiller prescriptions

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

In the latest installment of his ongoing investigation for the Milwaukee Journal Sentinel and MedPage Today, John Fauber looks for the source of America’s prescription painkiller boom (graphic), outlining what he describes as “a network of pain organizations, doctors and researchers that pushed for expanded use of the drugs while taking in millions of dollars from the companies that made them.”pills-and-money

Beginning 15 years ago, the network helped create a body of dubious information that can be found in prescribing guidelines, patient literature, position statements, books and doctor education courses, all which favored drugs known as opioid analgesics.

Apparently, that network has been effective. Federal data shows that prescription painkiller sales have quadrupled in the past decade or so, Fauber found, and some of those sales may not have been warranted.

A band of doctors who get little or no money from opioid makers has begun to challenge the hype behind the drugs. They say pharmaceutical industry clout has caused doctors to go overboard in prescribing the drugs, leading to addiction, thousands of overdose deaths each year and other serious complications.

Several of the pain industry’s core beliefs about chronic pain and opioids are not supported by sound research, the Journal Sentinel/MedPage Today investigation found. Among them:

  • The risk of addiction is low in patients with prescriptions.
  • There is no unsafe maximum dose of the drugs.
  • The concept of “pseudoaddiction.”

That concept holds those who display addictive behavior, such as seeking more drugs or higher doses, may not be actual addicts – they are people who need even more opioids to treat their pain.

His investigation dips deep into each of those beliefs and how they helped push painkillers. For a case study, see this companion infographic.

AHCJ calls for accessible reporting of physician payments

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

The Centers for Medicare & Medicaid Services should create an easily usable and searchable database when it publishes information from drug and device makers about payments to physicians, according to comments (PDF) submitted by the Association of Health Care Journalists  on proposed rules for carrying out the Physician Payment Sunshine Act.

The act will open a window on financial relationships between physicians and industry. Starting in 2013, pharmaceutical and device manufacturers must report to CMS any “transfer of value” worth more than $10 to a physician, and CMS will post the information online.

“Overall, we believe your regulations would faithfully enact the provisions of the Payment Sunshine Act,” AHCJ President Charles Ornstein wrote. “To serve its purpose, the information must be easily accessible to anyone who wants to know about an individual doctor or doctors in a community, as well as for researchers and reporters seeking a larger view.”

The law comes in response to growing concerns that industry payments to doctors can skew prescribing decisions and encourage use of brand-name drugs.

AHCJ made several specific recommendations: provide unique identifiers for each physician, note when a company updates its information, include gifts of textbooks and educational materials in the reporting requirements, and include partial data from 2012.

Additionally, the association noted that because the law applies exclusively to physicians, companies do not have to disclose payments to nurse practitioners and physician assistants. AHCJ urged CMS to consider reporting payments to non-physician prescribers who work in group practices with physicians.

Related

The Pew Prescription Project has a collection of documents about the Physician Payment Sunshine Act.

Pharma discloses free meals, ProPublica expands database

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

In his latest report, ProPublica senior reporter and AHCJ board president Charles Ornstein explains exactly how, since its founding last October, ProPublica’s Dollars for Docs database of pharma payments to physicians has mushroomed from 30,000 entries to more than half a million. They answer, he writes, has a lot to do with free meals and other perks that pharmaceutical companies are starting to publish ahead of strict federal disclosure regulations which will go into effect in 2013.

Pharmaceutical company representatives say the meals serve an important educational purpose, and they have adopted their own set of rules for such interactions.

A voluntary code of conduct adopted by the Pharmaceutical Researchers and Manufacturers of America says that “it is appropriate for occasional meals to be offered as a business courtesy” to doctors and members of their staffs attending information presentations by sales reps.

In such cases, the guidelines say, the presentations have to “provide scientific or educational value,” and the meals should be “modest” by local standards and not part of an entertainment or recreational event. Meals for spouses and take-out meals are not appropriate, the guide says.

To put it all into perspective, Ornstein demonstrates with numbers from Pfizer that, while the meal numbers have certainly increased the number of entries in their database, they haven’t had as significant an impact upon the overall dollar amounts in question.

Relatively, the meals didn’t add up to much money. Pfizer’s meals amounted to only $18 million last year, compared to $34 million for promotional speakers and $108 million for research.

As with previous installments, Ornstein, Tracy Weber and Dan Nguyen’s database work has spawned follow-up reports around the country. In fact, the response was such that Ornstein and Weber even took the step of re-nationalizing the localizations of their story, with the follow-up “News Reports Cite Drop in Physician Speaking Fees.” Below, I’ve linked to a few notable localizations and follow-up stories. If you’ve got another one to point out, add it in the comments.

CPI investigation details health information technology sector’s lobbying efforts

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Writing for The Center for Public Integrity’s iWatch News, Josh Israel reports that, with billions of stimulus dollars still at stake, the number of health information technology lobbyists taking advantage of the lucrative “revolving door” between Capitol Hill and the private sector is sky-high, even by D.C. standards.

The Obama administration is still working to iron out the details of the “meaningful use” mandate expressed in the recovery act, and the big players in health IT are pulling out all the stops to ensure the rules are written to their advantage.

Healthcare Informatics magazine publishes an annual ranking of the 100 largest health IT companies by annual revenue. According to the Senate Office of Public Records, 15 of the companies in the 2010 ranking — most of them ranked in the top third by revenue — reported health IT-related lobbying activity in the first quarter of 2011 or the last quarter of 2010. Of the 90 lobbyists listed as having done health IT lobbying for those firms, at least 63 were former Congressional and/or executive branch staffers, many of whom worked for health-related agencies or committees.

For those interested in additional details on HIT’s lobbying efforts, Israel also included two sidebars:

Fla. juvenile justice system relies on heavy antipsychotic use

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

In looking into the state Department of Juvenile Justice’s use of powerful prescription antipsychotics, The Palm Beach Post‘s Michael LaForgia “analyzed department drug purchasing information and state Medicaid billing data and reviewed thousands of pages of DJJ inspection reports, drug company disclosure records and court documents.” It shows, as he surfaces with some powerful numbers and equally alarming anecdotes (Part 1, Part 2, Infographic).

…in state-run jails and residential programs, antipsychotics were among the top drugs bought for kids – and they routinely were doled out for reasons that never were approved by federal regulators, a Palm Beach Post investigation has found.

A key concern is that the prescriptions may be driven by their improper use as chemical restraints, or by the hefty speaker (and related) fees being paid from pharmaceutical companies to the most prolific prescription writers. Unfortunately, specifics are hard to come by as most homes are run by private contractors and the state doesn’t have the resources for close monitoring. For this story, the reporters were only able to obtain two years worth of data for 25 jails and three programs – a fraction of the statewide total. Those data still paint what LaForgia calls a “startling story.”

A look at the sheer numbers of drugs purchased … suggests a startling story is unfolding in state homes for wayward kids.

In 2007, for example, DJJ bought more than twice as much Seroquel as ibuprofen. Overall, in 24 months, the department bought 326,081 tablets of Seroquel, Abilify, Risperdal and other antipsychotic drugs for use in state-operated jails and homes for children.

That’s enough to hand out 446 pills a day, seven days a week, for two years in a row, to kids in jails and programs that can hold no more than 2,300 boys and girls on a given day.

PR rep says journalists’ stipend to attend Allergan event was misconstrued

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

An invitation to journalists to participate in an Allergan-hosted “Facial Aesthetics Advisory Panel” that included an offer of a $250 stipend was misconstrued, according to the public relations representative who sent it.

Sarah Smedley, of Chandler Chicco Companies, said the panel was intended to be “in the nature of a focus group.”

The agency, which sent the invitation to 10 freelancers, wanted the journalists to tell them what types of questions their readers have. Smedley characterized the questions they would put to journalists as broad and not product-specific. Allergan manufactures Botox, Juvederm and Latisse.

They chose freelancers because they have a broad view and write for multiple outlets, according to Smedley. “There was no intention to get stories or coverage; we wanted to listen.”

Two journalists have accepted the invitation but one of them has declined the stipend, she said. “We expected a few to come to participate as experts in the media.”

AHCJ member Lisa Collier Cool shared the invitation with AHCJ, saying she considers this “an all-time low in drug company promotion to the media.”

Karl Stark, AHCJ’s vice president, said the organization’s board of directors was alarmed by the offer.

“We report all the time on the potential conflicts of interest that money creates between drug companies and doctors,” said Stark, a Philadelphia Inquirer editor. “How would this be any different?”

AHCJ’s Statement of Principles includes the advice to:

  • Deny favored treatment to advertisers and special interests and resist their pressure to influence news coverage.
  • 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.

“We really regret that Lisa [Collier Cool] misconstrued this,” Smedley said. “The allegation that it was a bribe took my breath away.”

Smedley, who said she has worked in health care public relations for about 15 years, said she was “disappointed that Lisa wouldn’t have called, reached out somehow … for more information.”

She said the invitation has been “misconstrued terribly wrong and out of proportion.”

When asked if she is aware of journalists’ codes of ethics, she replied, “We’re highly aware and we respect journalists and their code of ethics.” She said she also observes the PRSA’s code of ethics.

She does not believe their invitation was unethical and her agency will “conduct focus groups and adhere to codes of ethics, as we’ve always done.” This is the first focus group of this kind for Allergan.

A spokeswoman for Allergan told Forbes’ Matthew Herper that the stipend was “for their participation in a three-hour meeting as a means to compensate them for their time, nothing more.”