- http://www.jsonline.com/multimedia/video/?bctid=2044222494001
- http://www.jsonline.com/watchdog/183995971.html
- http://www.jsonline.com/watchdog/168151336.html
- http://www.jsonline.com/multimedia/video/?bctid=1828247989001
Provide names of other journalists involved.
John Fauber Ellen Gabler
List date(s) this work was published or aired.
Feb. 19, 2012: Networking fuels painkiller boom May 30, 2012: Narcotics use soars among seniors May 30, 2012: Death risk overstated (sidebar) Sept. 9, 2012: What happened to the poster children of OxyContin? Nov. 18, 2012: Advair boomed amid health risks Nov. 18, 2012: 1990s trial gave early danger signs for asthma drugs Dec. 19, 2012: Health guideline writers conflicted Dec. 19, 2012: Pushing unproven pills
Provide a brief synopsis of the story or stories, including any significant findings.
In 2012, the ongoing “Side Effects” investigation exposed a troubling web of drug company influence over the practice of American medicine. The stories showed how drug companies funded nonprofit groups that advocate for more use of opioids and how treatment guidelines that recommend their use were written by panels stacked with doctors with financial ties to drug companies. They examined why sales of Advair boomed amid health concerns and despite warnings from the U.S. Food and Drug Administration’s own doctors. Part of the answer: Asthma treatment guidelines written by a panel of financially conflicted doctors. And they examined the conflicts in treatment guidelines related to the nation’s 25 top-selling drugs. The most startling finding: Of the 20 treatment guidelines examined, nine were written by panels where more than 80% of doctors had financial ties to drug companies.
Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
We’ve used many records, data sets and online resources for this series of stories. For “Networking fuels painkiller boom,” we used a variety of records, including many that had been posted on the websites of various pain advocacy groups that had been receiving millions of dollars in funding from companies that make narcotic painkillers. Many of these records provided evidence the organizations had been disseminating questionable or unproven claims about the safety and effectiveness of opioids in treating chronic pain. These included position statements, patient information brochures and books. In one case, a Michigan pain specialist provided us with a copy of a 2008 letter he sent to the pain organizations saying he was resigning from an important committee that was drafting new guidelines for treating pain. His letter said he was doing so because drug companies had gained too much financial influence over committee members and the organizations themselves. For “Health guideline writers conflicted,” we essentially had to construct our own social science research method. We wanted to analyze clinical practice guidelines in a systematic way that would matter to people. First, we read medical journals that had articles about conflicts of interest and clinical practice guidelines. We studied the methodology and spoke with research and medical experts about the pros and cons of different methodologies we were considering. We decided to focus on the best-selling drugs in the United States because of the immense health and financial impact those drugs have on Americans. (The top 25 drugs account for 30% of all drug revenue in the United States!) We obtained a list of the 25 top-selling drugs in 2011 from IMS Health, a research firm. We then needed to identify the year each drug was approved by the U.S. Food and Drug Administration and the condition for which the drug was first approved because that’s how we would find relevant clinical practice guidelines. Among other resources, we used the FDA’s approved drug database, which has tons of information, including scanned documents that detail when a drug was approved and the conditions for which it had been approved. Reporters then searched for relevant clinical practice guidelines using the National Guideline Clearinghouse, PubMed and other medical databases. We searched for clinical practice guidelines that related to conditions those drugs treated, and guidelines that were issued by major medical associations or government institutions. Some guidelines could not be found online but were located at the Medical College of Wisconsin or requested through medical associations. Reporters went through each guideline and checked to see if specific drugs were recommended as treatment options. We then identified the number of panel members on each guideline who disclosed conflicts of interest at the time. We also recorded whether a chairman of the panel had financial conflicts and determined how many people on each panel had ties to companies that made or marketed major drugs. All of the information was managed in a Google spreadsheet. The spreadsheet was later turned into a searchable database for readers, and all of the data for graphics came from the spreadsheet we complied. (www.jsonline.com/sideeffects) For other stories in the “Side Effects” series, we filed records requests with medical examiners throughout the state to gauge the number of people who had died from specific causes. For examp
Explain types of human sources used.
All of our 2012 “Side Effects” stories are continuations of our commitment to covering conflicts of interest in medicine. And at the root of that ongoing coverage has been people. Most of these stories got started because at some point a doctor or insider suggested that we take a look at something. Many of the human sources were detailed above, but to summarize: We spoke with many researchers, doctors and academics to make sure our methodology for the conflicts of interest story was sound. We interviewed doctors with conflicts who wrote guidelines and the companies that paid them. We spoke with family members of people who died from accidental overdoses and interviewed medical examiners to understand medical jargon in autopsy reports. We spoke with government sources within the FDA, legislators, representatives of medical associations, advocacy groups and hospital administrators.
Results:
In the last two years, “Side Effects” stories have been at least partly responsible for two investigations by the U.S. Senate Committee on Finance. In May, the committee — citing investigative reports in the Journal Sentinel and ProPublica — began an investigation into financial relationships between companies that make narcotic painkillers and organizations that advocated for use of the drugs. That inquiry is ongoing. An earlier Finance Committee investigation, completed in October, found that marketing employees of Medtronic were secretly involved in drafting and editing favorable medical journal articles about the company’s lucrative spine surgery product, Infuse. Those ghostwritten articles bore the names of prominent surgeons from around the country who had been paid $210 million by the company over the course of 15 years. More importantly, Journal Sentinel stories have been on the forefront of informing the national debate about the use of opioids, specifically, and the pervasive influence of the drug and medical device companies on the practice of medicine in general.
Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
No corrections or clarifications have been run or requested.
Advice to other journalists planning a similar story or project.
It’s important to understand the science and be skeptical about studies and recommendations issued by major medical associations and government institutions. Also, hammer out your methodology early on and asks experts to help. Share your data with those experts when you are finished and ask for their feedback.