My Run-in with so-called "Investigative" Reporters from ProPublica (New York) and the Scene (Nashville), a disappointing experience with one-sided journalism

My Run-in with so-called "Investigative" Reporters

I have now been mentioned in several articles related to the required publication of income from pharmaceutical companies for my lectureship services. The first was the expose by ProPublica: http://www.propublica.org/article/dollars-to-doctors-physician-disciplinary-records and the second was from a local Nashville paper, The Scene: http://www.nashvillescene.com/nashville/should-you-be-worried-if-your-doctor-is-on-big-pharmas-payroll/Content?oid=2052989.

In both cases, the reporter who contacted me appeared friendly, protested their lack of bias, and assured me that their reporting of shared information would be handled in a balanced and fair manner. I presented each of these reporters with a lengthy questionnaire to establish the extent of their knowledge of the industry in general (e.g. the life-cycle of medications, the cost of drug development, the marketing requirements to cover the investment costs of drug development) and the educational programs sponsored by pharmaceutical companies (e.g., the PHARMA guidelines, FDA restrictions of lecture content, the level of knowledge of guidelines and disease states by general practitioners). I also requested information on editorial policy, the income and sources of income of the reporting staff, possible conflicts of interest and declared biases. In both of the cases, the reporters refused to respond to my full queries.

In the ProPublica article, I was listed as a physician in an article titled: "Docs on Pharma Payroll Have Blemished Records, Limited Credentials" with the implication that I had a blemished record and that GSK developed me “as an expert”. Although I had clearly defined my credentials, I was characterized as a “not a researcher with published peer-reviewed studies to his name. Nor is he on the staff of a top academic medical center or in a leadership role among his colleagues." Although in my conversations with the reporter, my background education was mentioned (BA, University of Pennsylvania; MD, University of Tennessee, MPH, Yale University) and clinical training was discussed (Internal medicine residency at Yale affiliated hospitals, Cardiology fellowship at Brown University affiliated hospitals, and Post-cardiology fellowship at Harvard’s Massachusetts General Hospital), the reporter chose not to include my credentials in describing me for the presumed purpose of diminishing my status as a physician. Interestingly, I have published (http://www.amcp.org/data/jmcp/august_suppl.pdf), albeit one, and another on the way. Additionally, I am currently engaged in clinical research. My practice is one of a limited United States investigation sites for several large international clinical trials related to diabetes and cardiovascular diseases. I hold a number of membership positions in professional societies, but I have chosen to avoid seeking leadership roles in such organizations because of time restraints, certainly available to me if I were to purse them. I am well-respected in my community and across the country by physicians that have heard my lectures. The implication of the article was clear- I was a fabricated expert for the purpose of supporting GSK’s Avandia diabetic drug and that I lacked expert credentials. If the reporter had reviewed the article I had written and my FDA presentation, he would have realized that I was a credible expert in the area of diabetes and cardiovascular diseases. But it was easier for the sake of a good story line to diminish my professional standing without truly investigating the issues. Sensational journalism, with obvious biases, was the real purpose underlying the publication.

In the case of the Scene article, the reporter again presented himself as lacking biases. As with the earlier reporter, I requested evidence that the reporter was knowledgeable of the subject matter and that he would approach the subject in a fair-balanced manner. He failed to respond to my lengthy questionnaire. When I asked for proof from the reporter of his unbiased perspective, he offered this response in writing: "It’s not that I’m avoiding your questions; I’m simply not interested in the hardships the industry faces when attempting to bring a drug to market. They made $300 billion last year. In 2004 they spent more than 24 percent of their budgets on marketing and only 13 percent on R & D. They seem to be doing fine to me. And if the way the spend money is any indication, they seem more interested in marketing than they are in developing new drugs and bringing them to market." The reporter was obviously prejudiced against the pharmaceutical industry before he even wrote the story, which may explain his single sided approach expressed in the article.

The article was titled “Should you be worried if your doctor is on Big Pharma's payroll? -Pharm League.” Pictured on the front cover of the magazine is a hack actor dressed up as a physician with a stethoscope around his neck yelling into a megaphone labeled “Pharma League” and cheering on their Big Pharma benefactor. The message is clear- yet again, another large corporation buying influence. But when you start looking at the substance of the article, the report falls short in fully demonstrating that the relationship between industry and physicians, or for that matter, large institutions, causes harm. The inferences are obviously projected and predictable, but actual damages not identified. The implication underlying this article is that money buys influence, but does it? I know of no studies that have demonstrated adverse effects from the educational programs provided by Big Pharma.

In the article, in which I am featured as an example, I am characterized as a minimally credentialed physician with “no academic affiliations” that have carried the flag of GSK’s Avandia diabetic drug against overwhelming data suggesting harm. He cites GSK’s own internal study, the Nissen meta-analysis, and Dr. Graham’s mortality estimates attributed to Avandia without offering other valid perspectives. The implication is clear, that I continue to defend the drug despite the FDA’s decision to severely limit its use. If the reporter had done his research, he would have realized that there is more to this story than he obtained by doing a Google search on the subject.

As it relates to his reporting of my defense of Avandia (rosiglitazone), I just wish the reporter would get his facts straight. It should be emphasized that the scientific information surrounding this contentious issue is complex and confusing. A definitive consensus about the safety of Avandia has yet to be established; the recent actions of the FDA to severely limit the distribution of Avandia were taken as a prudent measure given this uncertainty. My statements, which have been taken out of context in this and the ProPublica articles, have been consistent. The scientific evidence for affirming a cardiovascular risk to Avandia is incomplete and conflicting. In fact, in the FDA statement explaining its  ruling on Avandia, Dr. Woodcock, stated,“the cardiovascular safety profile of rosiglitazone is still an open question because there are conflicting data on the existence and magnitude of the risk.” If interested, please refer to her complete statement that has been published on FDA’s website: http://www.fda.gov/downloads/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/UCM226959.pdf. Finally, my opinions comport with that of the American College of Cardiology and American Heart Association: http://circ.ahajournals.org/cgi/reprint/CIR.0b013e3181d34114. Contrary to the representation of me in this article, I believe that my viewpoint is credible and defensible, regardless of the appearance of bias related to my GSK association.

At the heart of these reports is the implication that the pharmaceutical industry is buying influence and prescriptions by paying off doctors. That is farthest from the truth. If the pharmaceutical companies had to depend upon the prescribing habits of me (or that of all of my colleagues on lecture bureaus, for that matter), they would become unsolvable quickly. I was not chosen for my usage of a medication, but for my ability to distill science and disease understanding to other physicians and to offer both experience and knowledge about drug therapy. Given the poor national record of compliance of the medical system with national guidelines governing areas of hypertension, lipidology, coronary artery disease, and diabetes, the need of these lecture programs to remind physicians of therapeutic goals and national standards are obvious.

Addendum: Questionnaire Testing Bias

Based upon your positive comments, I suspect that you do not have such prejudices and enter this area of journalism with a sincere interest to understand the purpose of the lecture bureaus and the relationship between physicians and industry. In order to test that hypothesis, I would like for you to answer honestly the following questions:

Sources of personal income that may influence the objectivity of your journalistic reporting: Based upon your federal income tax returns, what is your annual income for the last three years? What are the main sources of your income?

Prior education or personal experiences that may adversely affect your objectivity: What is your educational background? Did you take any courses related to medicine or the healthcare delivery system? Have you or your family had any adverse experiences related to medical treatments or care?

Editorial positions and policy that may adversely affect the objectivity of the report: Does the editorial board of your news agency abide by the ethical standards of investigation based upon: http://www.spj.org/ethicscode.asp? Does the journal have any written standards or guidelines of behavior that govern investigative reporting? Do you or your journalistic organization have any preconceived notions about the pharmaceutical industry? If so, please elaborate in writing. Are any editorial policies in place, either written or understood, directed to the medical industry in general and the pharmaceutical companies, in particular?

Preexisting knowledge about the subject area of your report: What prompted your interests in the pharmaceutical industry? What books, articles, or other reading material that may have or currently are influencing your opinions of this subject? Did you have any preexisting concepts about the pharmaceutical industry that may influence your investigation? What benefits do the society derive from the pharmaceutical industry? What is your understanding of the marketing life cycle of drug development? What are the current barriers to get FDA approval of a new agent on the US formulary? What intellectual protection is available to a pharmaceutical company after gaining FDA approval? What are the current costs of bringing a new drug to market?

What is your current understanding about the lecture programs offered to health care providers? What are your understandings of the term “affirmative or promotional programs” offered by the pharmaceutical companies? Do you believe at this point that these programs have any benefits? Is there any data to suggest that such promotional programs have an adverse effect on patient’s health or life? What is you understanding of the nature of post-graduate education that the average healthcare provider receives following graduation from medical or nursing school? What is your knowledge of the PHARMA guidelines? What effect are you aware of its influence over promotional programs provided by the pharmaceutical companies?

Preexisting knowledge about the pharmaceutical industry: How does the profit margin of this industry compare to the computer software industry or the managed care health industry. What is the usual marketing budgets for similar size industries? Why do you feel that the industry requires such a significant outlay of moneys to market their products? Does direct consumer marketing cause harm to the population? If you criticize the profit margins of the pharmaceutical industry, are you not inherently criticizing the capitalistic system of maximizing profits? What is an appropriate profit for bringing a life changing medication to market? Are you aware of the contribution of medications to the increased longevity that has been extended to the population? Do you believe that drugs should be commodotized? Do you believe that health care, including drug availability, is a right or an entitlement? Do you feel that the pharmaceutical companies should spend more than they do on research and development? What is the absolute amount spent on research? What impact does such research have on this country’s basic science research system, independent of drug development? What proportion of the budget of universities is directly or indirectly supplied by the pharmaceutical companies? What proportion of the pharmaceutical company’s marketing budget constitutes the costs of the lecture bureaus or the promotional programs?  

Sources of the journal’s income and board of directors and advisors that may influence your journalistic reporting: What are the main advertising income sources of the journal or magazine of which you are employed? Are any companies or individuals involved in the medical delivery system provide any advertisement income or administrative or managerial support to your journalistic company? Are any members of the Board of Directors of the journal involved in any businesses that may or have any relationships or financial ties with the health care system or to competitors of the industry?

Previous reporting on the subject material: Have there been any articles in the last five years on the pharmaceutical industry or the health care system in general or any individuals involved in the medical delivery system in general? If so, Please submit.

Miscellaneous: Please submit any other information that are not covered in the above questions that may influence in any manner your investigation.

Thanks in advance for revealing the type of reporter you are. I will review your responses and assess whether an interview is expected to be unbiased.

Thanks,

Hal Roseman, MD, MPH, FACC, FACP

2400 Patterson Street, Suite 215

Nashville, TN 37203

Office: (615) 884-4425

Email (Office): cardiowellness@bellsouth.net

URL: www.cardiologywellness.net