Fake Pharma — The Ghosts in a Very Big Machine
Another media outlet has been caught promoting the interests of Big Pharma under the guise of real news. This time, somewhat surprisingly, it was news outlet STAT, which otherwise has a solid reputation in reporting science and health news. The story was titled, “How Pharma Sales Reps Help Me Be a More Up-to-Date Doctor,” written, supposedly, by Dr. Robert Yapundich, an experienced neurologist. You can see where this is going.
The article praised drug reps for providing vital information to doctors. And why wouldn’t it offer such praise? Yapundich has received more than $300,000 from drug companies in recent years, a fact pointed out by numerous Twitter users and readers in the article’s comments section, who suggested the obvious conflict of interest ought to be disclosed.1 The problem was, it wasn’t, at least not at first.
The article remained untouched for at least four days, during which other commenters pointed out more problems, like the fact that Yapundich said he’d not heard of a drug (Nuplazid) until he had lunch with a drug rep, yet, it turns out, he was previously paid for consulting services regarding the same drug.2 Commenters soon started calling on STAT to disclose the ties, fix the seemingly false statement or retract the article. STAT chose the latter.
STAT Retracts Ghost-Written Piece
The controversial article now contains an editor’s note stating that it was retracted because “it did not meet our standards,” continuing:3
“As a matter of policy, we ask all our contributors to disclose payments from industry and other possible conflicts of interest. In this case, the author disclosed no conflicts other than his affiliation with an organization that supports expanding manufacturers’ ability to discuss off-label uses of drugs.
In response to reader questions, we contacted Yapundich and he told us he had received more than $300,000 in recent years from pharmaceutical companies, including one he mentioned in the article.
He also acknowledged that his organization was funded in part by pharmaceutical companies. We disclosed that information at the bottom of the article … We also asked Yapundich to address reader questions about the veracity of the central anecdote in the piece. He said the anecdote was accurate as written.
But Yapundich later told HealthNewsReview that the anecdote was not, in fact, accurate. After that interview was posted … we contacted Yapundich again and he conceded to STAT that the anecdote was inaccurate. We then retracted the article.”
The organizational affiliation that STAT speaks of is the Alliance for Patient Access (AfPA), a group that receives money from close to 30 drug companies; Yapundich sits on the board. Kevin Lomangino, managing editor for HealthNewsReview, reported that, when he spoke with Yapundich, he said the article was AfPA’s idea and was written by a ghostwriter.
Yapundich then made some changes and edits to the article prior to it being published by STAT. Reportedly, when he asked his contact at the AfPA what he needed to do in terms of conflict of interest disclosures, the person wrote, “Hold on financial info. Hopefully only needed for AfPA and not for you individually.”4
HealthNewsReview then revealed another layer to the story, which is that Yapundich was working in some capacity with Washington D.C.-based PR firm Keybridge Communications, who says their goal is to “brand thought leaders.” It’s unclear who was paying for their services, as well as who was ultimately responsible for the lack of financial disclosure in the article. “It seems that wherever the op-ed originated,” Lomangino wrote, “it received careful attention from PR messaging pros before it ever reached Yapundich’s desk.”5
‘Ghost-Written Puff Pieces From PR Companies’ Passed Off as Op-Eds
“While authors of op-eds may get more latitude than they would in a straight news piece, the boundaries shouldn’t be so wide as to include ghost-written puff pieces from PR companies,” Lomangino wrote. Industrial ghost writers first became popular when tobacco executives hired them to spin positive press about cigarettes and secondhand smoke, published in the name of various scientists, according to New York University journalism professor Charles Seife.
“Since then, ghostwriters employed by parts of the pharmaceutical industry have been busily tobacconizing the scientific literature. Gaze into the depths of PubMed for long enough, and they will materialize before your eyes, promoting Wyeth’s Prempro, Merck’s Vioxx, and Pfizer’s Neurontin, just to name a few,” Seife says.6
Even Monsanto has gotten into the mix, with glyphosate articles ghostwritten by Monsanto’s toxicology manager published using names of academic researchers, and the practice is well-known among peer-reviewed journals. For medical journals, ghostwriting usually refers to writers sponsored by a drug or medical device company, who make major but uncredited research or writing contributions.
The pharmaceutical company hires a medical education and communications company, which is a company paid almost exclusively by pharmaceutical companies to write articles, reviews and letters to editors of medical journals in order to cast their products in a favorable light. One cross-sectional survey found that more than 20 percent of articles published in six leading medical journals during 2008 were likely written by honorary and/or ghostwriters.7
With the STAT piece, however, we’re now seeing that industrial ghostwriting has come to the mainstream media, allowing corporate interests to spread their propaganda over an even wider audience. Seife continued that many news outlets, including STAT, are aware that some of their opinion pieces are ghostwritten, but when the ghost-writers are being sponsored by powerful people with powerful agendas, that’s where the problems begin:8
“Many opinion sections have a grudging acceptance of some degree of ghostwriting in their pages; after all, high officials and A-list celebrities have entire staffs hired to meticulously shape each public utterance.
But even if you accept that kind of ghostwriting, the industrial version of ghosting is an entirely different beast. Instead of putting the words of an unknown in the mouths of the powerful, it does just the opposite — it disseminates the words of the powerful by putting them in the mouth of the unknown.
Indeed, in this case, it used the trusted institution of a friendly doctor to spread the gospel of the pharmaceutical industry. It’s not the sheep in wolf’s clothing that’s to be feared, but the reverse … It may be a losing battle; the wealthy industries using these tactics are adept at harnessing the forces of capitalism to defeat any attempt at transparency. After all, it’s nigh impossible to see who’s really pulling the strings when the invisible hand gets involved.”
Another STAT Blunder: Patient Praising TV Drug Ads Connected to Drug Company
Yapundich’s now-retracted piece wasn’t the first time STAT published an op-ed without disclosing the author’s true affiliations. In 2016, an op-ed titled, “You Can Complain About TV Drug Ads. They May Have Saved My Life,” was featured, written by patient Deborah Clark Dushane. Suffering from chronic hepatitis C, Dushane wrote that drug ads on television prompted her to ask her doctor about new drugs to treat the disease, which “cured” her.
“I strongly believe that if I hadn’t seen TV ads about chronic hepatitis C and new drugs to treat it, I wouldn’t have done anything to protect myself against it. Those commercials raised my awareness of the disease and gave me the courage to try again to beat it. I’m sure I’m not the only person they have helped,” Dushane wrote in the STAT piece.9
Again, reporting by HealthNewsReview revealed that the author wasn’t operating totally independently. A PR firm for Gilead, a drug company that manufacturers drugs to treat hepatitis C, contacted Dushane and asked her to write the piece. The positive press was intended to offset another STAT article that had recently been published, outing the “$100 million ad blitz for a $1,100-a-pill drug for hepatitis C.”10
Dushane wasn’t paid to write the piece, but Gilead flew her to California to learn more about the company and its products, after which she appeared on local TV stations to talk about the drug. Dushane was coached by Gilead’s PR people on what message to relay in the article and on TV.
STAT added an updated disclosure to the article on September 13, 2017, after HealthNewsReview brought the conflict to their attention. Seife, meanwhile, described Dushane’s role as a sock puppet for the industry11 while HealthNewsReview quoted Dr. Carl Elliott, a professor at the University of Minnesota Center for Bioethics and an affiliate faculty member in the School of Journalism and Mass Communications:12
“Of course this is wrong, and it’s wrong because it’s deceptive. I think the editors need to explain just what their policy is about corporate influence on the editorials they publish … Do they permit editorials that are completely ghosted by pharma? By a PR company working for pharma? What if the author wrote it himself or herself, but was paid to do it by pharma or a PR company?
What if the author wasn’t paid directly to write the editorial, but was coached what to write and got other benefits from a company? All of these scenarios seem disturbing to me, and I’d like to know if they are disturbing to the STAT editors too.”
Drug Company Faked Cancer Diagnoses in Patients to Sell More Opioids
A federal indictment and congressional investigation by Missouri Sen. Claire McCaskill allege that Insys Therapeutics concocted a fraudulent scheme to sell more of Subsys, an expensive, highly addictive, sprayable form of fentanyl.13 Prior authorization was required from insurance companies before the drug could be prescribed by doctors, and a diagnosis of cancer was a requirement for prescription clearance.
Insys wanted to make it easier for patients to get the drug, even if they didn’t have cancer, so they had their own employees to talk to patients’ insurance companies, pretending they were working with their doctors. According to CNN, “The Senate report documented how beginning in 2014, when someone needed to obtain prior approval for a Subsys prescription, it was actually an Insys employee who called the insurer and its affiliates to persuade them.”14
The insurance companies would ask whether the patients had “breakthrough” pain caused by cancer. CNN reported, “Insys got around this by finding calculated ways for its employees to create the impression on the phone calls that the answer was yes, they did have cancer, without explicitly saying so, according to the report.” 15
Further, six former Insys executives were charged in 2016 with fraud and racketeering charges, alleging they paid kickbacks to bribe doctors to prescribe Subsys and defraud insurance companies. Another former Insys manager pleaded guilty to charges that she taught salespeople how to entice doctors with money, chocolate or spending time with them, and to look for “money hungry” doctors willing to “play ball.”16
Drug Reps Target ‘Thought Leaders’
Drug companies have long tried to influence doctors’ prescribing habits by giving them gifts, vacations, fancy dinners and the like. This practice has since become frowned upon, but paying them for research activities, speaking and other “consulting” gigs continues. In fact, it’s interesting that PR firm Keybridge Communications used the phrase “branding thought leaders,” because drug reps use this tactic too.
Speaking to NPR, pharmaceutical rep Mathew Webb said asking doctors to become speakers was a surefire way to get them to write more prescriptions. In particular, calling them “thought leaders” apparently has “incredible psychological power,” he said, continuing, “When you do say ‘thought leader’ I think it’s a huge ego boost for the physicians. It’s like a feather in their cap. They get a lot from it.”17
While doctors may think they’re being recruited because of their qualifications or know-how, former drug rep turned whistle-blower Angie Maher told NPR, “I think nowadays a thought leader is defined as a physician with a large patient population who can write a lot of pharmaceutical drugs. Period.”
Webb said that after paying a high-prescribing doctor $1,500 to speak, he might write an additional $100,000 to $200,000 worth of prescriptions for the company’s drugs. They know because they purchase data about each physician’s prescribing habits from companies like IMS Health, ensuring they get a good return on their investment.18
Is Your Doctor Being Bribed by Drug Companies?
What can you take away from the knowledge that Big Pharma’s ties run deep, perhaps to your local newspaper’s opinion pieces or even to your own doctor? It’s important to take what you read with a grain of salt, and do your own research if an “independent” source reeks of conflict of interest. This applies not only to what you read in the media but also what you hear from your doctor.
Drug companies have long tried to influence doctors’ prescribing habits, however it hasn’t always been possible to find out what gifts your own doctor might be accepting. The Physician Payments Sunshine Act, which is part of the Affordable Care Act, went into effect in 2013.
For the first time, the Act required drug and medical device makers to collect and disclose any payments of more than $10 made to physicians and teaching hospitals. The Centers for Medicare & Medicaid Services (CMS) is in charge of implementing the Sunshine Act, which it has done via its Open Payments Program.19 You can easily search the site OpenPaymentsData.CMS.gov to find out what (if any) payments your doctor has received, along with the nature of the payments.
ProPublica’s Dollars for Docs website is another great tool you can use to search for general payments (excluding research and ownership interests) made to doctors from August 2013 to December 2015.20 If you don’t like what you see, you can take the steps necessary to put your health care in the hands of someone with your best interests — not Big Pharma’s — at heart.