Naming Names: Is there an unbiased doctor in the house?
VERACARE
Promoting Openness, Full Disclosure, and Accountability
http://www.ahrp.org and http://ahrp.blogspot.com
FYI
One of our pet peeves is the failure of most--but not all--science and
medical reporters to investigate potential financial conflicts of interest
of medical experts whom they quote in their news reports. Failure to inform
readers about financial ties such experts have with manufacturers of
products they recommend is a great disservice to readers--both doctors and
consumers--who are likely influenced by recommendations from prominent
"authorities" who are quoted by leading news media.
Jeanne Lenzer and Shannon Brownlee, two investigative reporters covering
medicine have compiled a list of 100 independent, financially unbeholden
experts to whom journalists can turn as unbiased sources of credible
information. See: www.healthnewsreview.org/independentexperts.php
Contact: Vera Hassner Sharav
vera...@ahrp.org
212-595-8974
Published 23 July 2008, doi:10.1136/bmj.a930
Cite this as: BMJ 2008;337:a930
Medicine and the Media
Naming names: is there an (unbiased) doctor in the house?
Jeanne Lenzer, medical investigative journalist, New York, Shannon Brownlee,
senior fellow, New America Foundation, Washington, DC
Correspondence to: J Lenzer jeanne...@gmail.com
<mailto:jeanne...@gmail.com>
Journalists often forget that conflicts of interest may bias the opinions of
their expert sources. Jeanne Lenzer and Shannon Brownlee explain how, in an
attempt to disentangle commercial messages from science, they have compiled
a list of nearly 100 independent medical experts to whom reporters can turn
Ho hum, another medical scandal in the news. Earlier this month US Senator
Chuck Grassley announced his intention to investigate Alan Schatzberg,
chairman of the psychiatry department at Stanford University and the
incoming president of the American Psychiatric Association, about his
multimillion dollar interest in Corcept Therapeutics, a company that is
seeking to market a drug that Dr Schatzberg is researching with federal
funding, and the extent to which he disclosed and was required to disclose
that interest to Stanford.1 In June the New York Times broke a front page
story about the alleged failure of three top research psychiatrists at
Harvard, each of them a proponent of drug treatment for psychiatric
conditions in children, to report that since 2000 they had collectively
received more than $4.2m (#2.1m; {euro} 2.6m) from various drug companies.2
After ignoring the growing controversy over conflict of interest for years,
journalists now seem only too happy to expose wrongdoing in medicine. Yet
when it comes to reporting medical news, those self same reporters often
seem to forget that conflicts of interest might also bias the opinions of
their expert sources. The media are filled with happy talk about "medical
breakthroughs" that is based on information gathered from sources with ties
to the industry. Yet simply knowing that conflicts of interest can create
bias doesnt answer the question of which studies we ought to believe.
Because journalists fail to seek out sources who can offer an independent
perspective, many medical stories in the popular media are either unbalanced
or simply wrong.
In an attempt to disentangle commercial messages from science and to
contribute to better reporting we took a drastic step that we believe can go
to the heart of the problem: we decided to name names. We created a list of
nearly 100 international medical experts in a wide variety of disciplines.
But contrary to the "gotcha" tradition of journalism, the lists members are
not physicians on the take but rather the reverse: they are leading
independent experts, many of them sources we have cultivated over years of
reporting. It includes, from journal publishing, two former editors of the
New England Journal of Medicine, the former editor of the Western Journal of
Medicine, and a senior editor of PLoS Medicine; former advisers to the US
Food and Drug Administration; physician educators; researchers;
bioethicists; epidemiologists, methodologists, geneticists, and clinicians
from various specialties; medical whistleblowers; and several medical
journalists.
Those applying to be on the list fill out a form affirming that they have
not received "any financial support in any form from pharmaceutical or
medical device manufacturers during the past five years" and that they dont
have other affiliations or financial involvements that would present a
conflict of interest. A three member board decides whether to accept
applicants. We also maintain a "page 2" list of experts who willingly
disclose their conflicts of interest or have ended their industry ties but
only within the past five years. Despite their recent commercial ties, these
experts are included in the list because they have provided key insights
into the inner workings of partnerships between physicians and the
industryand thus have bitten the hand that feeds them, in effect.
The reaction to the list, which has been embraced enthusiastically by our
fellow reporters and roundly condemned by several allies of the drug
industry, suggests that the effect of simply gathering these names together
could well go beyond making life a little easier for our fellow journalists.
Seeking unbiased sources
The need for such a resource is evident from studies showing that bias and
poor reporting on medical topics are widespread in the popular media. Gary
Schwitzer, a professor of journalism at the University of Minnesota,
publishes HealthNewsReview.org, a website that reviews healthcare news for
balance, accuracy, and completeness. Schwitzer and a team of academic
researchers analysed 500 stories published in top outlets between April 2006
and April 2008 for two key criteria: did the journalist quote an independent
expert, someone not involved in the relevant research; and did they make
some attempt to report potential conflicts of interest. The result? Half the
stories failed to meet these two very basic requirements.3
In another study Alan Cassels, a pharmaceutical policy researcher at the
University of British Columbia, and his colleagues analysed media coverage
of five prescription drugs published in 193 Canadian newspapers in 2000.4
Cassels, who is on our list, found that the stories were overwhelmingly
positive towards the drugs: all 193 articles included at least one drug
benefit, while 68% (132/193) failed to mention any potential harm. Two
thirds of the stories quoted a source by name, but only a scant 3% (5/164)
included information about conflicts of interest for sources who were not
government or industry officials.
In the view of one list member, Arnold Relman, former editor in chief of the
New England Journal of Medicine and professor emeritus of medicine and of
social medicine at Harvard Medical School, such bias fails to serve the
public good. "The public has a lot at stake, and the media has a
responsibility always to be aware of the source of information and the
conflicts those sources might have when they report the results of clinical
research," he said. "People who have a financial stake in the results of
clinical research can well be biased in the way research is conducted, in
the way they report it, and what they say about it when interviewed by the
media."
Changing the status quo
The question is why reporters seem unable to grasp the connection between
the large body of evidence showing that financial conflicts of interest
create bias in medical research and the need for the media to seek out
independent sources. To be fair, journalists face a daunting task when
trying to sift through medical research, and many are as yet unaware of the
profound influence the drug industry has over research results and the ways
in which the industry shapes medical "truths." Many reporters also fail to
realise that the individuals and organisations they turn to for expert
commentary, such as professional groups and charities, professional
guideline authors, federal advisory panellists, and patients groups, often
depend financially on the industry. Thus there is a self reinforcing process
in which commercially sponsored researchers, whose prominence is enhanced by
the industrys public relations machine, are dubbed "experts," while
independent sources are cited less often.
>From informal conversations with colleagues we also know that other factors
are at work when reporters fail to take conflicts of interest into account.
Some confess that they hesitate to ask sources about any potential conflicts
for fear that the source will take umbrage and refuse to be interviewed.
Others assume that if a study appears in a peer reviewed journal it must be
valid.
One of the solutions to the problem of biased news reporting, in the view of
Michael Wilkes, professor of medicine and director of global health at the
University of California, Davis, is greater transparency.5 We think the
list is a step in that direction. The chief requirement for membership,
besides a recognised area of expertise, is that the expert must not have
taken any industry funding for at least the past five years. Beliefs about
certain drugs or treatments were not criteria for inclusion or exclusion.
Indeed, the list includes experts who sit at opposite poles of the spectrum
of beliefs on certain issues.
Backlash and honour
Within days of our announcing that we would make our list available to
reporters the requests began pouring in. Thus far we have sent a copy of the
list to 105 reporters, authors, and editors from such media outlets as the
New York Times, Newsweek, Forbes, Fortune, Bloomberg News, the Washington
Post, US News & World Report, the Canadian Broadcasting Corporation,
Medscape, and many other publications across the US and several other
nations. Senators and a state attorney general have also requested it.
Surprisingly, we are also receiving requests from recognised experts who
wanted to be onthe list. Being a member, it seems, is a badge of honour, say
several of the list members we interviewed for the BMJ. Others, like list
member Barnett Kramer, want to improve the quality of medical reporting.
Kramer, a medical oncologist and associate director for disease prevention
at the US National Institutes of Health, said, "Working journalists can be
overwhelmed by PR, and they are often looking for experts who can make
comments." Its useful, he said, to have experts "who are not involved
directly with the research and have no potential conflicts of interest
relevant to the research."
The other surprise came after the publication of a story we wrote in the
online magazine Slate that mentioned the list.6 Within days bloggers were
furiously accusing us of everything from biased, sloppy reporting to being
members of the Church of Scientology (which is opposed to psychiatric
drugs). Many of our criticsvirtually all of them backed by the
industryopined that our list was undoubtedly filled with experts who were
on the payrolls of plaintiffs attorneys. (A few have testified in court
cases, and those who have been paid for their testimony have disclosed it
for the list.) This venom was unexpected, as we imagined that the list would
be viewed as a positive step towards helping reporters identify doctors and
other experts who can address thorny and complex medical issues without
having competing financial interests. Now we think we understand the
backlash a little better.
One of the problems recognised by Schwitzer is that many journalists rely
for story ideas on news releases from the industrys public relations
departments, and some even use releases as the sole source of information on
experts to interview. By offering an alternative list of highly credible,
independent experts, the industry may fear that its paid key opinion
leaders7 and the professional societies whose favour they cultivate will no
longer be the first source of medical news.
Peter Gxtzsche, director of the Nordic Cochrane Centre and a member of the
Danish group Doctors Without Sponsors, described why he joined the list:
"Industry knows that buying doctors is an effective marketing tool . . . far
more effective than the dollars they spend on drug representatives. This
leads to less than optimal health care for patients."
Beyond the lists usefulness to journalists, we hope that it will also be
used by government agencies, medical journal editors, and professional
societies as they seek out experts to serve as editorialists and members of
clinical guideline and advisory panels. The FDA, for example, has a copy of
the list. We would be pleased to send it to other agencies and professional
societies.
It is widely claimed that genuine experts in medicine who arent funded by
the industry are nearly impossible to find. Indeed, one expert who declined
our invitation to be listed said, "If you eliminate people to whom industry
turns for advice, youre eliminating people who are more likely to have
something worth saying."
Readers can decide for themselves whether our list of independent experts
includes any experts with "something worth saying."
The list of independent medical experts
John Abramson, clinical instructor, Harvard Medical School
Marcia Angell, former editor in chief, New England Journal of Medicine
David Antonuccio, professor, Department of Psychiatry and Behavioral
Sciences, University of Nevada
Michael J Barry, chief of general medicine unit, Massachusetts General
Hospital, Harvard Medical School
Ken Bassett, professor of family practice, pharmacology, and therapeutics,
University of British Columbia
Lisa Bero, professor, University of California, San Francisco
Stephen Bezruchka, Department of Health Services and Department of Global
Health, School of Public Health and Community Medicine, University of
Washington, Seattle
Laura Boylan, assistant professor, Department of Neurology, New York
University
Phil Brewer, university medical director, Quinnipiac University,
Connecticut; and past medical safety fellow, US National Highway Traffic
Safety Administration
Howard Brody, director, US Institute for the Medical Humanities
Steven R Brown, Banner Good Samaritan family medicine residency, University
of Arizona College of Medicine
Daniel Carlat, assistant clinical professor of psychiatry, Tufts University
School of Medicine, and editor in chief, The Carlat Psychiatry Report
Alan Cassels, pharmaceutical policy researcher, University of Victoria,
British Columbia
Robert Cook-Deegan, director, Center for Genome Ethics, Law and Policy, Duke
Institute for Genome Sciences and Policy
Sam S Dahr, Retina Center of Oklahoma
John M Davis, Gilman professor of psychiatry, University of Ilinois at
Chicago
Raymond De Vries, professor, bioethics programme, University of Michigan
Medical School
Richard Deyo, Kaiser Permanente professor of evidence based family medicine,
Department of Family Medicine, Oregon Health and Science University
Kay Dickersin, director, US Cochrane Center
Mark Ebell, deputy editor, American Family Physician, and professor,
University of Georgia
Carl Elliott, University of Minnesota Center for Bioethics
David J Elpern
Margaret Ewen, Health Action International, Netherlands
Anne Rochon Ford, coordinator, Women and Health Protection, Canada
Adriane Fugh-Berman, professor, Department of Physiology and Biophysics,
Georgetown University Medical Center, and director, PharmedOut.org
Joseph Glenmullen, clinical instructor in psychiatry, Harvard Medical School
Robert Goodman, founder and director of No Free Lunch and general internist
at Montefiore Medical Center, New York
Merrill Goozner, director, Integrity in Science, US Center for Science in
the Public Interest
Peter Gxtzsche, director, Nordic Cochrane Centre, Denmark
Mark E Helm, medical director, EBRx, Arkansas Evidence-Based Prescription
Drug Program, and assistant professor, College of Pharmacy, University of
Arkansas for Medical Sciences
David Himmelstein, associate professor of medicine, Harvard University
Jerome Hoffman, professor of medicine and emergency medicine, University of
California, Los Angeles
John P A Ioaniddis, professor and chairman, Department of Hygiene and
Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece,
and Institute for Clinical Research and Health Policy Studies, Department of
Medicine, Tufts-New England Medical Center, Tufts University School of
Medicine
Peter Juni, head of division, Institute of Social and Preventive Medicine,
University of Bern, and director, Clinical Trials Unit, Bern University
Hospital
Jon Jureidini, head, Department of Psychological Medicine, Childrens Youth
and Womens Health Service, Adelaide, and associate professor, disciplines
of psychiatry and paediatrics, University of Adelaide
Scott Kim, assistant professor of psychiatry
Peter D Kramer, clinical professor of psychiatry and human behaviour, Brown
University, Providence, Rhode Island
Barnett Kramer, associate director for disease prevention, US National
Institutes of Health
Sheldon Krimsky, Tufts University, and Council for Responsible Genetics
Stefan Kruszewski, Stefan P Kruszewski and Associates
Richard A Lange, professor of medicine, Johns Hopkins Hospital, Baltimore
Jeffrey Lacasse, assistant professor, Department of Social Work, College of
Human Services, Arizona State University at West Campus
Dara K Lee, staff cardiologist, Presbyterian Heart Group, Albuquerque, and
vice president, Medical Staff Affairs, Presbyterian Hospital, Albuquerque
Gretchen LeFever, director of patient safety and performance excellence,
Sentara, US
Trudo Lemmens, associate professor, Canada
Jonathan Leo, associate professor of neuroanatomy, US
Joe Lex, emergency physician, US
Joel Lexchin, professor, School of Health Policy and Management, York
University, Toronto
Abby Lippman, professor, McGill University, Montreal
Peter Lurie, Health Research Group at Public Citizen, United States
William K Mallon, associate professor of clinical emergency medicine, Keck
School of Medicine at the University of Southern California, and director,
Division of International, LAC+USC Medical Center, Los Angeles
Peter R Mansfield, director, Healthy Skepticism, Australia
Linda Marsa, freelance journalist, US
Charlea Massion, Center for Education in Family and Community Medicine,
Stanford University School of Medicine, and member of board of directors,
American College of Womens Health Physicians
Charles Medawar, Social Audit, UK
Steven Miles, professor of medicine, Center for Bioethics, University of
Minnesota
Barbara Mintzes, assistant professor, Department of Anesthesiology,
Pharmacology and Therapeutics, University of British Columbia
Steven Morgan, associate professor and associate director, Centre for Health
Services and Policy Research, School of Population and Public Health,
University of British Columbia
Ray Moynihan, journalist, Australia
Vijaya Musini, assistant professor, Department of Anesthesiology,
Pharmacology and Therapeutics, University of British Columbia, and
Therapeutics Initiative, Canada
Thomas L Perry, clinical assistant professor, Department of Anesthesiology,
Pharmacology and Therapeutics and Department of Medicine, University of
British Columbia
Bruce Psaty, professor of medicine and epidemiology, University of
Washington Cardiovascular Health Research Unit
Arnold Relman, former editor in chief, New England Journal of Medicine
David Rind, senior deputy editor, UpToDate, and assistant clinical professor
of medicine, Harvard Medical School
Charles Rosen, clinical professor of surgery, University of California,
Irvine, and founding director, US Association for Ethics in Spine Surgery
Haya Rubin, director, research and evaluation, Palo Alto Medical Research
Institute, California, and adjunct professor of medicine, Johns Hopkins
University, Baltimore
Larry Sasich
John Schumann, assistant professor of medicine, University of Chicago, and
MacLean Center for Clinical Medical Ethics, Chicago
Lisa Schwartz, Dartmouth Institute for Health Policy and Clinical Practice,
Lebanon, New Hampshire
Gary Schwitzer, director, health journalism, MA programme, University of
Minnesota School of Journalism and Mass Communication
Vera Hassner Sharav, Alliance for Human Research Protection, US
Allen Shaughnessy, professor, Tufts University School of Medicine, Boston,
Massachusetts
Anthony So, programme on global health and technology access, Terry Sanford
Institute of Public Policy, Duke University, Durham, North Carolina
Robert C Solomon, American College of Emergency Physicians, and medical
editor in chief, ACEP News, US
Des Spence, general practitioner, Glasgow, and UK spokesman of No Free Lunch
Sydney Z Spiesel, clinical professor of paediatrics, Yale University School
of Medicine, and regular commentator for Slate and US National Public Radio
Alex Sugerman, attorney, Prescription Access Litigation, US
Leonore Tiefer, New View Campaign, and New York University School of
Medicine
Alexander Tsai, residency training programme, Department of Psychiatry,
University of California at San Francisco
Jennifer Washburn, journalist, US
H Gilbert Welch, Dartmouth Institute for Health Policy and Clinical
Practice, Lebanon, New Hampshire
Michael Wilkes, professor of medicine and director of global health,
University of California, and former vice dean of education and former
editor in chief, Western Journal of Medicine, University of California,
Davis
Sidney Wolfe, director, Health Research Group of Public Citizen, US
Steven Woloshin, Veterans Affairs Outcomes Group
Alastair Wood, US
Steffie Woolhandler, associate professor of medicine, Harvard University
James Wright, managing director, Therapeutics Initiative, Canada
Gavin Yamey, senior editor, PLoS Medicine, US
Cite this as: BMJ 2008;337:a930
________________________________
The list can also be viewed at
www.healthnewsreview.org/independentexperts.php.
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