Do you know where your health news and information comes from?
If a commercial entity provides $3-4 million to finance a news service to produce in-depth coverage of policy issues that make a case for its services — including paying journalists to write columns, and create video interviews, multimedia and free content for syndication to news outlets around the world — would most readers consider the news to be unbiased journalism or paid marketing?
If a stakeholder pays a medical journal and a health policy journal $1.4 million for editorial activities to publish special editions that raise awareness of the need for its services — including paying experts to author articles and hosting media policy briefings — would most medical professionals feel the journals’ content would be more or less likely to be objective?
The integrity of medical education and health information free from industry influence have been turned topsy turvy this past month. Yet, not one medical professional appears to have noticed that it might warrant thoughtful consideration about disclosures with health information intended for both professionals and consumers.
To better grasp the issue requires us to recall recent events…
Just six months ago, the Journal of the American Medical Association produced a history-making issue when its editors impugned the integrity of medical reporting, education and research for being inundated with industry influence. “It is time to stop,” wrote editors Dr. Catherine D. DeAngelis, M.D., MPH; and Dr. Phil B. Fontanarosa, M.D., MBA. They called for the medical profession to clean up its act in regards to conflicts of interest and proposed sweeping changes.
As covered here, the editors had written:
[M]anipulation of studies and misrepresentation of study results could not occur without the cooperation (active and tacit) of clinical researchers, other authors, journal editors, peer reviewers and… public trust for clinical research is in great jeopardy especially when the extent of how widespread such practices have become is unknown… [I]n addition to clinical research, clinical practice and medical education also are greatly influenced by for-profit companies. Drastic action is essential, and cooperation of everyone involved in medical research, medical editing, medical education and clinical practice is required for meaningful change to occur.
The journal editors had gone on to make eleven proposals to preserve and strengthen the integrity of medical science, which had included:
“All journals must disclose all pertinent relationships of all authors with any for-profitcompanies, and must publish all funding sources for each article.” Funding sources and author disclosures should included in journal editors’ decisions of accepting a paper for publication.
“For-profit companies… should not be solely or primarily involved in… preparing the manuscript reporting study results. These responsibilities should primarily or solely be performed by academic investigators who are not employed by the company sponsoring the research.”
“To maintain a healthy distance from industry influence, professional organizations and providers of continuing medical education courses should not condone or tolerate for-profit companies having any input into the content of educational materials or providing funding or sponsorship for medical education programs.”
“Any editor who knowingly allows (or is party to allowing) for-profit companies to manipulate his or her journal must be relieved of the editorship.”
At that time, JFS had highlighted a major oversight in these proposals: for-profit pharmaceutical and medical device companies are not the only sources of conflicts of interest. Nonprofit organizations and foundations are also important sources of conflicts, as exampled. While the source for any information is never a measure of its soundness or completeness, in reality, it can be difficult for many people to recognize sound science and information from spin and marketing, and disclosures can help understand the perspectives of a source and alert us to potential bias. That might, perhaps, encourage us to think more critically about what we hear.
Currently, so much of our health information is funded by stakeholders, with most consumers unaware of those entanglements. The lines between education, entertainment and marketing have become blurred, perhaps irreparably. We’ve seen it in canned health news segments; television specials, documentaries and paid public television specials; press events; and journalists wooed by trips and writing awards and even unconsciously motivated to write copy favorable to sponsors. It’s not just a concern in mainstream media, as the internet has become a ready venue for marketing through patient advocacy groups, social media marketing and bloggers, and even scientists and doctors writing for PR firms while their industry backers are undisclosed to readers.
A new health nonprofit
SCAN Healthplan is one of California’s fastest-growing Medicare Advantage plan providers, with more than 100,000 members, and is a provider of long-term care management for individuals enrolled in Arizona’s state long-term care system. Earlier this year, on April 11th, it announced it had funded its own new nonprofit foundation with $205 million. Their new SCAN Foundation will be one of the country’s largest foundations focused on senior care, according to the press release. “Because SCAN Health Plan is itself a not-for-profit organization, there were no shareholders or stock conversions involved in the creation of this Foundation.”
Health Affairs reported last month on the new foundation and its $205 million endowment. The SCAN Foundation will be headed by Bruce Chernof who told Health Affairs that its public awareness and public policy work will have a state and national focus. “Given that federal policy and funding drive so much of long-term care through the Medicare and Medicaid programs, an active national presence is critical.”
Last week, on November 20th, the SCAN Foundation issued a press release saying it was awarding “nearly $1.4 million in grants aimed at recasting the dialogue between health professionals, policymakers, and the public about how to provide long-term healthcare.” According to the media release:
A $450,000 two-year grant to [University of California, San Francisco] will support the organization and writing of a special patient and caregiver-focused section on aging and independence to be submitted for peer review and possible publication in JAMA. For this special section, Dr. Seth Landefeld and colleagues at the UCSF will organize the section, interview patients, and work with experts in the field who will author articles on issues in aging important to maintaining independence and reducing morbidity. The grant will fund these editorial activities at UCSF.
“JAMA is pleased to work with The SCAN Foundation and the University of California, San Francisco. America's demographic changes are presenting a challenge to the medical profession to develop and disseminate new techniques and protocols that respond to the growing demand for long-term healthcare,” said Dr. Catherine DeAngelis, editor-in-chief of JAMA.
Two grants totaling $947,389 will be given to Health Affairs: $197,389 to fund a half-day policy briefing in Washington, DC, in mid-2009, aimed at making the case for why long-term care must be on the nation's broader health reform agenda; and $750,000 to support a special issue of Health Affairs journal on such themes… and issues surrounding financing long-term care and long-term care insurance.
Susan Dentzer, editor-in-chief of Health Affairs, said: “Along with changes in how medical care is provided, we must raise the awareness of policymakers and the public about long-term senior care and the prominent role it must have in any discussion about the nation's health priorities.”
On October 29th, Kaiser Family Foundation announced it was launching Kaiser Health News, a new news service to provide in-depth coverage on political and policy debates surrounding the healthcare system. “Supplementing the stories will be columns, video interviews, graphics, and multimedia features, as well as a daily synthesis of news stories from around the country,” it stated. Kaiser Family Foundation’s own Kaisernetwork.org, established in 2000, will be merged into Kaiser Health News, creating a comprehensive news service.
Journalists who work for KHN will have resources for research and travel to get out and cover stories… KHN will also enter into partnerships with news organizations to jointly produce and publish articles, and will provide content for syndication to news organizations in the U.S. and around the world, free of charge. Over the next several months, a team of full-time of journalists will be hired and top freelance journalists will be recruited to write stories and series for distribution through KHN.
Yesterday, the New York Times and International Herald Tribune reported that Kaiser Health News will be “the largest and best-financed project of its kind,” with funding expected to reach $3 million to $4 million in its first two years. The new news service will not accept advertising. Instead, it is being financed by the SCAN Foundation.
Reporter, Kevin Sack, noted that this is not the only health foundation funding health news. The California HealthCare Foundation, with an initial budget of $239,000, is launching a pilot project to report on health issues in California. If the pilot succeeds, the foundation may fund it with multi-millions, he said. Seven health foundations provided the seed money for Florida Health News. And Kansas Health Institutes’ own news service is also founded by a foundation.
Healthcare is big business. The money, and more importantly, the potential influence, is too great to believe that the most successful news and information sources will be immune. Accurate health information is important for everyone, though. Do you feel you deserve to know where your information is coming from? When stakeholders form their own nonprofit foundations, should that release them from disclosing those interests to you?
If health information was labeled as paid advertising, would that change the way you look at it and make you apt to think more critically about it?
Medicare Advantage is an example of just one issue easy to underestimate its significance. Bloomberg reported Monday that three companies — Humana, WellCare Health Plan, HealthSpring Inc. — depend on Medicare Advantage for more than 80 percent of their earnings before interest, taxes, depreciation and amortization, according to Carl McDonald, an analyst with Oppenheimer & Co. in New York. Medicare Advantage is so lucrative for insurers, said Kaiser Family Foundation, it estimated that 70% of the entire $46 million advertising budgets of insurers was spent to advertise Medicare Advantage plans.
With $100 billion in government payments to Medicare Advantage plans this year alone, and four times that possible, it’s understandable the companies would be committed to shaping the public policy debate. Similarly, those opposing them have their own even larger financial and political interests, yet we almost never hear about those, either.
With issues as important as our health, ideally media would objectively report the facts, use knowledgeable professionals and dig deep with investigations of original sources, while keeping staunch separations of editorial and advertisers, to enable us to make more informed choices for ourselves. There is no evidence that we’re heading in that direction. Health information is one area where that old adage caveat emptor can stand us in very good stead.
© 2008 Sandy Szwarc