A Dart to Health Affairs

Policy journal jumps in bed with Aetna

In this day and age, when medical journals have come under fire for failing to disclose researchers’ conflicts of interest; hyping faulty studies; and publishing too many positive stories about drugs…it’s puzzling to see the latest edition of Health Affairs. The impartial, peer-reviewed health policy journal recently allowed Aetna, the nation’s third largest insurance company—and one with a ferocious dog in the health care fight—to take liberties with its cover.*

Health Affairs got grants from Aetna and the Aetna Foundation to sponsor the current issue of the journal (the Commonwealth Fund gave additional support)—an issue built around the theme of “Bending the Cost Curve.”* That’s jargon the wonks who write for Health Affairs use instead of saying: “controlling or containing medical costs which might send shivers up the spines of the special interests, like Aetna.” Jargon, I might add, that filters down through the press to the general public, where it is absolutely NOT understood.

Aetna bought 4,000 copies to send out and got to create a cover that was pasted on to the journal’s real cover on these issues.* The faux cover, which is the one readers see unless they look under the hood, features a “Dear Colleague” letter from Aetna CEO Ronald A. Williams. In the letter, Williams professes his company’s concern for the interests of patients and improving the overall quality of medical care. He writes:

We believe that the right solution will be based on what is already working in the private sector, and should include an individual coverage requirement and guaranteed issue with no pre-existing conditions. Addressing health care costs is equally important, and we must simplify the system so that doctors and caregivers can spend more time with patients.

So: what exactly did the sponsorship entail besides the cover? Did it pay for printing, stipends to the authors of articles, influence over what subjects Health Affairs would tackle, overhead for Project HOPE, the publisher of the journal? It kind of makes you wonder what’s inside.

I took a look and found many thoughtful articles, including one by University of North Carolina health policy expert Jonathan Oberlander, whom CJR featured in an Excluded Voices post earlier this year. There are several pieces detailing lessons learned about cost-containment in the states. And in the section called “saving money,” there’s a perspective article called “Opportunities To Improve The Quality Of Care For Advanced Illness,” which describes a care management program that Aetna is piloting that “gives people culturally sensitive supporting information, to make informed choices and obtain palliative services in a timely manner.”

Gosh, that sounds like what the “death panel” legislation was trying to do! Perhaps it’s okay for insurance companies to help seniors make informed choices about end-of-life care, but not for the government to help in that department. The article is written by high-level Aetna officials, including the company’s chief medical officer.

Health Affairs makes other sponsorship deals. The back of the book tells of support from the Bill and Melinda Gates Foundation to expand the coverage of global health. But Aetna trumpeting its concern for cost-control and the plight of the uninsured on the cover of a respected journal smacks of the kind of lobbying trickery that has become so familiar to us. Throughout the year, the insurance industry has portrayed itself as a good guy in this fight, all the while working behind the scenes to get what it wants. And what better way to polish up that image than to be on the cover of Health Affairs? It’s a PR adviser’s dream. Health Affairs should think long and hard before it allows the Gates Foundation or any other sponsor to engage in similar line-blurring. If, that is, it wants to maintain credibility with the press.

Correction: This article originally implied that Aetna’s faux-cover appeared on every single copy of the Sept/Oct 2009 issue of Health Affairs. Actually, the cover only appeared on 4,000 copies that Aetna had bought for the purposes of sending out to various recipients. This article has been revised accordingly.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.