Those who say watchdog journalism is dead and gone are just plain wrong. And there’s no better way to refute that notion than to explore the body of work Milwaukee Journal Sentinel reporter John Fauber has created over the past five years. Fauber, who came to the medical beat from the trenches of business news, set his sights on the underexplored, story-ripe intersection of medicine and business. For his work, Fauber merits a CJR laurel.
One early example: in January 2009, Fauber and then-colleague Susanne Rust, acting on a tip, looked into an online continuing medical education course at the University of Wisconsin-Madison School of Medicine and Public Health that was sponsored by Wyeth Pharmaceuticals. It’s common for drug companies to pay for such programs, but this one deserved special scrutiny. In 2002, a major clinical trial showed that hormone replacement therapy resulted in increased risk for breast cancer, heart disease, and blood clots. Researchers stopped the trial mid-stream. That same year, Fauber and Rust found, the university began a medical education program for doctors that “promoted the therapy, touted its benefits, and downplayed any risks.” Wyeth, a maker of the drugs used in the study, poured $12 million into the program, $1.5 million of which went to the university. When the reporters sniffed out the conflict and questioned the university, the course was removed from its website, although Fauber and Rust reported the course material remained on the Internet available to doctors and the public.
In 2009, Fauber, whose work has won several awards, reported other stories dealing with the nexus between the university and big pharmaceutical money. One revealed an orthopedic surgeon at the university received $19 million in royalty payments from device maker Medtronics, but he failed to disclose all of those payments to his employer because university rules were fuzzy about the amount that had to be reported. Another story detailed how the university received money from Solvay Pharmaceuticals to pay for a series of medical journal articles touting the benefits of testosterone therapy and downplaying the risks. The testosterone phenomenon, the Journal Sentinel found, was “based largely on iffy science, promotion, manipulation and conflicts of interest.”
And thus the paper launched in early 2009 its ongoing series, “Side Effects,” in collaboration with MedPage Today, an online medical news source for doctors that underwrites part of Fauber’s salary and runs the stories simultaneously on its website. The 40 or so stories in the series to date untangle the web of financial relationships tightly woven in America’s medical industrial complex, showing that universities, researchers, friendly family physicians, medical device makers, educators, even regulators are caught in its threads. All theses ties, of course, raise serious questions about the independence of American medicine, its stratospheric price tag, the honesty of information patients receive about medical interventions, and the quality of care they receive. It’s a sickness gone viral, spread by big money―which is the theme of most “Side Effects” stories.
In the past few years, Fauber, who covers this beat full time, has branched out beyond conflicts of interest near the banks of Lake Mendota. Last year, he showed how the American Academy of Pediatrics endorsed guidelines that recommended drugs to treat childhood acne, but didn’t tell doctors that 13 of the 15 experts who drafted the guidelines were paid consultants or speakers for companies that make the drugs. The paper reported the organization that developed the guidelines, the American Acne and Rosacea Society, had received nearly all of its revenue in 2011 from companies that make acne drugs.
Some of Fauber’s pieces have shown how regulators charged with protecting the public are also ensnared in the medical industrial complex. In 2013, the Journal Sentinel and MedPage Today obtained, through public record requests, emails between FDA officials and drug industry representatives showing that they had held private meetings at expensive hotels at least once a year since 2002 sponsored by IMMPACT, an organization funded by drug makers. At the meetings, they discussed clinical testing procedures and other matters that affect the public. The public, though, was absent.
And in a story appearing shortly before Christmas, Fauber detailed how a 46-year-old gospel singer and former construction worker injured on the job died of an accidental dose of opioids―including the drug tramadol, thought to pose little threat. Fauber explained that the drug was not placed under the Controlled Substance Act and the FDA had failed to consider a key piece of research indicating tramadol had the potential to be abused. “Despite recent research affirming its abuse potential, restrictions on prescribing it are no more stringent than for Lipitor or Viagra,” he wrote. The man’s widow told the paper her husband never believed the drug was dangerous. “Tony’s thing was, the doctor gave it to him so it must be safe,” she said. Where were the regulators, the piece seemed to be asking.
Journalism that exposes how people make their money in questionable ways inevitably brings howls from the exposed. “My stories tend to get a lot of polarized comments,” Fauber told me. “But they tend to be three-to-one in favor.” A majority of readers believe revealing these conflicts is necessary and important for the benefit of the patients. But, he added, “there are folks who think it’s the liberal media going after doctors and drug companies. There’s a significant number of people who don’t like the idea of stories about conflicts of interest in medicine. They feel it’s a private concern between doctors and drug companies. It’s a laissez faire attitude about this stuff.”
What about the medical businesses whose practices Fauber has dissected? Drug companies have a way of adapting and responding to criticism, he says. The University of Wisconsin-Madison has banned the practice of doctors doing promotional speaking on behalf of drug companies. So drug companies now use private doctors not tied to the institution to deliver their messages and help sell their products.
As recently as five or seven years ago, there wasn’t much media interest in covering conflicts of interest in medicine. The work of the Journal Sentinel and MedPage Today–as well as ProPublica’s continuing disclosures about money medical practitioners receive from drug and device makers–shows this is fertile terrain. “It’s a hard topic to get into if you’re a new reporter,” says Fauber. “You have to have the backing of editors and know where to look. These stories often hide out in the shadowy world where business and medicine hook up.” The goals of business and medicine are often not compatible, he pointed out. What’s good for the corporate bottom line is not always good for patients. And that’s exactly the spot where good journalism like the kind Fauber is doing comes in.
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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.