Last September, the federal government rolled out a website that offered a searchable database of the $3.5 billion in payments that drug and device companies provided to physicians and teaching hospitals in the last half of 2013.
Data for 2014 is still being accumulated, but the breadth of information already completed has given unprecedented insight into a medical economy that dispenses money into the hands of thousands of doctors who turn around and dispense medical advice to patients.
Since this website went live, reporters from across the country have been combing through the data, producing dozens of stories about physicians with lucrative arrangements. But it appears that the reporters have not yet taken a look at how this database, which the government calls Open Payments, may uncover conflicts of interest in the field of journalism as well, conflicts that should prompt the profession to tighten up its own disclosure policies.
A review of the database finds physician journalists—those who appear regularly on news shows like Fox News, ABC News, and CBS News—are offering medical advice without disclosing that they’re receiving money from the pharmaceutical industry, which could benefit from the doctors’ on-air recommendations. For example, companies have provided free lunches to Jonathan LaPook, the chief medical correspondent for the CBS Evening News with Scott Pelley and professor of medicine at NYU.
While this may not seem important, studies published in the medical literature have found that even small gifts like lunches can alter prescribing behavior. This is why many medical schools have moved to ban free meals and why one company was found to have spent $36 million one year on free lunches for doctors as part of a campaign to increase sales of a drug. Pharmaceutical companies have also paid for lunches and travel for Dr. Jennifer Ashton, ABC News’ senior medical contributor who appears on Good Morning America. On top of free food, Forest Laboratories has paid Dr. Keith Ablow, a member of the Fox News Medical A-Team, $3,850 in speaking fees.
These fringe benefits of a sort violate ethical standards of most all newsrooms, imposed to ensure their audience that their reporters have no conflicts that could discredit their work. The code of ethics for the Society of Professional Journalists states that reporters should refuse “gifts, favors, fees, free travel and special treatment, and avoid political and other outside activities that may compromise integrity or impartiality, or may damage credibility.” But it has been a practice for some time for companies to provide free lunches to doctors in order to buy influence.
“My policy is not to accept gifts—either as a journalist or physician,” wrote CBS correspondent Dr. LaPook in an email response to questions. He said that the free lunches were arranged by his hospital’s department; however, protocols were later tightened and drug representatives are no longer allowed to buy lunches. CBS News did not disclose their policy to CJR, but say that they consider this matter closed.
When asked about payments to her, Dr. Ashton responded by email, “My ethical standards are to do the right thing for my patients, and for the issues that I consider to be medically sound and valid.” She said that she sometimes receives an honorarium for speaking at events but that she has turned down product endorsements. The payment for travel that appears in the database was made by Bristol Myers Squibb so she could give a speech at the request of ABC News on the state of cancer. “I expect that my travel be covered if I am taking time away from seeing patients and earning income in my medical office.”
Dr. Adriane Fugh Berman is an associate professor of family medicine at Georgetown University who runs Pharmed Out, a nonprofit that studies industry-physician relationships. She said that she finds it troubling that Dr. Ashton does not probe the doctors who appear on her show to surface potential conflicts. “Viewers deserve to know whether an expert is being paid by a company, even if the link between the company and what they are saying isn’t clear,” she said. Getting a company’s point of view on television is worth millions in free advertising, Ashton said.
Dr. Ablow did not respond to repeated requests for comment, but he has also spoken out against industry influence on the practice of medicine. In 2011, he resigned from the American Psychiatric Association and later went on Fox, where at one point he questioned the APA’s ethical credibility. “[T]he APA has a history of getting into bed with the pharmaceutical companies,” he said, later adding, “this is what’s wrong with American healthcare.”
Perhaps no other physician in the media is more aware of the sensitivity of these relationships than Dr. Scott Gottlieb, a resident fellow at the American Enterprise Institute, columnist at Forbes, and frequent contributor to the Wall Street Journal and Politico. Ten years ago, Dr. Gottlieb came under heavy scrutiny for his ties to industry and Wall Street by the Seattle Times and the Boston Globe when he was chosen by the Bush administration for the number two job at the FDA.
In a May column for Forbes, Dr. Gottlieb blamed new federal disclosure rules on “past marketing excesses of the drug and device makers” and the inability of physicians to regulate their own behavior. Perhaps because he has received such intense scrutiny in the past, he says now that he remains vigilant in disclosing his outside consulting when writing for news outlets, and he personally oversees his bio at Forbes to ensure it remains complete and up to date.
But he also says the government’s new website is incomplete and difficult to navigate. For instance, the site only lists Dr. Gottlieb’s consulting with Vertex Pharmaceuticals, but he said that he also consults for GlaxoSmithKline, a venture capital fund, and Avalere Health, a firm that advises healthcare companies. Dr. Gottlieb is not alone in his complaints. The government has admitted that the Open Payments site has been dogged by problems and as much as one third of the payments reported to the government were not included in the database due to data inconsistencies. This means that further revelations could come to light as the government improves the database.
Financial ties between medical companies and physicians in the media will likely continue to draw greater scrutiny as updates are made to Open Payments, a site that resulted from an Affordable Care Act requirement that the medical community to report financial transactions.
Last year, the editorial board of USA Today praised the Open Payments site, noting that the free lunches, paid speaking gigs, and free drug samples have begun to look like “legalized bribery.”
In an opposing view also run by USA Today, Dr. Thomas Stossel of Harvard Medical School called the new website “a cheap, shortsighted public relations exercise.” Dr. Stossel has been a long-time critic of such disclosure, and the editorial did not note that he is the scientific founder and director of BioAegis Therapeutics and a director of Velico Medical Corporation.
“Our practice is to disclose, and we would have shared information about Dr. Stossel’s ties if we had known,” said Brent Jones, standards and ethics editor at USA Today. “We should have asked, but we didn’t.”