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October 21, 2010

ProPublica: Doc’s for Dollars or Journalist for Dollars?

Interview2 
 
Investigative journalism usually consists of objective reporting of the facts and the unbiased presentation of evidence. Readers are then able to make judgments based on the facts presented. In contrast, many of this week’s coverage of physician-industry collaboration often make the conclusion such partnerships are unethical, without even pretending to give balanced and fair presentation.

The major media that broke the story on physician-industry payments (Chicago Tribune, NPR, Boston Globe, PBS, Consumer Reports) used a highly unusual method. They collaborated with ProPublica, a group that received a recent one million dollar grant traced to the Prescription Project, an avowed enemy of the branded pharmaceutical industry. (More on this below).  ProPublica combined seven pharmaceutical company websites reporting of physician payments. ProPublica, founded in 2007, only began publishing in June of 2008.

Although most stories revealed the involvement of ProPublica, they did not fully explain 1) the nature of ProPublica itself or any other relevant facts related to the company and 2) why it was necessary to use an “investigative journalism shop” instead of traditional open methods. Journalists do  the investigating themselves. This may be one of the first times where media have coordinated an effort to use investigation from third party sources.  

A close look at ProPublica, shows that they bill themselves as “an independent, non-profit newsroom that produces investigative journalism in the public interest.” ProPublica is a collection of 30 investigative journalists, many formerly with major media. 

Compensation for many of their employees is significant for journalists. Their CEO earns over $500,000 a year, great pay for a nonprofit of its size. The managing editor also makes almost $500,000 a year, with six other employees making well over $100,000 a year. In total, "ProPublica paid out $6.4 million in salaries, other compensation and employee benefits last year, up from $4 million in 2008."

More importantly, a close look at the donations supporting ProPublica’s non-profit status reveals that the Pew Charities, who fund the anti-industry Prescription Project, donated $1 million to ProPublica (over 10% of their annual budget). Is Prescription Project an “independent” source of investigative journalism? On ProPublica’s “About Us” page, they assert that they will not “ally with politicians or advocacy groups.” Is taking money from them an exception?

When billionaire couple Hebert and Marion Sandler founded ProPublica in 2007, they had a long history of being politically active, at least through financial contributions. As an article in Slate Magazine revealed, the couple has donated millions of dollars to democratic candidates and other liberal organizations for years. However, their enthusiasm for journalism was “late arriving.” Consequently, it is often said that those philanthropists, like the Sandlers, who earned the fortune they are giving away, “tend not to distribute their money with a blind eye to the results.” This lead Slate to wonder, “How happy will they be if ProPublica gores their sacred Democratic cows? Or takes the “wrong” position on their pet projects: health, the environment, and civil liberties?”

Digging into ProPublica’s short journalistic history reveals that the non-profit never carried out any major investigation related to any sort of industry-physician payments prior to the Pew Donation of $1 million in 2010.  Readers may ask themselves is this a coincidence or conflict?

ProPublica did however receive the Pulitzer Prize for Investigative Journalism last year, covering a story of what happened at a New Orleans hospital cut off by the floodwaters of Hurricane Katrina. However, the story received a fair amount of criticism for spending more than $400,000 to rehash of a well-known story, about a completely exceptional circumstance that is uncommon. Others, such as Dave Kopel, have noted that ProPublica’s articles sometimes contain “shaky facts.”

What is also clearly problematic about this project from ProPublica, as an article in the Nieman Journalism Lab discussed, “is the sheer scale of the collaboration itself: “Dollars for Docs” represents the collective work of six — yes, six — different news organizations.” Such a large, “anger-inducing, broadly affective narrative, is the bread and butter of investigative journalism, and is quite literally, outrageous.”

The problem with such an endeavor was the difficulty created by trying to coordinate efforts among all of these partners, who are “not only individual reporters, but also representatives of different media and outlets, each with its own way of doing things.” This is problematic because it led Tom Detzel, the ProPublica editor who oversaw the endeavor, to acknowledge that ProPublica just decided, “To loosen the reins and let everyone run free.” Do these sound like accountable and fair journalistic methods?

Moreover, Detzel asserted that as editor of the project, he and ProPublica did not try to draw any lines in the sand: ‘Here’s what you can do, and can’t do.’ They just said, ‘Here’s the topic we want to work with, and here’s the data we have. Take it and run with it.’ So one way to look at it is that what  Detzel and ProPublica wanted to do from the onset was to create a mega-story to boost their individual reputations at the expense of the companies and their physician collaborators.

This view of  Detzel’s practices seem contrary to ProPublica’s mission. The company claims that because “today’s investigative reporters lack resources” such as time and budget, these constraints are curbing the ability of journalists not specifically designated “investigative” to do this kind of reporting in addition to their regular beats. As a result, the company claims to have created an “independent newsroom” in the public’s interest, to offer media sources the “investigative journalism” they are unable to conduct.

As the Society of Professional Journalism (SPJ) Code of Ethics clearly states, “Journalists should be honest, fair and courageous in gathering, reporting and interpreting information.” Other components of this Code state that journalists should:

  • Test the accuracy of information from all sources and exercise care to avoid inadvertent error. Deliberate distortion is never permissible.
  • Diligently seek out subjects of news stories to give them the opportunity to respond to allegations of wrongdoing.
  • Identify sources whenever feasible
  • Make certain that headlines … and quotations do not misrepresent. They should not oversimplify or highlight incidents out of context.
  • Avoid undercover or other surreptitious methods of gathering information except when traditional open methods will not yield information vital to the public. Use of such methods should be explained as part of the story

The goal of ProPublica, they claim, is to “stimulate positive change” by uncovering unsavory practices in order to stimulate reform. Have they done so with their coverage of physician-industry payments? A closer look at the articles, although sometimes including quotes from contradictory sources, almost certainly suggests a portrait that payments from industry are inappropriate or unethical. ProPublica asserts that they uncover these unsavory practices in “an entirely non-partisan and non-ideological manner, adhering to the strictest standards of journalistic impartiality.” Is this so?

While the accuracy of the information, being from the companies themselves is probably genuine, it appears like ProPublica and their news sources have distorted these payments to paint a negative picture of legal and ethical work of physicians and industry. They show no evidence or investigation into the harm caused to patients by such payments, but they suggest it.

By just presenting these numbers in their report, they have not diligently sought out responses to allegations of wrongdoing. Perhaps ProPublica thought they were doing a service, and as such were being responsible. However, an overview of these articles, the titles, pictures, and dollar symbols clearly indicates a negative light on such payments. As a result, their reporting failed to adhere to fair reporting the Code of Ethics demanded of them.

The articles produced by the authors only look at one side of the issue: the negative impact of industry-physician payments. They use headlines (i.e. Dollars for Docs) that make it impossible for a reader to believe anything other than these payments are wrong. Moreover, instead of trying to understand, explain, or even acknowledge the significant and clear benefits from these relationships, ProPublica adheres to the minimum standards. They simply report the numbers and state they are for speaking, meals, or consulting.

Where is the balance and objectivity of discussing what these payments were actually for? Did ProPublica look in depth to determine that a physician who spoke fifty times about a particular treatment or product may have influenced and enhanced the adherence to approved guidelines to treat a particular disease? Where was the “investigative journalism” in finding out the clinical outcomes for the patients of the physicians’ patients who had attended such speaking events? Did the journalists even think to interview physicians who attend commercial events to find out why they voluntarily choose to go?

ProPublica ignores the fact that industry sponsored speaking provides significant benefits to health care providers by making them aware of new treatments and products which have been approved for their safety and efficacy. They make no effort to elaborate on the content of these programs, and that the FDA mandates that the sponsor control the content so that speakers do not talk about off-label used or non-evidence-based application of products.

One of the other goals of ProPublica is to “shine a light on inappropriate practices, by holding them up to public opprobrium and by continuing to do so until change comes about.” However, isn’t that exactly what the company website with physician payment data are for? Companies, some voluntary, some under enforcement mandates, posted these payments as a way to inform the public of their services and relationships with physicians. Now the companies and physicians are being punished again for their transparency actions.

What is problematic about using the numbers this way is how others will use them. As one of the comments on ProPublica’s page indicates, plaintiff’s attorneys in pharmaceutical cases are going to try to discredit physicians for receiving such payments to bolster their legal cases against them. Such a practice begs the question, what help did Pro-Publica receive from the plaintiff attorneys who would benefit from information on physicians?

Another goal ProPublica claims to stand for is to “focus on the media … when they are abusing the public trust.” As Harris Polls have consistently found, physicians rank at the top or near the top for trustworthiness. In 2006, they ranked first, with 85% of adults agreeing that doctors generally can be trusted to tell the truth.” In addition, a 2010 national survey by Research!America that 78% of respondents trusted their health care providers as sources for medical research information. As a result, at a time when patients, consumers, and the American public have a high level of confidence in the medical profession, it seems like ProPublica is violating the very principle which they stand for by stigmatizing the ethical and informative work physicians are carrying out with industry.

It is important to make a distinction. The payments discussed in the ProPublica data are for physician consulting and FDA regulated promotional events, not for accredited continuing medical education (CME).

Using an investigative journalism shop to let reports “run free” and trust that they will find a story is an uncommon practice in journalism. As discussed above, many of the practices that ProPublica employed in publishing these stories and collaborating with other media sources appear to violate the SJP Code of Ethics. The collaboration between physicians and industry provides immense value to the training and education and physicians, which directly correlates to improved patient outcomes and better clinical care. 

Traditional and responsible investigative journalism would have looked at the purpose of these events, how they educated physicians, how physicians used the information and data these programs provided. Objective and fair information gathering would have uncovered how many hours these speakers and consultants spent researching, preparing, and finding evidence for programs and events.

Physicians and pharmaceutical companies who risk everything to provide this care and place their lives, careers, and now names on the line deserve more than a biased group of reporters easily pointing to numbers.

Source articles

ProPublica

About Docs for Dollars

Docs on Pharma Payroll Have Blemished Records, Limited Credentials

How Patients Can Use Data

Forbes

Whats Wrong With Docs Taking Money?

Boston Globe

Prescription for Prestige

Doctors with questionable records earn a lot as drug firms’ speakers

Company Disclosures

Consumer Reports

Consumers Wary of Doctors Who Take Drug-Company Dollars

NPR

Drug Companies Hire Troubled Docs As Experts

Company Disclosures

Chicago Tribune

Doctors Draw Payments From Drug Companies

Doctors Speak on Bad Drugs – Some Drugs Draw Red Flags

PBS

Nightly Business Report

About ProPublica

ProPublica About Us Page

Note on Financial Statements

2009 Tax Return

Slate Magazine

Wikipedia

Contribution from Pew Charities

$6.4 Million ProPublica Pay, Expensive Offices Fuel Criticism

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