Good News Bad News

Industry executives frequently lament the way pharma is portrayed in the media. They don't understand why an industry that develops medicines allowing patients to live longer, healthier, and more productive lives is so frequently cast as the villain. Outsiders might be quick to discount that concern as self-serving, but a recent analysis of print coverage supports the notion that the media is largely negative toward the ethical positions taken by pharma.

In the News

This article analyzes the results of Saint Joseph's University's Haub School of Business' first annual audit of newspaper coverage of ethical issues in the pharma industry. The survey examined the top five newspapers in the United States (as defined by circulation) over a 12-month period and identified and analyzed a select group of articles pertaining to "hot button" pharma issues. The audit focused on shedding light around the following questions:

• What ethical and legal controversies face the pharma industry—and what kinds of coverage do they attract?

• How do the issues reported by top newspapers compare to the list of important topics developed by the Pharmaceutical Research and Manufacturers of America (PhRMA)?

• Do the articles support or oppose the positions taken by the industry, as defined by PhRMA?

• How often do reporters include the industry's perspective in the stories that cover the issues of the day?

• What are the implications of these findings for the industry?

Processing the News

Between October 1, 2003 and September 30, 2004, we audited the top five US newspapers with the highest circulations:

USA Today

,

Wall Street

Journal

,

New York Times

,

Los Angeles Times

, and the

Washington Post

. For inclusion in the study, we selected articles that focused on an ethical or legal issue facing the pharma industry and that appeared either as a front-page story or on the editorial page—an indication of major news and public sentiment. (See "Who Says What?".)

Who Says What?

The research team—which includes the authors of this article with research assistant Theresa Garvey—selected and analyzed a total of 105 articles. For each article, the team first analyzed the headlines and categorized them as positive, negative, or neutral toward the industry. For example, "When Drug Companies Hide Data" (New York Times, June 6, 2004) was clearly classified as a negative headline, while "Buying in Canada Won't Cut Drug Costs" (Los Angeles Times, August 31, 2004) was labeled positive.

Next, we identified the issues discussed in the article, and categorized them according to a list of nine topics PhRMA posted on its website during October 2004 under a heading labeled "The Issues." The miscellaneous category of "other" was added to capture any issues reported by newspapers but not included in PhRMA's list. Twenty-three articles covered more than one issue and were included in relevant sections.

Content Analysis

We also analyzed each complete article to determine whether it took a positive, negative, or neutral position toward the pharmaceutical industry. For example, any article that espoused the merits of programs or legislative attempts to approve drug imports from Canada—a position that the industry opposes—was deemed negative. In contrast, an article that focused on the safety concerns of imported drugs was designated as positive, given the industry's perspective.

The vast majority of articles focused on ethical issues that had defensible pro and con positions. For example, allowing drug importation from Canada may cut drug prices for Americans and make drugs more accessible to the uninsured—this is a pro. But importation may also compromise drug safety and make it increasingly difficult for pharmaceutical companies to recover R&D expenditures—con. Articles that had no defensible opposing view were not included in the analysis. For example, one article discussed "one of the biggest health scourges of the developing world: counterfeit pharmaceuticals." The text described how fake, substandard, and expired medicines were being sold in pharmacies and outdoor markets. But given that few if any people think that counterfeit medication is a good thing—that is, there was no controversial point—the article was omitted from the analysis.

Regardless of the dominant position taken by the article, we also looked to see if the articles included the opposing point of view. When an explicit statement about an opposing view was included in the article—even if the two sides did not receive equal coverage—we concluded that the article covered both sides. When no mention of the opposing view was presented, the article was labeled as one-sided.

Hot Button Issues

This audit clearly confirms industry's perception: Press coverage tends to be critical of pharma practices and positions. Almost 70 percent of the articles the research team audited took positions contrary to those endorsed by PhRMA. Those articles most often focused on pricing, data disclosure, and importation/reimportation of drugs.

Pricing Pricing emerged as the single most dominant issue in the audit, with 68 hits in 105 articles (64.8 percent). Many of the articles in that group focused on generics and drug imports in the context of ways to reduce drug prices.

USA Today reported, "AARP's study of 155 name-brand drugs found an average price increase of 27.6 percent over four years... compared to a 10.4 percent inflation rate." A Washington Post editorial predicted that drug price control legislation is likely, and said, "the key question is how quickly it will come." The Los Angeles Times reported efforts by the city to enact a proposal to establish a consortium to buy drugs in bulk to receive better pricing for residents, employers, and hospitals, claiming that "the [federal] ban on negotiating bulk-rate prices benefits only the powerful drug companies, not the taxpayers."

In defense of the industry, the Washington Post published an editorial by Robert Goldberg, director of the Center for Medical Progress at the Manhattan Institute for Policy Research, arguing that the US produces more new drugs "than any other country because it is largely free of price controls." It also said, "About 75 percent of all new drugs are discovered and used in the US first." Further, "Innovation and patients will get hurt" if the emotional appeal for price controls is heeded.

Data disclosure Articles about data disclosure of research results (especially for clinical trials and adverse events) were the second—albeit a distant second, compared with pricing—most-reported topic.

Articles that discussed allegations of data suppression by pharma companies hit the top newspapers in light of the problems with antidepressant use by children. A headline in the Washington Post proclaimed: "Drugmakers Prefer Silence on Test Data; Firms Violate US Law by Not Registering Trials." The Washington Post contended that "conflicts of interest and company control of data have thrown out the scientific method."

Some articles called for enforcement of a mandatory national drug registry of clinical trials. USA Today published an editorial by then-president of PhRMA, Alan Holmer, arguing that efforts to expand access to clinical trial data are already underway and that PhRMA supported the establishment of a central registry that it has encouraged its members to participate in. Similarly, a Washington Post editorial suggested that a requirement to publish all results "might backfire and wind up discouraging companies from conducting any trials at all." Instead, the article encouraged Congress to study the issue and develop a system for disclosing trial results.

Drug importation/reimportation The coverage of importing or reimporting drugs, primarily from Canada, was the third highest covered issue. Primarily, the articles discussed reimportation as a way to cut the cost of prescription medicines for individual patients and to help states and communities balance their healthcare budgets.

Efforts to legalize reimportation or circumvent the existing ban were also commonly reported. According to the Washington Post, "United States Customs estimates 10 million US citizens bring in medications at land borders each year. An additional 2 million arrive annually by mail from Thailand, India, South Africa, and other points. Still more come from online pharmacies in Canada."

The Washington Post also reported that the "clamor for legislation to permit Americans to buy lower-cost prescription drugs from Canada will grow." It also reported a simple fact that hit home with many at FDA: The Montgomery County Council, a district in which many FDA employees live, voted to begin buying drugs from Canada, defying a federal law in an effort to "save as much as $20 million per year."

A USA Today editorial argued against reimportation, stating that "lifting a ban on Canadian imports would provide little relief" on drug prices, suggesting that a better answer is to inject more competition into the system through a website for price comparisons, pooled buying by states, and more generics. On the other hand, a Los Angeles Times editorial supported a proposal to allow drugs to be imported from pre-approved Canadian pharmacists and wholesalers that have registered with FDA and claimed that the risk of unsafe drugs is "hysterically overstated."

PhRMA issues But that's where the issues highlighted by PhRMA and pharma news ended. The survey showed that only pricing, data disclosure, and drug reimportation—out of the nine issues PhRMA identified on its website—recevied heavy front or editoral page coverage. Four other PhRMA issues received moderate attention in the newspapers: generics, marketing restrictions, intellectual property, and FDA approvals. Manufacturing restrictions and research restrictions, the remaining PhRMA issues, received no coverage at all.

The audit also uncovered 15 articles that focused on ethical or legal issues not included on PhRMA's list. Three stories dealt with the growth of drug counterfeiting, including the production of adulterated or diluted medications and the sale of these drugs over the Internet. Other issues were each covered twice: calls for the National Institutes of Health to ban drug industry payments in the form of consulting fees to NIH scientists; discussions of the merits of experimental trials preceding full-scale clinical study; efforts by pharmaceutical benefit managers/insurers to restrict drugs on the Medicare formulary; and the pros and cons of programs designed to provide AIDS treatments to developing countries.

Headlines vs. Stories

Headlines are so influential in shaping public perceptions, and are often all that consumers read or remember in their morning newspaper. The analysis found that, indeed, the majority of headlines opposed the industry: 57.1 percent were negative, 18.1 percent were positive, and 24.8 percent were neutral.

Taken as a whole, the tone of the headlines was less negative than the bodies of the full-text articles themselves. Interestingly, there were a greater number of positive and negative articles compared with the headline analysis, meaning that the headlines were more neutral toward the industry—mostly because they were more general. Although the percentage of favorable articles was only slightly greater than the headlines (20 compared with 18.1 percent), the proportion of articles critical of the industry was much greater, 57.1 percent compared with 69.5 percent. (See "Content Analysis.")

The analysis shows that, although most headlines and articles did not support the positions of the industry, the coverage did include pharma's point of view: 77.7 percent of the articles mentioned both sides of the disputed issue.

Implications for Pharma

The findings of this study have several important implications for the pharma industry and for PhRMA.

Medicare drug benefit The industry is facing many of the same challenges that it has faced for years. But with the new Medicare drug benefit, pharma needs to focus on how coverage will affect the decisions of payers and those that influence payers as the 109th Congress debates how the bill will be finalized, administered, and funded. After all, there is a strong underlying impetus in Congress to look to the pharma industry as a way to make the plan more affordable by reducing drug prices.

Responsibility for data reporting In this area, the industry may want to consider taking a more proactive position by reporting the findings of all studies, ideally in the NIH Registry, but at a minimum, in a registry enabling easy access to providers and patients. This will not only avoid a potential confrontation with FDA, but also will keep FDA's focus on the approval of new drugs. If the industry does not provide full disclosure of data, it invites greater FDA scrutiny and/or increases the risk of regulatory action.

Prioritize the issues Only three of the nine issues PhRMA identified were commonly reported on: drug pricing, data disclosure, and reimportation of drugs from Canada or other countries. However, the remaining issues on PhRMA's list received relatively little or no attention. Similarly, the audit revealed that the media is reporting on issues that are not on PhRMA's radar screen, such as drug counterfeiting, a ban on drug industry payments to NIH scientists, experimental trials preceding full-scale clinical studies, efforts by PBMs and other payers to restrict drugs on the Medicare formulary, and efforts to speed healthcare in developing countries.

Better communications This analysis suggests that industry must place greater emphasis on the issues highlighted by the media and re-evaluate the issues PhRMA prioritizes. This focus can bring public attention to the issues that depict the positive things the industry does to improve overall healthcare.

Pharma's tainted image is a result of many complex issues, but may also be a result of the industry's ineffectiveness at communicating its messages, or failure to make those messages compelling to the public. In short, the industry must work more proactively with the media, especially through PhRMA. This will help patients better understand the unique issues the industry faces and reaffirm its contributions to US healthcare delivery.

Stephen J. Porth, PhD is associate dean and professor of management, and George P. Sillup, PhD is assistant professor of management, both at Saint Joseph's University in Philadelphia. They can be reached at sporth@sju.edu and sillup@sju.edu' respectively. The authors wish to thank Theresa Garvey and Cynthia Slater for their contributions to our research.