Media Audit: Stop the Presses!

No pharma exec can last long at the top without developing a thick skin about the media's harsh glare. Big Pharma (read: "Evil Pharma Empire") has emerged as one of the industries the public, the polls, and the press love to hate—and not always without cause. Still, most industry members agree that when it comes to the pharma beat, reporters too often check their fairness and accuracy at the door. • The third-annual media audit by the Arrupe Center for Business Ethics at Saint Joseph's University confirms these suspicions: While the amount of coverage remained constant in 2006, the content was more negative and one-sided than ever. As in the previous two studies, we ID the hot-button issues attracting media attention over the past year, evaluate spin and slant, and then compare how the issues and agendas compare to previous years.

A Count of Pharma's Clips

Here are the three top findings of 2006:

• Drug safety remained the most-inked issue, but there was also a new focus on generics as well as on marketing and sales.

• Headlines became more sensational, with more negative and fewer neutral.

• Unlike in the previous two years, the industry, at least as represented by PhRMA, appears to be more in touch with the issues of concern to the press and the public.

Grading the Press

The audit analyzed content from the top-five US newspapers by circulation—USA Today, The Wall Street Journal, The New York Times, the Los Angeles Times, and the Washington Post. The purpose was to shed light on the following questions:

• Which controversies face the pharma industry—and what kind of coverage do they get?

• 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 their stories ?

• How do PhRMA's high-priority issues compare to those covered by top newspapers?

• What does it all mean for pharma?

To be included in the study, an article had to be published between October 1, 2005 and September 30, 2006. It also had to (a) focus on an ethical or legal issue facing the industry and (b) run either as a front-page story or on the editorial page—an indication of major news and public interest. We then compared the results to those in 2004 and 2005. (For a breakdown by paper, see "A Count of Pharma's Clips".)

We focused on daily newspapers rather than the broadcast media or weekly magazines for a number of reasons. Dailies can cover a broader range of issues and in more depth than radio and TV. Business and news magazines are also constrained by their weekly or monthly formats. Furthermore, it is critical to evaluate the top newspapers' editorial pages, which frequently take strong positions—pro or con—toward controversies and exert considerable influence.

Keep on Spinning

Of the articles selected for the study, we examined four factors:

1. Issues We identified the issues discussed in each article relating to pharma. Of the 270 articles on the front or editorial pages, 108 covered two or more issues and were included in relevant sections.

2. Headline For each article, the team analyzed the headlines and categorized them as positive, negative, or neutral toward the industry. For example, "Escalating Prescription Drug Prices," (The New York Times, June 26, 2006) was classified as a negative headline, while "Breast Cancer Drug Hailed," (USA Today, October 20, 2005) was labeled positive.

3. Tone We also analyzed the complete article to determine whether it took a positive, negative, or neutral position toward the industry. For example, an editorial that called for restrictions on DTC advertising—a position the industry opposes—was deemed negative. In contrast, an article claiming that DTC advertising results in better-informed patients was designated as positive.

4. Balance Regardless of the specific slant of the story, we also looked to see if the reporting 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

Our research has found that, over the past three years, the media focus on pharma has increased by 157 percent. However, the amount of newsprint was virtually unchanged from 2005 (271 relevant articles) to 2006 (270). Of all the newspapers, the most significant change is the increased coverage in the The New York Times, especially on the editorial page, where the number of articles on pharma jumped from 16 in 2005 to 64 in 2006.

What's It All About?

Here's what the audit of the four components of coverage revealed:

Drug safety is down, pricing is up The ranking of the top-three most-covered issues remains unchanged from last year: 1. drug safety, 2. drug prices, and 3. clinical study design and sponsorship. (See "What's It All About?".)

Even though drug safety retained its top spot, the volume of articles on safety dropped by 36 percent, perhaps reflecting the denouement of the Vioxx (rofecoxib) dramas that dominated the news in 2005. On the other hand, the focus on drug prices jumped, up by 30 percent from 2005 to 2006. Meanwhile, media coverage of the drug importation/reimportation debate faded, dropping from 24 articles in 2004 to five articles in 2006.

Interestingly, other issues emerged. Most striking was the growing focus on marketing and sales incentives used by the industry, which rose from 14 articles in 2005 to 34 in 2006, and on generics, which rose from 3 to 22 articles. Also attracting more notably new attention this year were FDA (15 articles) and bioterrorism (12 articles).

Head slams were up... Newspaper headlines are influential in shaping public perceptions—and are often all that consumers read or remember. In 2006, newspaper heads tipped toward the negative—51.9 percent came down against pharma. (See "Keep on Spinning," this page.) That's a shift from 2005, when headlines were more likely to be neutral (46.9 percent) than negative (43.9 percent) or positive (19.2 percent).

And body checks, too As in previous years, our audit found more negative coverage (60.7 percent) than neutral (15.6 percent) or positive (23.7 percent). What's also interesting to note is that articles tend to take a positive or negative position on pharma's ethical issues compared with headlines, which are more often neutral.

Balance is down In 2006, only 59 percent of articles mentioned both sides of a story, down significantly from 83 percent in 2005 and 78 percent in 2004.

PhRMA's Response

Critics have charged the pharmaceutical industry with being out of touch with the issues of greatest import to consumers. To get a reality check on the "issues" issue, in February we talked with Billy Tauzin, president and CEO of the the industry trade group Pharmaceutical Research and Manufacturers of America (PhRMA). Tauzin provided his views of media coverage, the issues of the day, and his priorities for PhRMA.

As it turns out, Tauzin's main issues match four of the top five identified by the audit as dominant in the coverage: drug safety, drug pricing, clinical design and sponsorship, and data disclosure. He says that the industry is focused on these issues, pointing to to www.clinicalstudyresults.org, a Web site established by PhRMA in 2002 that reports trial results, as one way pharma is placing greater emphasis on "more discussion, more transparency, and more sharing of data."

In fact, the only issue uncovered by our audit not mentioned by Tauzin was reimportation/importation, which has faded in media coverage recently.

Knowing the Negatives

The pharmaceutical industry not only continues to invest in the research and development of medicines but is committed to help society by funding corporate social-responsibility programs. So why does the industry continue to attract more negative than positive coverage in newspapers?

The following issues provide a cache of clues:

Pricing problems Over the three-year period of the audit, drug prices have consistently ranked first or second in priority of coverage. Consumers clearly don't like to pay more and more money out of pocket for their drugs—and blame pharma for the rising cost of healthcare. According to Tauzin, the industry needs to do a better job of educating the public about the economics of healthcare, given that drug prices are rising much more slowly than other healthcare expenditures.

Meantime, most of Big Pharma refuses to budge on its position on prices. They pumped up their bottom lines in 2006 by raising prices beyond the increase in manufacturing costs. What's more, they lobbied for legislation, such as Proposition 78, which is against capping states' drugs prices.

The industry must be profitable to continue to make the social and medical contributions it does, yet patients—even those who benefit from drug companies' patient assistance programs—want a low-cost alternative.

Safety suspicions There are connections among safety, the type of clinical study done to establish safety and efficacy, and the way FDA assesses those studies—they're called influence. Pharmaceutical companies and prestigious peer-reviewed publications like The New England Journal of Medicine are familiar with this topic, having come to a guarded understanding about publishing clinical studies by the same firms that pay to advertise.

But two significant adverse events reported in The Wall Street Journal last April raised more than a few eyebrows about the industry's influence on FDA. There were 25 sudden deaths of children being treated with at least one of the six drugs for attention deficit hyperactivity disorder. Then there was the re-approval of Tysabri (natalizumab), the multiple sclerosis drug that was removed from the market because two patients died from drug complication. Following on the Vioxx debacle, these deaths only deepened doubts about both FDA's and pharma's priorities.

FDA is requiring more testing, and approvals are taking longer. But even a perfectly designed study can't anticipate all potential negative effects when a drug is in wise use. Perhaps prospective product registries beyond the agency's required post-approval market surveillance have a better chance to identify any untoward complications before they become front-page news.

Generics Generics account for more than 60 percent of the prescriptions filled in the United States, and this trend is likely to grow as branded blockbusters continue to lose their patent status. Meanwhile, the generic pricing advantage is being fueled by pharmacy benefit managers' programs to motivate switching, such as waiving copayments and Wal-Mart's "150 cheaper than anywhere else generics" program.

Whenever branded-drug makers move to block generic competition, it draws media attention. The industry needs to weigh the pros and cons of the price differential between branded medicines and generics—particularly in light of the considerable coverage—and consumer interest—patent battles garner.

All ads, all the time The sales and marketing tactics used by the pharma industry are attracting an increasing amount of media scrutiny, much of it negative. This is somewhat surprising because the PhRMA voluntary direct-to-consumer marketing guidelines serve as the basis to standardize promotional activities and prevent the transgressions that attract the negative attention.

Part D opportunities Much of the media coverage of the Medicare drug benefit in 2006 reported on the problems many senior citizens faced when trying to find out which of the many programs to select. While this is in no way pharma's responsibility, it does suggest that patient-assistance programs, albeit creative and well-intentioned, are not providing the right kind of help. This may be an opportunity for PhRMA and pharma companies to coordinate activities with providers and payers to make it easier for patients. Although Partnership for Prescription assistance, on PhRMA's Web site, is not targeted to Part D patients, it is an example of a program that appears to be giving uninsured patients the kind of assistance they need. Making Part D enrollment easier and eligible patients more informed will mean sustained market penetration.

Certainly, greater transparency and accountability will help the industry answer to its critics instead of taking the "no comment" approach. As Tauzin stated, "Although the pharmaceutical industry often faces a hostile environment, I want people to remember that our main enemy is disease, especially disease where there is no treatment alternative." This is important to all of us who are or will be "customers" of the pharmaceutical industry and have a vested interest in healthcare delivery, an issue that will continue to play an important role in the 2008 elections—and the media that covers it.

Stephen J. Porth is a fellow of the Arrupe Center for Business Ethics and professor at Saint Joseph's University in Philadelphia. He can be reached at sporth@mailhost.sju.eduGeorge P. Sillup is an Arrupe Fellow and assistant professor at Saint Joseph's University. He can be reached at sillup@sju.edu