Pharm Exec: Annual Press Audit 2014

Pharm Exec's tenth Annual Press Audit of issues in the pharmaceutical industry finds that the level of media scrutiny increased in 2013, driven primarily by a rise in coverage in two high profile outlets: The New York Times and the Washington Post. Two issues dominated the news in 2013 and neither was a surprise – drug safety, which typically signals bad news for the industry, and healthcare reform, which drilled down on implementation of the Patient Protection and Affordable Care Act (PPACA) and ongoing questions about the policy behind the legislation.

Sponsored by the Arrupe Center for Business Ethics at Saint Joseph's University, this year's audit featured the following top findings:

» Coverage of the industry was up for the third consecutive year, increasing 20 percent from last year to 136 articles in the publications surveyed, exceeding the five-year annual average of 121 articles.

» Drug safety dominated the news, not only retaining its top position among issues but also receiving more than twice as much coverage as last year, and more than triple the focus of the next two hot button issues – interaction with the FDA and drug prices.

» The focus on healthcare reform skyrocketed in 2013 from 16 to 60 articles; not surprisingly, 56 of the 60 articles addressed issues related to PPACA, the number one healthcare reform issue.

» Media coverage of the industry continues to be more negative than positive or neutral; 47 % of articles were negative toward the industry in 2013, compared to 36% in 2012.

» High drug prices are back in the news, moving up the list of hot button issues to third place and reversing a trend of less media scrutiny in previous years.

» Media coverage mentioned 97 companies and/or their products this year, which is the highest number of company mentions since we began reporting in 2005.

Processing The News

We analyzed the top five newspapers in the United States as defined by circulation for a 12-month period and identified all front-page and editorial articles pertaining to "hot button" pharma issues. The purpose of the audit was to shed light on the following questions:

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

» Do the articles and headlines support or oppose the positions taken by the industry, as defined by the Pharmaceutical Research & Manufacturers' Association (PhRMA)?

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

» What pharmaceutical companies and brand names are identified and discussed in the articles?

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

To be included in the study and in our EthicsTrak™ database¹, an article had to be published between October 1, 2012 and September 30, 2013 in one of the top five US newspapers (as measured by circulation) – USA Today, Wall Street Journal, New York Times, Los Angeles Times, and the Washington Post. It also had to (a) focus on an ethical or legal issue facing the pharma industry and (b) appear either as a front-page story or on the editorial page—an indication of major news and public sentiment. We focused on daily newspapers rather than the broadcast media or weekly magazines for a number of reasons. The newspapers cover a broader range of issues and in more depth than the sound bites reported on radio and TV. Business and news magazines are also constrained by their weekly or monthly formats while the newspapers have the advantage of editorial coverage that takes a specific and unambiguous position – pro or con – toward the controversies in question.

For each article, we examined four elements:

Issue: We identified and categorized the hot-button issues that were discussed in each article. Many articles covered two or more issues that were included in relevant sections.

Headlines: We analyzed the headlines and categorized them as positive, negative, or neutral toward the industry.

Tone: 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 called for restrictions or a prohibition on DTC advertising—a position that the industry opposes—was deemed negative. In contrast, an article that claimed that DTC advertising resulted in more informed patients was designated as positive from the industry's point of view.

Balance: Regardless of the dominant position taken by the article, we also looked to see if the stories included the opposing point of view. When no mention of the opposing view was presented, the article was labeled as one-sided.

Table 1 shows the breakdown of coverage by newspaper. The 20% increase in coverage of the industry for the year is driven almost exclusively by the New York Times and the Washington Post. In fact, the amount of coverage dropped in USA Today and the Wall Street Journal and was flat in the Los Angeles Times.

Table 1

What Are The Hot Buttons?

Table 2 identifies the issues covered in the articles, the frequency of their coverage, and how the results compare to previous years. Retaining its top spot on the list of topics attracting media attention is drug safety, an issue that dominated the news in 2013. We identified and tracked 61 articles on drug safety this year compared to 27 last year. Furthermore, drug safety received more than triple the coverage of the next issue on the list, interaction with the FDA, which had a count of 19. Much of the increased coverage in the New York Times and the Washington Post discussed above was focused on drug safety. "Deaths Tied to Painkillers Rising in the U.S." (Los Angeles Times, March 30, 2013) is one example of the reaction to reports of increasing cases of overdoses and the mounting pressure to restrict use of certain prescription drugs. Likewise, "Problems Cited for Years at Drug Firms" (Washington Post, February 8, 2013) focused on shoddy practices and unsanitary conditions at the New England Compounding Center, whose contaminated steroid shots were linked to a meningitis outbreak resulting in 45 deaths. The Washington Post reported that "state and federal authorities did little to systematically inspect and correct hazards posed by specialty pharmacies, which custom-mix medications for individual patients, hospitals and clinics. In the lightly regulated industry, pharmacies were rarely punished even when their mistakes had lethal consequences."

Table 2

Second on the list this year was interaction with the FDA followed closely by high drug prices. Whereas drug safety articles are predominantly negative for the industry, FDA articles are a mixed bag. Compare, for example, "FDA Approves Bionic Eye to Help Blind" (Washington Post, February 15, 2013) to "After Tainted Drugs Kill 53, Time to Fix 'Broken' System" (USA Today, April 29, 2013). High drug prices were back in the news in 2013 with a count of 18 articles, compared to only six last year. The New York Times focused heavily on drug prices with both editorials (e.g., "Exorbitant Prices for Leukemia Drugs," May 2, 2013) and articles (e.g., "Improper Efforts to Limit Competitive Drugs," February 9, 2013).

Research and development of new drugs which is typically good news for the industry dropped from second to fifth place on the list this year with 14 articles compared to 24 last year. Also moving down the list this year was marketing and sales incentives, dropping from eight articles to only two. This is a positive change for the industry and seems to reflect changing policies and sales practices in the industry.

Increased Coverage of Companies and/or Their Products

Integral to our audit is assessment of the number of times a pharma company or one of its products is mentioned to determine what companies are attracting positive, neutral or negative media attention and being covered in the news. For example, the second most reported company this year, Perdue Pharma, was mentioned 10 times. Four of the 10 mentions were the company by name and six of the mentions were by the company's beleaguered product OxyContin. The higher the number of mentions a company and/or its products gets, the greater attention that company is getting in a given year.

Table 3

This year there were 97 companies mentioned with 27 of the companies identified by their products. This is the highest number of mentions since we began reporting in 2005 and 10.2 percent higher than the second highest number of mentions, which was 88, in 2009. Clearly responsible for this increase is the tragic problems associated with the New England Compounding Center, which accounted for 26 (26.8%) of the 97 mentions. It also invited mentions about four other pharmacies (e.g., Olympium Pharmacy). Completing the most frequently mentioned companies are GlaxoSmitKline with seven, some of which were about Avandia, its diabetes drug, and its link to cardiovascular problems, and Amgen and Novartis, with five apiece. After that, there are two mentions for 10 companies and one mention for 12 companies. Additionally, there were 11 "other" products mentioned, which were primarily generic drugs. A summary of the number of mentions can be observed in Table 3.

Table 4

Newspaper Coverage of Healthcare Reform –Significantly More than Last Year

This year's newspaper coverage of healthcare reform increased about 3.7 times over last year's coverage, expanding from 16 to 60 articles. This is the highest number since the PPACA (a.k.a. Obamacare) was signed into law on March 23, 2010 and Congressional debate continued before and after its passage. A summary of coverage is found in Table 5.

Table 5

What Were the Issues Related To Healthcare?

The number one issue mentioned was healthcare reform, which is largely attributable to issues and interactions about healthcare reform and the PPACA. It was the focus of 56 of the 60 articles and was responsible for the significant increase from 12 articles related to healthcare last year. The number two issue was contraception, which was linked to healthcare reform and President Obama's eventual compromise about having insurance companies cover the cost of contraception. Additionally, coverage about contraception was high due to the controversial FDA decision to allow over-the-counter access for Plan B One-Step with levonorgestrel through the Women's Capital Corporation and Teva Women's Health. Overall, coverage about contraception was either the focal point or mentioned in 22 of the 60 articles. Other issues affiliated with PPACA articles and mentioned were high drug prices in U.S. (9), interaction with the FDA (7), drug safety (6) and Medicare/Medicaid coverage for drugs (3). There were also a few mentions about genomics and biologicals (3) and marketing/sales incentives (2). A breakdown of all issues is shown in Table 6.

Table 6

Healthcare Coverage and Associations with Pharma Companies or Drugs

For the second time since newspaper coverage has merited collecting healthcare data separately, there were specific mentions about companies and/or their products. This year there were 26 mentions and, clearly the most mentioned was Teva and/or its drug levonorgestrel, which accounted for 18 of the 26 mentions. Not surprisingly, these mentions are linked to the coverage about contraception/Plan B (22 mentions in 60 articles). The other companies mentioned were Amgen (3), Genentech (2), Perdue Pharma (1) and Johnson & Johnson (1).

Implications for Pharma

From the big Pharma perspective, the most reported issue, drug safety, was linked to the New England Compounding Center and accentuates the benefits of pharma's efforts to enhance GMP protections and expand quality standards throughout global operations. Yet, media coverage continues to remain on balance negative toward the industry, by a slight margin: 47% this year compared to a 46% average over the last seven years.

This negativity is combined with additional scrutiny by way of the highest number of companies and/or their products, 97, since we began reporting in 2005. Even if the 26 mentions associated with the New England Compounding Center scandal are discounted, the media is paying more attention to specific companies. This increased scrutiny, combined with a 20% increase in coverage from last year, gives the second and third most reported issues, interaction with the FDA and high drug prices, increased traction, especially when those issues are related to a specific company.

Another key impact for pharma is healthcare reform for which coverage has skyrocketed, largely due to the flawed introduction and controversy over PPACA (e.g., inaccessibility of HealthCare.gov). Along with this emphasis on healthcare, the industry went from the optimism about the market potential of newly insured patients to headlines about the loss of potential customers as a consequence of the delay in the deadline for employers to meet the obligations of the individual mandate for insurance until 2015. Furthermore, it's anticipated that pharma's interface with customers will be with more informed patients and prescribers due to electronic data systems that provide more information to patients, a trend that will make it harder to differentiate their products from those of competitor firms. It also suggests the pharma business model will move from individual prescribers to more networked business-to-business transactions, where image issues will be increasingly diffuse.

George P. Sillup is Arrupe Fellow and Associate Professor at St. Joseph's University, Philadelphia, PA; Stephen J. Porth is Associate Dean and Arrupe Fellow and Professor at St. Joseph's. Cynthia Slater, SJU's Business Reference Librarian; Ryan Fox, Ethics Trak Administrator; and Danielle Puccino and Dante Gleason, SJU Summer Scholar Program students, also contributed to this research.