Pharm Exec’s 14th Annual Press Audit: The Opioid Crisis Takes Center Stage

The opioid crisis dominated the news in this year’s annual audit of press coverage of the pharmaceutical industry. The results of the fourteenth Annual Press Audit of issues in the pharmaceutical industry indicate that media coverage of pharma dropped in 2017 to its lowest level since 2012. Coverage was down across the board in all five of the top selling U.S. newspapers. Our audit identified 117 articles this year compared to 214 a year ago, a decrease of over 45%. The decrease belies some troubling news, however. Articles focused on opioids skyrocketed, representing more than a third of all articles on the industry. In addition, high drug prices, a perennial hot button issue, continues to garner much of the attention of the major newspapers and media outlets. Not surprisingly given this list of hot button issues, the news was not good. Both headlines and articles were more negative toward the industry than in the past. Full text articles, in particular, are trending more negative toward the industry. Not since 2008 has our audit found a more negative proportion of articles.  

The annual audit sponsored by the Arrupe Center for Business Ethics at Saint Joseph’s University tracks and analyzes the industry issues covered by the media. Prior audits have found that media coverage is largely negative toward the positions taken by pharma. This year’s audit identifies the “hot button” issues attracting media attention in 2017, compares the issues and how they are covered to previous years, and reports on the pharmaceutical companies and brands most often cited in the news. We also updated our analysis of how healthcare reform has been reported by the press.

Some of the top findings for 2017 include:

• Coverage of the industry dropped in 2017 and was at its lowest level since 2012.

• Drug Safety, particularly concerns about opioid use and misuse was the hot button issue of the year. Drug safety has been a perennial issue on the hot button list but what was new and different this year was the overwhelming focus on opioids; a topic that did not even register on the list just a few years ago, dominated the news in 2017.

• High drug prices in the U.S. continues to be a major theme in the news, placing second on the hot button issues list this year. Research & Development for New Drugs, Interaction with the Food and Drug Administration, and Medicare/Medicaid Coverage for Drugs also received heavy coverage in 2017.

• Healthcare reform coverage more than doubled since last year (75 versus 36 articles); 64 of the articles were about revision/replacement of the Affordable Care Act and Medicare/Medicaid drug coverage. Other key issues identified were drug safety and high drug prices.

• Media coverage of the industry has always been more critical than positive or neutral but the tone of the coverage was even more negative than usual this year. In 2017, 55.6% of articles were negative toward the industry, the highest percentage since 2008.

• More than half of healthcare reform articles (52%) were neutral toward the industry, which was driven by the New York Times with 65.7% of its 35 articles analyzed as neutral. Only 10% of all the articles had a positive message.  

Processing the news

Once again 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™ database[1], an article had to be published between October 1, 2016 and September 30, 2017 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. While we focused on daily newspapers because they include a broad range of issues with in-depth coverage, we also reviewed other media to evaluate the scope of their coverage. Specifically, we looked at three sources – the NBC Nightly News, NPR: All Things Considered and Google Trends – and, as we discuss below, learned that their coverage was comparable to the newspapers.

For each article, we examined four elements:

Issues: 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. For example, “Scrutiny for High Drug Prices” (Los Angeles Times, February 28, 2017) and “Washington City Sues Oxycontin Drugmaker; Everett, Hit Hard by Opioid Addiction, Alleges that Purdue Pharma Ignored Criminal Trafficking” (Los Angeles Times, January 20, 2017) were classified as negative headlines, while “Racing to Alter Patients' Cells to Kill Cancer” (New York Times, July 24, 2017) and “Health Secretary Pick Fought Hard for Doctors & Providers” (New York Times, January 17, 2017) were labeled positive.

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 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.                    

Figure 1 below shows the number of articles for 2017 compared to previous years. Results indicate that the amount of coverage the industry received, 117 articles, is down 45.3% year over year and well below the five-year average of 164 articles.

Figure 1 – Number of Articles by Year

Table 1 below shows the breakdown of coverage by newspaper. The decrease in coverage of the industry for the year reflects less coverage across all of the leading newspapers. 

Table 1: Number of Articles by Newspaper and Year

Newspaper

2017 Front Page

2017 Editorial

2017

Total

2016 Total

2015 Total

2014 Total

2013 Total

% Change from 2016-2017

USA Today

2

0

2

12

2

17

9

-83.3%

Wall Street Journal

5

5

9

48

38

32

8

-81.3%

New York Times

17

20

33

59

60

75

61

-44.1%

Los Angeles Times

6

9

13

40

23

35

24

-67.5%

Washington Post

23

30

52

55

36

37

34

-5.5%

Total

53

64

117

214

159

196

136

-45.3%

What are the Hot Button issues?

Figure 2 identifies the issues most frequently covered in the articles and the frequency of their coverage. Drug Safety continues to be among the most frequently reported topics attracting attention in the media. Drug Safety has held the number 1 or 2 spot on the list in nine of the last ten years. What is new and different this year, however, is the emergence of attention on a specific type of drug safety concern - the opioid crisis is the top issue on the hot button list. Three years ago, opioids did not register on the list. Last year it emerged from obscurity to the second most frequently covered issue. This year no other issue received more scrutiny than opioids. In fact, 36% (42 of 117) of all articles focused on the topic. Combining these articles with others that focused on drug safety (5 additional articles) and misuse and abuse (an additional 3 articles), a staggering 42.7% of all articles focused on drug safety. This is an unprecedented and overwhelming focus and reflects the heightened awareness and tragic consequences of opioid addiction. Some examples of these articles are “Opioid Addiction Can Start in ER” (Los Angeles Times, February 27, 2017), “Opioid Firms Must Clean Up Their Mess” (Washington Post, August 11, 2017) and “Let’s Go for a Win on Opioids” (New York Times, April 4, 2017). This later article states: “There are roughly two and a half million Americans addicted to opioids. Between 1999 and 2015, the number of those who died rose from 8,200 annually to 33,000. That means that over two years more Americans died of opiate addiction than died in the entire Vietnam War… At the peak of the crack epidemic there were about two deaths per 100,000 Americans. Today, the opioid epidemic is killing 10.3 per 100,000.”

High drug prices in the U.S. is another perennial topic at the top of the hot button list, taking second place this year with 24 articles. Indeed, over 22% of all articles we tracked this year on the pharmaceutical industry discussed the high price of drugs. Examples include “How to Stop Drug Price Gouging,” (New York Times, April 20, 2017), “How FDA Rules Made a $15 Drug Cost $400,” (Wall Street Journal, April 6, 2017) and “Low Supplies, Price Spikes Limit Cost Savings of Generic Drugs” (Washington Post, August 2, 2017).

Figure 2: Top Pharma Issues in 2017 

This year, once again, we assessed the scope of coverage by other media by evaluating coverage by three media sources: NBC Nightly News, NPR-All Things Considered and Google Trends. NBC Nightly News and NPR-All Things Considered had coverage that dramatically increased for opioids; NBC went from 19 to 33 (173.7%) and NPR went from 5 to 130 (2600%). Coverage for high drug prices remained the same at 6 for NBC and increased from 12 to 15 (25%) for NPR. These are depicted in Table 2 below.

Table 2: Coverage of Top Two Issues by NBC and NPR

Opioids

2017 / 2016

High Drug Prices

2017 / 2016

NBC Nightly News

    33 / 19

    6 / 6

NPR All Things Considered

    130 / 5

   15 / 12

The data reported for Google Trends this year was acquired by using Google’s free data explorer. Results are measured as “interest,” defined as an unbiased, anonymous sample of all Google search data in which data are categorized (issue determined for each search) and aggregated to measure interest for a particular issue, such as opioids or high drug prices in the U.S. Interest is calculated by dividing the number of queries for an issue by the total number of Google search queries [(# of queries for search issue) ÷ (total Google search queries)] to generate a normalized result (Rogers, 2016). This means the reported 0-100 values are relative and not absolute numbers. While this may have some limitations, it is very useful when we look at interest over time for an issue like opioids.

The Google data suggests that interest in the topic of “opioids” was significant, ranging from an average per month of 40 in October 2016, decreasing to less than 20 in December but then steadily rising to 55-60 throughout 2017 with a spike to 100 in April (Google Trends Opioids, 2018). Spikes are sudden accelerations of search interest in an issue compared to usual search volume and are an indication of issues drawing keen attention. This is certainly a dramatic increase over the observations we identified in last year’s audit and is depicted in Figure 3 below.

Figure 3: Google Trends – Interest in Opioids Issue

For “high drug prices,” we identified a similar increase in the number of observations. In October, the interests were just under 40 and dropped to 30 in November. Then, it increased to 40 in December and stayed at 40 or higher (January and March were at 50) for the balance of our year until it dropped to 20 in August and rebounded to almost 40 in September (Google Trends High Drug Prices, 2018). Again, these results are a dramatic increase over the results reported last year. These findings are expressed in Figure 4 on the next page.  

Figure 4: Google Trends – Interest in High Drug Prices Issue

Connecting the “Hot Button” issues with pharma companies

For the fifth consecutive year, pharma companies and/or their products were connected with the hot button issues. This year there were fewer companies and mentions than last year; 54 versus 77 companies and 106 versus 212 mentions. Nineteen of the 106 companies were mentioned multiple times. Major pharma companies accounted for 100 of the 106 mentions. Sanofi and its vaccines division, Sanofi Pasteur, attracted the most media attention with 12 mentions; Sanofi, due to its work toward a generic form of Cialis® as it goes off-patent for Lily, and Sanofi Pasteur, due to the limited anti-viral spectrum of their flu-shots. Two companies that had six mentions apiece were Perdue Pharma (continuing travails related to Oxycontin®) and Mylan [$465 million settlement with the Department of Justice due to exorbitant pricing of the EpiPen® in 2008 (from $100 to $600)]. Interestingly, six of the 34 companies mentioned once were not pharma companies but rather companies involved with the distribution and sale of pharmaceuticals. These companies – WalMart, AmerisourceBergen, Healthcare Distribution Alliance, KeySource Medical, Express Scripts and Walgreens/Boots – were cited in the context of high drug prices.

Coverage

Our 14-year audit has found that the tone of headlines and articles tends to be more negative than positive for the industry. This year the results of our headlines analysis show fewer positive headlines and more negative ones. In fact, Table 3 shows that the proportion of positive headlines have consistently trended lower and hit a five-year low of only 8.6% of all articles. Furthermore, the proportion of negative headlines increased slightly this year to 37.6%. The proportion of headlines that were neutral to the industry dropped to 52.9% compared to 56.1% last year. 

In terms of the tone of full-text articles, the trends are mixed. As shown in Table 3, on the one hand, the percentage of positive articles increased from 13.6% to 18.8% this year. The negative articles also increased, however, from 50.5% to 55.6%, the highest proportion of negative articles in several years. With opioids, drug safety and drug prices dominating the news, it is not surprising that newspaper coverage of pharma was largely critical in 2017.

Table 3: Analysis of Headlines and Full-Text Articles

Year

Positive

Negative

Neutral

Headline

2013

14.7%

36.8%

48.5%

2014

16.3%

37.8%

45.9%

2015

18.9%

32.7%

48.4%

2016

9.8%

34.1%

56.1%

2017

8.6%

37.6%

52.9%

Articles

2013

26.5%

47.1%

26.4%

2014

29.1%

46.9%

24.0%

2015

36.5%

44.7%

18.9%

2016

13.6%

50.5%

36.0%

2017

18.8%

55.6%

25.6%

Regardless of whether the article takes a primarily positive or negative tone toward the positions of the industry, our audit analyzes whether both sides of the disputed issue are at least acknowledged. This year 32.5% (38 of 117) of articles mentioned both sides, a slight increase from last year’s mark of 31.8%. 

Analyzing coverage of healthcare reform

This year’s coverage of healthcare reform in the top five newspapers was a little more than twice that of last year’s coverage – 75 versus 36 articles. In fact, the 75 articles mark the second highest number of articles since we began to track articles about healthcare reform. The highest number was 86, identified in our ninth annual press audit in 2013. Coverage by all the newspapers except the Los Angeles Times increased with the New York Times and Washington Post accounting for 54 (72%) of the 75 articles. See details in Table 4 below.

Table 4: Number of Healthcare Reform Articles by Newspaper and Section

Newspaper

2017 Front Page

2017 Editorial

2017

Total

2016 Total

2015 Total

2014 Total

2013 Total

% Change from 2016-2017

USA Today

8

1

9

1

2

6

3

800.0%

Wall Street Journal

0

2

2

3

5

4

1

-33.3%

New York Times

16

19

35

13

8

30

21

169.2%

Los Angeles Times

6

4

10

11

9

11

20

-9.1%

Washington Post

11

8

19

8

6

9

15

137.5%

Total

41

34

75

36

30

60

60

108.3%

As in all prior audits, we analyzed and answered the following questions:

•  Do the healthcare articles and headlines support or oppose the positions taken by the pharmaceutical industry?

•  What ethical issues does the pharma industry face in these articles?

•  Are the pharma industry’s perspectives included in the articles?

•  What pharma companies and/or pharma products’ brand names are identified in the articles?

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

Both headlines and articles were analyzed as positive, negative, or neutral toward the pharmaceutical industry. A little over half of this year’s articles were neutral (52%), driven by the 65.7 % neutral articles in New York Times. An example of the New York Times’ coverage that was neutral toward the pharma industry is their March 6, 2017 editorial entitled “What the Republican Plan Gets Right.” Two newspapers, the Wall Street Journal and the Los Angeles Times, were evenly split between neutral and negative articles. The USA Today and Washington Post were primarily negative as evidenced by the Washington Post’s front-page article, “One Idea to Counter High Drug Prices: Federal Intervention” from July 4, 2017. Overall, only 10% of the articles were positive toward the pharma industry. Details are depicted in Table 5 below.

Table 5: Five-Year Analysis of Healthcare Reform Articles

Newspaper

# of Articles 2017

% Positive

% Negative

% Neutral

# of Articles (2013-2017)

% Positive

% Negative

% Neutral

USA Today

9

22.2%

44.4%

33.3%

21

19.1%

33.3%

47.6%

Wall Street Journal

2

0.0%

50.0%

50.0%

15

20.0%

46.7%

33.3%

New York Times

35

11.4%

22.9%

65.7%

107

18.7%

28.0%

53.3%

Los Angeles Times

10

20.0%

40.0%

40.0%

61

22.9%

26.2%

50.8%

Washington Post

19

0.0%

57.9%

42.1%

56

12.5%

33.9%

53.6%

Total

75

10.7%

37.3%

52.0%

260

18.5%

30.4%

51.2%

This year’s coverage primarily addressed nine issues related to healthcare reform. Not surprisingly, 45 of the mentions included discussion of deletion and/or alterations to the Affordable Care Act. If the third most prolific issue, Medicare/Medicaid Drug Coverage’s 19 mentions are included, then there were 64 mentions related to determining better and more affordable healthcare for uninsured and underinsured Americans. Linked to those mentions is the concern about high drug prices (15 mentions), which is a recurring salvo in both parts of our audit. Drug safety, also present in both portions of our audit, had 20 mentions. See details in Table 6 on the next page.

  Table 6: Ranking of Ethical Issues in Healthcare Reform

Ethical Issues in Healthcare Reform

2017 # of Mentions

2016 Ranking

2015 Ranking

2014 Ranking

2013 Ranking

Healthcare Reform / Affordable Care Act

45

1

1

1

1

Drug Safety (Misuse/Abuse)

20

N/A

4

4

3

Medicare/Medicaid Coverage for Drugs

19

N/A

3

5

4

High Drug Prices in the US

15

2

2

3

2

Interaction with the FDA

6

N/A

N/A

7

6

Opioids

5

N/A

N/A

N/A

N/A

Medical Marijuana

4

N/A

N/A

N/A

N/A

Generics (F)

4

N/A

N/A

8

6

R&D for New Drugs

3

N/A

3

N/A

N/A

Connecting the “Hot Button” issues with pharma companies

Forty-two companies were mentioned in the healthcare reform portion of this year’s audit, the largest number of companies ever mentioned. That included 31 pharma companies, 18 of which were identified in the first part of our audit. The other 13 of the 31 was a combination of pharma companies attracting prior media coverage, such as Danco [Mifeprex®/mifepristone (a.k.a. RU-486), the abortion pill], Shire [fined $56.5 million for overstating Aderall®’s ability with attention deficit hyperactivity (ADHD)] and the three manufacturers, Amphastar Pharmaceutical, Adapt Pharma and Kaléo, of Narcan®/Naloxone (reverses side effect of opioids). Seven of the remaining 11 companies were mentioned in the context of pharmaceuticals that have been marketed for a long time after patent expiration, (e.g. Fentanyl was introduced by Janssen/Johnson & Johnson in 1959). Four mentions pertained to substances used as drugs, e.g., the fat-trimming chemical gamma butyrolactone (GBL) and, of course, marijuana (cannabis). The message behind the media coverage of these chemical substances and older drugs was their potential as cost-effective alternatives to high drug prices.

What do the findings mean for pharma?

What are some implications of our findings for the pharmaceutical industry? Much of the media’s attention is a result of behavior that is perceived to be focused on seeking profit rather than pursing improvement in patients’ healthcare. As mentioned in last year’s implications, the opioid crisis is a case where aggressive marketing programs contributed to the current opioid crisis. Over prescription and overuse have created efforts to diminish the use of opioids but are obscuring a perspective from many physicians that opioids do provide FDA-approved pain management. An example of an appropriate-use message is the recent publication in the Journal of Occupational and Environmental Medicine by Dr. Argoff, Professor of Neurology in the Comprehensive Pain Center of the Albany Medical Center (2018). But, can the industry continue to focus on appropriate use? Continued price hikes by the manufacturers of Naloxone make us wonder if they can (Denvir, 2017).

As the purveyor of one of the most visible prices and recognized components in healthcare delivery, pharma will continue to attract the media’s attention that will intensify as the U.S. ramps up for the mid-term elections. Healthcare is one of the top four issues, along with gun policies, immigration and the economy, that are important to voters (Edwards-Levy, 2018 and Golshan, 2018). Here pharma has the opportunity to be a component of healthcare reform and rise above some of the truly bad actors associated with the industry, such as Martin Shreli of MSMB Healthcare and Turning Pharmaceuticals, who raised the price of the anti-parasitic, Daraprim®, 5600% (from $13.50 to $756) and was convicted of securities fraud.

Lastly, there is an opportunity for pharma to continue to work constructively with the FDA on the development of safe and efficacious drugs, including cannabis-based drugs. After pharma went to the FDA about the regulation of medical marijuana after decades, there was receptivity as well as discussion about the potential challenges (Chen, 2018 and Sheridan, 2018). While the way forward may not be simple, there is an understanding that the use of medical marijuana should be supported by scientific studies and rigorous assessment, rather than driven by quests for tax revenue.

Works cited

Argoff, C. (2018). Readers Respond: Stop Stigmatizing Opioids. Accessed 14 July 2018 at (https://www.medscape.com/viewarticle/898663?nlid=123706_424&src=WNL_mdplsfeat_180710_mscpedit_psyc&uac=236187SY&spon=12&impID=1680620&faf=1).

Chen, A. (2018). The FDA Supports a Cannabis-Derived Drug, But It’s Still Too Hard to Study Pot. Accessed 16 July 2018 at https://.theverge.com/2018/4/20/17264070/fda approve cannabidiol epidiolex eplispey health research.

Denvir, D. (2017). These Pharmaceutical Companies Are Making a Killing Off the Opioid Crisis. Accessed 16 July 2018 at https://www.thenation.com/article/these-pharmaceutical-companies-are-making-a-killing-off-the-opioid-crisis.

Edwards-Levy, A. (2018). Voters Say Health Care Is a Top Issue In the 2018 Election-A Good Sigh for Democrats. Accessed 17 July 2018 at https://www.huffingtonpost.com/entry/voters-say-health-care-is-their-top-issue-in-the-2018-election-thats-a-good-sign-for-democrats_us_5ac642e2e4b09d0a119103c4.

Google Trends (2018). Interests for High Drug Prices Issue. Accessed on 27 July 2018 at https://trends.google.com/trends/explore?date=2016-10-01%202017-09-30&geo=US&q=high%20drug%20prices

Google Trends (2018). Interests for Opioids Issue. Accessed on 27 July 2018 at 

https://trends.google.com/trends/explore?date=2016-10-01%202017-09-30&geo=US&q=opioids

Golshan, T. (2018). Most American Voters Prioritize the Economy-Republicans Are Voting on

National Security. Accessed on 17 July 2018 at https://www.vox.com/2018/5/3/17314664/2018-midterm-polls-policy-priority-voters.

Rogers, S. (2016). What Is Google Trends Data - and What Does It Mean? Accessed on 28 July 2018 at https://medium.com/google-news-lab/what-is-google-trends-data-and-what-does-it-mean-b48f07342ee8

Sheridan, K. (2018). Pharmaceutical Industry Bring Cannabis to FDA after Decades of U.S. Denying the Value of Marijuana. Accessed on 16 July 2016 at https://newsweek.com/ pharmaceutical-industry-brings-cannabis-to-fda-after-decades-of-us-denying-789947.

[1] The EthicsTrak database contains assessments of 2,453 newspaper articles evaluated over a fourteen-year period.

George P. Sillup, Ph.D., M.S., is Arrupe Fellow & Associate Professor, and Stephen J. Porth, Ph.D., is Arrupe Fellow & Professor, both of Saint Joseph's University (SJU), Philadelphia, PA.  Cynthia Slater, SJU’s Business Reference Librarian and SJU Summer Scholar students, Claudia Barbiero, Olivia Capperella, Kayla Herbert and Tyler Pham, also contributed to this research.