Pharm Execs 13th Annual Press Audit

If it feels like the media’s scrutiny of pharma has intensified recently, there is a reason-it has. The results of the 13th Annual Press Audit of issues in the pharmaceutical industry indicate that media coverage of pharma jumped in 2016 and reached a ten-year high. Not since 2006 have the top five selling newspapers published more articles on pharma. Our audit identified 214 articles this year compared to 159 a year ago, an increase of 34.6%. The change reflects increased coverage across all but one of the major newspapers. High drug prices, a perennial hot button issue, tops the list of issues this year followed by the emergence of two new and related issues – misuse and abuse of prescription drugs and opioid addiction. 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.  

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 2016, 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 2016 include:

• Coverage of the industry has been trending up and reached a ten-year high this year.  

• High drug prices in the U.S. rose to the top of the hot button issues list this year. Misuse and abuse of prescription drugs, opioid addiction, mergers and acquisitions, and tax inversion and tax evasion also received heavy coverage in 2016.

• The focus on healthcare reform was largely around the Affordable Care and Act and high drug prices as part of U.S. healthcare delivery. Coverage was at 36 articles, with the New York Times and Los Angeles Times accounting for two-thirds of the articles.

• 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 2016, 50.5% of articles were negative toward the industry compared to the five-year average of 45.8%.

• Healthcare reform coverage was demonstrably neutral with 86.1% of the headlines and 69.4% of the articles neutral.

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[i], an article had to be published between October 1, 2015 and September 30, 2016 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, “A Drug Company's Price Tactics Pinch Insurers and Consumers” (New York Times, October 5, 2015) and “Turn Down the Volume on Drug Ads” (New York Times, November 27, 2015) were classified as negative headlines, while “Could One Little Pill End a City's AIDS Epidemic?” (Washington Post, January 28, 2016) and “Optimism Increases for Cancer Treatments” (Washington Post, April 20, 2016) 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 shows the number of articles for 2016 compared to previous years. Results indicate that the amount of coverage the industry received is up 34.6% year over year and well above the five-year average of 163 articles.

Table 1 below shows the breakdown of coverage by newspaper. The 34.6% increase in coverage of the industry for the year reflects increased coverage across all of the newspapers except the New York Times.

What are the “hot button” issues?

Figure 2 identifies the issues most frequently covered in the articles and the frequency of their coverage. High drug prices and drug safety have consistently been among the top hot button issues attracting coverage and this year is no exception. Articles about drug prices rose to the top of the list this year, addressed in 55 articles as shown in Figure 2. Indeed, over a quarter (25.7%) of all articles we tracked this year on the pharmaceutical industry discussed the high price of drugs. Examples include “Another Drug Pricing Ripoff,” (Los Angeles Times, August 25, 2016), “Patients Struggle with High Drug Prices,” (Wall Street Journal, December 31, 2015) and “The EpiPen Outrage Continues” (New York Times, September 22, 2016).

Drug safety, an issue that typically signals bad news for the industry, has held the number 1 or 2 spot on the list in eight of the last nine years. This year we identified and tracked a new category of drug safety articles that focused specifically on the opioid crisis. This topic emerged from obscurity in past years to the number 2 spot of the list with a count of 40 articles. Combining the articles focused on the misuse/abuse of opioids with other articles focused on drug safety other than opioids, the two groups account for a total of 48 articles focused on drug safety or 22.4% of all articles in the sample. Examples of these articles include “What Do I Tell My Patients Who Want Opioids?” (Washington Post, June 12, 2016), “Pfizer Agrees to Limit Opioid Marketing,” (Washington Post, July 6, 2016) and “OxyContin and Addiction” (Los Angeles Times, May 8, 2016).

When the three media sources, NBC Nightly News, NPR- All Things Considered and Google, were investigated for the top two issues, we learned that they identified the two issues with coverage that spanned the entire year of this article (Oct 1, 2015-Sep 30, 2016). The range of this coverage is depicted in Table 2 below.

The next two issues on the hot button list, mergers/acquisitions and tax inversion/evasion are also overlapping in many cases. While the merger topic has consistently appeared on the hot button list over the years of this study, the specific focus on tax inversion and/or evasion is a newly emerging topic. The tax inversion theme resulted in a mix of articles that offered opposing views on the topic. Examples include “Bring the Corporate Tax Exiles Home” (New York Times, December 14, 2015), “An Rx for Tax Avoidance” (Los Angeles Times, November 25, 2015) and “U.S. Tax Drives Firms Away” (Washington Post, November 9, 2015).

The legalization of marijuana is another issue that emerged from insignificance this year. Not surprisingly, the coverage included both pro and con positions with, for example, the Los Angeles Times reporting “Pot Policies Mired in the '70s” (August 12, 2016) and the Washington Post calling for caution in a trio of articles (“Don’t Reclassify Marijuana Yet - Research It,” August 16, 2016, “One Reason for Cannabis Caution,” July 31, 2016 and “What Needs to Happen Before We Legalize Marijuana,” April 30, 2016).

Articles focused on research and development of new drugs, the issue receiving the most coverage last year, fell off from 28 articles to only six this year. Similarly, articles focus on Ebola dropped from 16 to only one. Marketing and sales incentives, which used to attract coverage and was near the top of the list several years ago, fell to just one article this year. This lack of coverage is a positive outcome for the industry, and may reflect new policies and procedures in place to regulate incentives to physicians.

Linking pharma companies to the “hot button” issues

For the fourth year in a row, specific pharma companies and/or their products were linked to the hot button issues. This year 77 companies accounted for 212 mentions. Of those 212 mentions, Pfizer was mentioned 37 times, centering on price increases for 100 of their drugs and contributing to the 55 articles identified in Figure 2. Another 46 of the mentions were attributable to Allergan and Valeant, each with 23 mentions. Attention was directed to Allergan due to its failed merger with Pfizer along with a $2 billion decrease in sales. Valeant gained attention by losing $85 billion in valuation and then failing to sell assets as proposed by their new CEO, Joe Papa. Both contributed to the third and fourth issues of mergers/acquisitions and tax inversion/evasion. The remaining 129 mentions were distributed among the remaining 74 companies, many of which were related to drug safety.

Coverage

Our thirteen-year analysis has found that the tone of headlines and articles tends to be more negative than positive for the industry. This year the news about headlines is mixed for the industry. On the one hand, there were fewer positive headlines for the industry. In fact, Table 2 shows that positive headlines hit a five-year low of only 9.8% of all articles. Furthermore, the proportion of negative headlines increased slightly this year to 34.1%. On the other hand, headlines were not as consistently negative this year as they were in the years 2012 through 2014. In addition, more headlines were neutral to the industry (56.1%) as compared to previous years.

In terms of the tone of full-text articles, the trends are consistently bad. As shown in Table 3, only 13.6% of articles took a positive tone toward the industry, the lowest level in the past five years. Likewise, the proportion of articles taking negative positions towards the industry is at a five-year high of 50.5%. Clearly, the news was not good for pharma in 2016.

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 31.8% (68 of 214) of articles mentioned both sides, a drop from last year’s mark of 52.8%. 

Analyzing healthcare reform coverage

Consistent with previous years, we analyzed the top five U.S. newspapers and answered the following questions:

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

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

• How often are the industry’s perspectives included in the articles?

• What pharmaceutical companies and/or brand names are identified in the articles?

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

Headlines as well as the articles were analyzed as positive, negative, or neutral toward the pharmaceutical industry. There was a neutral bent to this year’s headlines with 86.1 % of the headlines neutral. When the full articles were assessed, 69.4% were neutral. These results are consistent with results from prior years but are the highest percentage of neutral headlines in the last five years and the highest percentage of neutral articles since 2013. Four of the five newspapers were consistent with the neutral coverage. The exception was USA Today which published only one article on healthcare reform and that was negative: “VA Watchdog Great 'Failure' to Vets Problems’ Allowed to Fester; Inspector General's Office Rejected Evidence, Sat on Report, Senate Investigation Finds” (May 31, 2016, p. A1). See the summary in Table 4 below.

Coverage this year increased slightly from 2015 from 30 to 36 healthcare reform articles. All papers had a least one article and the New York Times and Los Angeles Times had the most coverage with 13 and 11 articles respectively. Examples are, “The Fallacy of the Latest Contraception Case” (New York Times, Nov 7, 2015, p. A22) and “End-of-Life Law May Stir Ethical Debates; Cost Controls Emphasize Lethal Pills over More-Expensive Life-Extending Drugs, Medical Experts Say” (Los Angeles Times, Oct 19, 2015, p. A1). See Table 5 below for a breakdown of the coverage.

This year’s articles focused primarily on healthcare reform (including the Affordable Care Act) and, not surprisingly, high drug prices, which were also the top two issues last year (see Table 6). 

The pharmaceutical industry’s perspective was not in the healthcare reform articles. But once again, the link between pharmaceutical industry companies and/or their products and the ethical issues did occur in the articles (77 companies; 122 mentions) and are reviewed in the earlier section of this paper.

Implications for pharma

As has been the case in past articles, this year’s newspaper coverage of issues that affect pharma companies and issues related to healthcare reform has implications for the pharmaceutical industry.  Pharma continues to attract attention at a time when the industry is under scrutiny about the pricing of its drugs. For example, after announcing that it would increase the price of 100 of its drugs in 4Q2016, Pfizer raised prices an average of 20% between January and June 2017.  Compared to the 0.3% cost of living adjustment (COLA), that’s 66.6 times higher.      

Some issues identified in this audit are within the pharma industry’s capability to address (e.g., drug safety) and others are the harbingers of potential future impact (e.g., opioid epidemic). Based on its expertise with the manufacture and distribution of controlled substances, another area where pharma can take a leadership role is the legalization of medical marijuana. Legalization will have an impact on the sale of drugs for which marijuana is an alternative, especially for the Medicare population. Pharma is at risk of lost sales as more states approve the use of marijuana for medical purposes.

Finally, the healthcare reform findings suggest an opportunity for pharma to play a greater role in this area. While there is considerable wrangling about the latest version of the reform of the Affordable Care Act (ACA), pharma needs to continue to be proactive in shaping the attempted revisions in healthcare reform. As one of the key stakeholders in healthcare delivery along with patients, payers, policy-makers and providers, pharma’s actions over the next months can contribute to the stability of U.S. healthcare delivery as Congress wrestles with the latest version of reform for the ACA.

References

How Pharma Will Be Impacted by Trump’s Healthcare Reform Plans (2016). Accessed 20 June 2017. https://pharma.elsevier.com/pharma-rd/pharma-impacted-trumps-healthcare-reform-plans/.

Medical Marijuana Laws Reduce Prescription Medication Use in Medicare Part D in Health Affairs by Bradford, A.C. and Bradford, W.D. (2017). Accessed 22 June 2017, http://content.healthaffairs.org/content/35/7/1230

Pfizer Hikes Prices on Nearly 100 Drugs, Report Says by King, R (2017). Accessed 26 June 2017. http://www.washingtonexaminer.com/pfizer-hikes-price-on-nearly-100-drugs-report-says/article/2624829

Social Security Cost of Living Adjustment (2016). Accessed 19 June 2017. https://www.ssa.gov/oact/cola/colasummary.html.

Suing Big Pharma for the Opioid Epidemic–The Atlantic (2017). Accessed 19 June 2017. https://www.theatlantic.com/business/archive/2017/06/lawsuit-pharmaceutical-companies-opioids/529020/.

About the authors

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

[i] The EthicsTrak database contains assessments of 2,088 newspaper articles evaluated over a twelve-year period.