For the second time this year, the Public Broadcasting Service has taken a hit for running a program that was largely funded by medical products companies with key interests in the subject matter. Earlier this year, the issue arose when PBS aired an episode of a health series that was
underwritten by Glaxo - just as the drugmaker was awaiting FDA approval to sell its Alli diet pill over the counter.
The latest dust up occurred this month as PBS aired a three-part series called 'The Mysterious Human Heart.' As Roy Poses at Health Care Renewal notes, Medtronic and AstraZeneca were two of three corporate sponsors. And not only do those companies sell heart-related products - defibrillators and cholesterol meds, respectively - but both have had troubles with those same products. Yet as one viewer wrote Mike Getler, the PBS ombudsman, "viewers are never told about potential problems with those devices....or possible financial ties between the series' on-camera experts" and the two companies.
The press release and 'outreach tool kit' both clearly note that the companies underwrote the series. "But missing from the glowing approbation by PBS...in the release, and what should be prominently featured as well in the series," Jeff Chester, director of the Center for Digital Democracy, writes Getler, "is any discussion of the serious health-related risks from Medtronic and AstraZeneca products...We believe that the involvement of these two heart-related commercial entities illustrates disturbing flaws in the PBS underwriting guidelines. PBS programming should not be supported by any concern that has a stake — either financially or politically — in the editorial content of the show or series."
To his credit, Getler asked the series producer and a PBS exec about the accusations, and he admits "the responses, especially from PBS, do not address the real conflict, criticism and questions at issue here. This program, and the criticisms, once again put the spotlight on what has been a continuing source of viewer questioning and complaint about several PBS-supported and promoted programs — the seeming inappropriateness of funders for a number of programs and the residue of doubt that leaves in the mind of some viewers even though one may not see or sense any hint of influence."
To underscore the extent of the problem, Poses found something the critics and ombudsman didn't: The content advisers to the series web site - Peter Libby, who is chief of cardiovascular medicine at the Brigham and Women's Hospital in Boston and Mallinckrodt Professor of Medicine at Harvard Medical School, and Doug Zipes, professor of medicine, pharmacology and toxicology at Indiana University - have ties to the corporate sponsors. Libby has received grant support from, consulted for, and served on a speakers' bureau for AstraZeneca, and Zipes has received consulting fees or honoraria worth more than $10,000 from Medtronic. The conflicts weren't disclosed on the site, though.
We understand that PBS funding is a dilemma, and that sponsorship shouldn't automatically imply influence over program content. Nonetheless, PBS has a responsibility, at the very least, to do a better job of disclosing information. And that can be accomplished by including in its programs, web sites and press materials any potential conflicts and, specifically, pertinent problems with products that address the very issues raised in PBS programming.
Hat tip to Health Care Renewal
15 Comments
Please keep Big Pharma out of it!!!! They'll want to control content and tailor it to their desires.
Prove your statement. Notice that there is not an accusation that pharma or any other corporation controls the content of PBS broadcasts. Most large companies, including pharma, have extensive corporate philanthropy efforts. PBS support is part of this.
Do we really want to ban pharma from supporting PBS? Then, of course, I assume that you are in favor of keeping all corporations out of PBS. Afterall, every "greedy" corporations want to control content, yes? Now go and look at the PBS website and figure out how much of its operating budget comes from corporate donations and sponsorship. It would likely cease to exist without corporate support.
I agree with Atlex. Everything I watch on PBS seems to be sponsored by DOW chemicals. It doesn't bother me. I donate my own money to PBS because I think it's an important charity, but I understand that personal donations don't provide enough money for NOVA or the War documentary.
Oh dear, another case of the COI vapors! Overall, I'd say this ranks around an 8 out of 10 on the conflict-of-interest overreaction scale. I only watched a little of the special online (which was an excruciating 7 minutes, BTW), but from that and from what I've read, this was a simple, layman's educational series. No specific products were mentioned and what they reported in terms of treatments was straighforward and followed expert guidelines.
This isn't a clinical study or CME. Doing some type of disclaimer or fair balance about issues specific to AstraZeneca's or Medtronic's problems is ludicrous and inappropriate in the context of this type of program. Even statements about statins in general would be pushing it.
From all accounts, there wasn't even any pro-pharma bias in the presentation at all. In fact, from everything I've read, even from the critics, this seemed to be a pretty standard, well-balanced show in terms of the information. Health Care Renewal did write, "by increasing awareness and concern about cardiovascular disease, and emphasizing its treatability, the show could still have served a marketing purpose for companies that make drugs and devices used to treat cardiovascular disease." While this may be true on a very, VERY broad sense, it's really a stretch given the entirety of the content of the series. And, of course, corporate funding was prominently noted.
As for the content advisors' COIs, again, with no specific recommendations or claims being made, I have a hard time seeing how they would or could steer the content to favor the underwriters of the show, again, especially given the entirety of the content. Futhermore, statins and defibrillators are standard treatments, period. Even if the content reviewers had no pharma ties, they'd still say the same thing.
Should the advisors' ties to AZ and Medtronics should've been noted? Probably. But I think the level of criticism here goes far beyond the seriousness of the infraction, or lack thereof. Look, there are some very real and very troubling COI issues out there, but to me, this is not one of them. This is a case of someone looking for a problem.
Oh dear, another case of the COI vapors! Overall, I'd say this ranks around an 8 out of 10 on the conflict-of-interest overreaction scale. I only watched a little of the special online (which was an excruciating 7 minutes, BTW), but from that and from what I've read, this was a simple, layman's educational series. No specific products were mentioned and what they reported in terms of treatments was straightforward and followed expert guidelines.
This isn't a clinical study or CME. Doing some type of disclaimer or fair balance about issues specific to AstraZeneca's or Medtronic's problems is ludicrous and inappropriate in the context of this type of program. Even statements about statins in general would be pushing it.
From all accounts, there wasn't even any pro-pharma bias in the presentation at all. In fact, from everything I've read, even from the critics, this seemed to be a pretty standard, well-balanced show in terms of the information. Health Care Renewal did write, "by increasing awareness and concern about cardiovascular disease, and emphasizing its treatability, the show could still have served a marketing purpose for companies that make drugs and devices used to treat cardiovascular disease." While this may be true on a very, VERY broad sense, it's really a stretch given the entirety of the content of the series. And, of course, corporate funding was prominently noted.
As for the content advisors' COIs, again, with no specific recommendations or claims being made, I have a hard time seeing how they would or could steer the content to favor the underwriters of the show, again, especially given the entirety of the content. Furthermore, statins and defibrillators are standard treatments, period. Even if the content reviewers had no pharma ties, they'd still say the same thing.
Should the advisors' ties to AZ and Medtronics should've been noted? Probably. But I think the level of criticism here goes far beyond the seriousness of the infraction, or lack thereof. Look, there are some very real and very troubling COI issues out there, but to me, this is not one of them. This is a case of someone looking for a problem.
Hi Reality,
I understand your point. I think the issue here is one of perception. And in that regard, PBS could do a better job of providing full disclosure, if only to dispel the notion that any programming may somehow reflect commercial influence. No one suggested this latest series did have that problem. Rather, the idea is to avoid the issue from arising. The irony, by the way, is that PBS is in the communications business and underwrites some good journalism. So perhaps the expectation level is a bit higher. But the discussion is still worth having.
Thanks for writing in,
ed at Pharmalot
Ed,
I agree and understand about the perception thing. The COI pendulum is far over to the suspicion side of things, but isn't it also possible that it's also over on the overreacting side of things? One would be hard pressed to look at this particular instance and see any real underhandedness, perception or no, especially when the corporate sponsors were so prominently featured.
You note that I noted that no one suggested the series had a problem. That wasn't an oversight by me--indeed, it's exactly why I pointed it out: no one had a problem with the content, but they still treated it as though it had a bias problem, and in the process, impugned the reputations of two highly respected scientists and clinicians, even if inadvertently.
As you know, this is a pet issue of mine as well. The COI Cult, as Tom Stossel calls them, have generally good intentions, but they have trouble picking their battles and often seem to treat every instance with the same degree outrage and call to arms regardless of the seriousness or context. It's this lack of perspective--and the frequent reluctance to acknowledge it--that I find infuriating.
Hi Reality,
You asked a good question about overreacting, but I don't think it's too much to ask of PBS to cover all the right bases. Again, I think the endpoint, if you will, is to set a tone by taking steps to avoid perception issues, even when it involves organizations that have stellar reputations.
As for the scientists who acted as advisers, well, they had a long list of affiliations. I don't see how it would hurt to also list their affiliations witho the corporate sponsors, especially if PBS sponsor did a better job of explaining its approach to the funding and programming. PBS has to take some responsibility for allowing the questions to be raised. If PBS had simply noted the obvious, the issue may not have been raised.
You may not agree, but I'm enjoying the discussion, nonetheless.
Cheers ed
Ed,
Again, I don't disagree with the ideals -- I disagree with the reflexive demonizing of the offense and the offenders regardless of the situation.
For instance, your blog post title is "PBS: Public Trust or Corporate Shill," despite the fact that everyone seems to be in agreement that there was no shilling going on, and that the series was well balanced and without bias. Perhaps you were merely being snarky, but it goes to the point of painting all COIs and situations with the same broad brush.
You and HCR are not being unreasonable in wanting the COIs disclosed, but I do think you're being unfair in characterizing this episode as something unseemly.
Hi Reality,
Well, two things. I wasn't attempting to demonize anyone, and I honestly don't think I did. I was trying to raise awareness and, by doing so, push for change.
And the headline was, for better or worse, designed to generate discussion. It was a question, not a conviction. And it served its purpose - we got a chance to go round on the subject and sort out what's fact, what's fantasy and what, if anything, could be improved. So I understand your point, but I have no regrets about this one.
Again, thanks for debating this.
ed
Ed,
Well, if your point was to be provocative, then mission accomplished.
Let me ask you this: do you feel that Health Care Renewal's call for inclusion of AstraZeneca's and Medtronic's specific safety issues had any place in that type of rather nondescript programming? That's the type of overreaction and lack of perspective I'm talking about.
Hi Reality,
A belated reply to your question, and sorry for not doing so sooner. I think, at the very least, PBS could have included not just the sponsor logos, but a brief mention of the products they make and sell, since these are pertinent to the heart. Should that include the safety issues? It could, of course. Perhaps, in the form of links to the product web site, which should include that info. Perhaps, that covers the bases.
best ed
[...] singeing were Health Care Renewal (see our post here) and PharmaLot (see Ed Silverman’s post here). The PBS show was funded by AstraZeneca and Medtronic. Dr Libby and another physician were content [...]
[...] singeing were Health Care Renewal (see our post here) and PharmaLot (see Ed Silverman’s post here). The PBS show was funded by AstraZeneca and Medtronic. Dr Libby and another physician were content [...]
[...] singeing were Health Care Renewal (see our post here) and PharmaLot (see Ed Silverman’s post here). The PBS show was funded by AstraZeneca and Medtronic. Dr Libby and another physician were content [...]