Prescription For Bias
It didn't take long for the new Congress to try to increase government regulation of health care through mandated prescription prices. Less than one month after taking power, House Democrats OK'd a bill requiring federal drug price negotiation for 23 million people covered by Medicare's prescription drug plan.
The bill 'is likely to help shape the debate' over government control of drug prices, according to the Los Angeles Times.
The House Committee on Oversight and Government Reform took the issue further and held hearings on allegations that the pharmaceutical industry was 'profiteering from public health programs at the expense of the American taxpayer and the most vulnerable in our society.' Chairman Henry Waxman (D-Calif.) opened the hearing with a list of complaints about the drug business, among them that 'drug companies are reporting massive increases in their profits.'
Such complaints weren't new to viewers of the network news, which has criticized the pharmaceutical industry for being too profitable, downplayed the high cost of drug development and treated expensive drugs as an entitlement.
CBS reporter Trish Regan showed how the networks emphasized both consumers' higher drug costs and firms' higher profits. In her July 11, 2006, broadcast, Regan turned an earnings report into an attack. 'In the last year, the cost of cancer drugs climbed 15 percent. That's five times the increase for other prescriptions. And drug companies are reaping the benefits.'
Those were consistent themes in the news reporting that the Business & Media Institute (BMI) found in a nine-month survey of the network evening newscasts, January through September 2006.
Only three of the 132 stories the three broadcast network evening shows presented on prescription or over-the-counter drugs mentioned the cost of bringing drugs to market, while 33 referred to the price tag for consumers or drug company marketing.
BMI found the media took for granted the availability and accessibility of prescription drugs, downplaying when not outright ignoring the heavy research and development costs. Stories emphasized industry profit margins and the costs of drugs borne by consumers.
Indeed, 80 percent of stories in that time period on the network evening newscasts left out the perspective of the pharmaceutical industry entirely. Dr. Elizabeth Whelan of the American Council on Science and Health explained that the attitude becomes one of 'who the hell cares who made it?'
Whelan, a BMI adviser, said the media are changing the way drugs are viewed by the public. 'Pharmaceuticals are becoming more and more like an entitlement,' she said. The media strongly reflected that view, questioning the appropriateness of drug companies making a profit from products that help people.
Money Is No Object
Bringing a drug to market is enormously expensive. The Tufts Center for the Study of Drug Development has estimated that the cost of developing one new drug is $802 million before FDA approval. An additional $95 million is spent on 'post-approval R&D costs' such as studies on the 'long-term safety and effectiveness' of the drug.
But those facts barely made it on the air. Instead, the industry was depicted as having to 'defend' drug costs against journalists and critics.
There were only three mentions of the cost of developing drugs in the 132 stories surveyed. By contrast, there were 11 times as many references to drug company profits, drug company advertising budgets, or prescription drug costs.
NBC didn't mention R&D costs at all, while ABC mentioned them once and CBS mentioned it in two stories. A total of 25 percent (33 stories) of the coverage among the three networks dealt with drug company profits, the cost of prescription drugs to the consumer, or the industry's advertising efforts.
Even when drug development costs were raised, they were quickly attacked by skeptics and effectively dismissed by the reporter covering the story.
'The industry defends its prices' on cancer drugs, Trish Regan noted on the July 11 'Evening News,' adding that pharmaceutical companies say 'new medicines come with a cost but remain a very small part of total health spending.'
Regan then cut to a clip of Geoffrey Porges, a biotech industry analyst who suggested that 'there's just a little bit of to and fro about what's reasonable' in terms of drug costs.
That was subdued compared to a July 11 'World News Tonight' story, when ABC's John McKenzie included pharmaceutical firm Genentech's Dr. Susan Hellmann saying that the 'clinical trials that we're running' for cancer drugs are 'risky and time consuming' and take 'hundreds of millions of dollars' to finance.
Yet right after Hellmann's sound bite, McKenzie interjected Deborah Schrag of the Sloan-Kettering Cancer Center angrily denouncing that claim.
'That's hyperbole. Their R&D budgets may be high, but they're not that high,' Dr. Schrag huffed, without citing a study or outside source to back up her claim. McKenzie failed to bring in an industry representative to react to Schrag, choosing to close his story on a sour note about cancer patients 'forced to confront the anxiety of mounting bills and debt from their cancer treatment.'
According to the Pharmaceutical Research and Manufacturers of America (PhRMA), of the '5,000 to 10,000 screened compounds' under development, 'only 250 enter preclinical testing, 5 enter human clinical trials, and 1 is approved by the Food and Drug Administration.'
Some 99.99 percent of potential drugs don't even survive clinical and regulatory scrutiny.
But despite those obstacles, the private pharmaceutical industry spends more per year on new drug research than the entire budget of the government's National Institutes of Health.
In 2004 alone 'PhRMA companies spent an estimated $38.8 billion to discover and develop new medicines,' according to the association's Web site. Of that nearly $40 billion, the vast bulk of it, $33 billion, went to research and development - exceeding the budget for the federal National Institutes of Health by some 22 percent.
Not only are massive amounts of money spent on new drugs, the rising cost of research is tied to more exhaustive study before drugs are sent to market, a positive development the media do not generally share with the public.
According to a May 2003 study by Tufts University, development costs for drugs are rising due to 'a greater emphasis on developing treatments for conditions associated with chronic and degenerative diseases, increasing clinical trial sizes, rising subject recruitment costs, and more procedures performed per subject.'
And that's something the media don't often acknowledge. Henry I. Miller, a former FDA associate commissioner, alerted the Business & Media Institute when one report omitted 'the impact of ever-increasing, risk-averse FDA regulation, which has pushed the cost of drug development to unprecedented levels and shrunk both the number of applications to FDA for marketing approval of drugs and the number actually approved.'
Then Again, Money Is the Object
While the media, by and large, ignored the heavy development and research costs to the drug industry, reporters showed great concern for the bite prescriptions take out of Americans' wallets.
All told, 25 percent of the stories referenced drug company profits or the price of drugs for consumers. That was 11 times the number of references to research and development costs for making new drugs.
Introducing a July 11 story, ABC anchor Kate Snow promised viewers 'A Closer Look' at 'the growing number of cancer patients forced to make truly agonizing decisions because of the skyrocketing cost of cancer drugs.'
The complaint of high consumer costs, coupled with an unwillingness to explore the heavy costs of drug development, left viewers with an unfair portrait of drug companies in general and featured manufacturer Genentech in particular.
In a news brief the following evening, Snow announced a breakthrough in AIDS treatments that combined 'three drugs now taken by many AIDS patients.' Snow added that the pill 'won't reduce the cost of more than $1,100 a month' but that doctors say the development makes it easier to take AIDS medication more regularly.
This time, Snow didn't name the company that developed the drug; nor did she mention how much money and how many failed prototypes they tried before finding a viable drug.
Trish Regan also left patients out of her July 11 CBS report, lamenting that the 'cost of cancer drugs climbed 15 percent' in the last year and that 'some of the most expensive drugs may only extend a patient's life by a few months or a year.'
Regan failed to include a drug company researcher or expert to explain the complexity and expense of developing successful anti-cancer drugs that significantly increase quality and longevity of life. Without patients' voices in the story, the audience couldn't see the impact of extending someone's life by what Regan called 'only' a few months or a year.
In addition to lamenting the heavy cost of drugs to patients, journalists attacked spending by companies advertising new drugs.
Reporter Bob Faw said on the February 23 'Nightly News' that 'giant pharmaceutical companies' spend 'over $4 billion to advertise prescription drugs,' often on the basis of 'those streams of scientific studies which sometimes seem to promise the moon.'
But $4 billion is just a little more than 10 percent of what is spent annually on research by the members of the Pharmaceutical Research and Manufacturers of America - $39.4 billion in 2005, according to PhRMA - a point Faw didn't raise in his story.
In another NBC story, anchor Brian Williams described a 'major health breakthrough' with a new eye treatment - 'the first-ever drug to treat an eye condition that is the leading form of blindness in the elderly.' But then the June 30, 2006, report turned negative: 'this breakthrough treatment comes at a high price.'
Robert Bazell interviewed a patient who said the drug 'gave [her her] life back,' but Bazell added 'there is hope for vastly improved vision but at a big financial cost.' The story did not mention how much it cost the manufacturer, Genentech, to develop the drug and get it to market.
Sometimes stories showed that whether the drug's cost was reasonable was a matter of opinion for reporters. Reporter Elizabeth Kaledin demonstrated how easy this was on the May 26, 2006, CBS 'Evening News.' She told anchor Bob Schieffer that a new shingles vaccine was 'worth every penny,' though the $150 price tag 'may seem like a lot.'
Fatherless Drug Breakthroughs
'Success has many fathers, but failure is an orphan,' goes the old saying. But that maxim doesn't hold true when it comes to breakthrough prescription drugs, at least as far as the media are concerned.
Fifty-three percent of the stories in the study treated prescription drugs in a favorable light, but even then it was rare that the networks mentioned the name of the drug companies producing them. Only 17 of the 70 favorably-slanted stories (24 percent) named the company responsible for drugs held up as 'promising' or a 'breakthrough.'
Although private pharmaceutical firms are essential to medical breakthroughs, a full 80 percent of the stories in this survey completely excluded the viewpoint of the pharmaceutical industry, failing to provide an industry voice or a company statement. Only 24 percent of the positively slanted stories even mentioned the name of the company that made the featured drug.
Elizabeth Kaledin gave an ideal contrast in her June 13, 2006, 'Evening News' story. The CBS reporter touted a new diabetes drug that was 'good news' and 'unique,' but she didn't bother to tell viewers who made it.
On the April 17 newscasts, NBC 'Nightly News' praised Evista (generic name raloxifene) as 'a major advance in combating breast cancer,' while ABC News called it a 'major medical breakthrough' and CBS called the pill a 'powerful tool in preventing breast cancer.'
While all three newscasts featured cancer specialists, none was directly employed by Eli Lilly, the company that manufactures Evista. Indeed, none of the stories that night featured a spokesman or a statement from the drugmaker, and correspondent Elizabeth Kaledin only mentioned the company's name in passing towards the end of her report.
In 132 stories, drug company sources appeared only 10 times, far fewer than the 156 appearances from experts from interest groups or research facilities and 33 appearances from government officials.
Sometimes news items were confined to a brief anchor read that gave no room for the industry to offer any defense, even in a written statement.
'A new study shows the drug [Accutane] raises the risk for potential heart and liver problems more than doctors had expected,' NBC anchor Brian Williams noted on the August 21 'Nightly News.' Williams failed to quantify how much greater the risk was or who put out the study, and he had no reaction from manufacturer Roche Pharmaceuticals about the safety of the product.
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Drugs with Liberal Champions Gained Favorable Coverage
While media coverage of drugs was generally favorable, one area received extremely positive coverage - drugs that also received extensive left-wing support. Nineteen stories in the study dealt with medicines or vaccines that were politically controversial for social reasons, such as Plan B (the 'morning-after' pill) and Gardasil, a vaccine for HPV, a sexually transmitted virus that often leads to cervical cancer.
For those drugs in particular, the networks set aside the usual scrutiny of drug companies' profit motives and wholeheartedly supported wide distribution of the medicines.
Journalists even allowed industry representatives to push the products in some stories. On the May 18 'Nightly News,' Dr. Richard Haupt of Merck's vaccine division told NBC's Lisa Daniels that his company had reached out to social conservatives 'about HPV and what the vaccine was all about.' On the July 31 'World News' on ABC, Bruce Downey of Barr Pharmaceuticals said he was 'optimistic' about the decision to make Plan B available for over-the-counter sales, adding that the wisdom of the decision 'will be in the final outcome.'
Gardasil also was given very positive treatment by the networks without the industry acknowledgement. On the June 8 'World News Tonight,' host Charles Gibson enthused that 'this breakthrough couldn't come soon enough' with more than 9,700 women contracting cervical cancer each year. The company that developed the vaccine, Merck, was not mentioned by name.
On the June 8 'NBC Nightly News,' anchor Brian Williams described the vaccine as a 'triumph in science and medicine.' The NBC report was glowing, yet the same story included no mention of the company that created this 'triumph.' This time, the network didn't bother to focus on how much the drug would cost consumers, despite talk of making the vaccine mandatory for young girls.
Gardasil wasn't the only example of politics spinning the drug reporting. On the July 31 'Nightly News,' Downey of Barr Pharmaceuticals was deployed by reporter Tom Costello as a foil to social conservatives such as Wendy Wright of Concerned Women for America in addressing concerns about Plan B, or the 'morning-after pill.'
'The faster' that Plan B is taken, 'the better,' insisted Downey, who worried that waiting for a prescription was too long for women who feared themselves to be at risk for becoming pregnant. Neither the Gardasil nor the Plan B stories mentioned potential side effects.
In a May 8, 2006, story, anchor Brian Williams talked about Plan B use rising rapidly, noting 'about 1.3 million prescriptions are written for it each year. And over the last three years, usage has gone up 200 percent.' Again, unlike media treatment of other drugs, the story didn't say how much profit the drug company had made from that skyrocketing usage, or how much more it stood to make if the drug was available to the masses over the counter.
This study looked at media coverage of drugs and the drug industry. To that end, BMI examined all 'drug' stories found in the Nexis database from January 1 through Sept. 30, 2006, on the CBS 'Evening News,' NBC 'Nightly News,' and ABC's 'World News.'
Stories were included if they pertained to vaccines or drugs, prescription or over-the-counter, either in development, on the market, or moving towards approval for marketing. Stories that dealt with treatment regimens and therapies that did not either fall into those classifications (new surgical procedures or physical rehabilitation regimes), were excluded.
Under those criteria, there were 132 stories in the 9-month time frame, comprised of 51 on ABC's 'World News,' 40 on the 'CBS Evening News' and 41 on the 'NBC Nightly News.'
BMI researchers recorded numerous variables in the stories studied, such as the number and type of sources consulted (patients, doctors, government officials, etc.), and whether drug company statements and/or spokesmen were included in news reports.
Conclusions and Recommendations
A penchant for sensationalism and a bias toward controversy were the foundation of media coverage of the pharmaceutical industry. The media presented news consumers with heights of euphoria over promising new drugs and the depths of tabloid hype with rarities such as 'sleep driving' on the influence of Ambien.
'It's either a miracle drug or a killer,' said Dr. Elizabeth Whelan, president of the American Council on Science and Health and a BMI adviser. She lamented the way the media often address drugs from a one-dimensional perspective. 'The fact is that everything comes with both benefits and risks,' Whelan said. She added that 'The media should be encouraged more to talk about that,' including how drugs may wind up causing unforeseen side effects, but also unforeseen benefits.
A spokesman for a drug industry trade group agreed. '[I]it's been my experience that if there's a bias in news today it's a bias among some reporters toward the sensational. Unfortunately for the reader or the viewer, fringe groups who make their living making unsubstantiated claims grab headlines while the factually laid out response debunking such claims usually only garner a line or two of coverage,' lamented Ken Johnson, senior vice president for communications for the Pharmaceutical Research and Manufacturers of America (PhRMA).
This issue isn't going away. 'The number of prescriptions in this country per year has essentially doubled from 1999 to 2006,' Dr. Wilson Pace of the Institute of Medicine shared with viewers of the July 20 'CBS Evening News.' Indeed, according to PhRMA, more than 40 new medicines were approved for the marketplace in 2006, from medicines for high blood pressure and diabetes to treating genital warts and preventing sunburn.
There's no easy way to improve news coverage of the drug industry, but what the media can do is to exercise objective journalism and provide viewers with a balanced diet of positive and negative aspects of the pharmaceutical industry and its products.
Remember the First 'W,' Who: The five W's - who, what, where, when, and why - are fundamental to journalistic storytelling. Stories focusing on the promise of breakthroughs in drugs should at least reference the company name and where possible include a company representative. Drugs Are More than Extremes: Too often drugs are portrayed as either a perfect cure or a dangerous killer. Most are neither extreme; instead, they extend and better people's lives. Journalists should seek to relay the pros and cons of a given drug in each story and remind the audience that ultimately, every patient's medical needs are unique and require physician consultation. Report Dispassionately on the Role of Money in Medicine: When reporting on the costs of drugs, journalists should take care not just to report on the cost of drugs to the consumer but the costs borne by companies in researching and developing them. Give Private Enterprise Its Due: While third-party experts from research labs, hospitals, and universities are crucial to reporting on medical and pharmaceutical stories, the media should include more representatives from pharmaceutical companies. News consumers gain a fuller perspective on the issue when drug company executives can bring the perspective of the industry to bear.