Associated Press Worships at the Altar of Big Pharm

In this journal, I do a close reading of the medical news articles written by the Associated Press journalist, Marilynn Marchione this year. Close readings take time, and she has written a lot of articles. So, this will be an unusually long thread, even for me. If you think it is too long, no one is making you read it.

Intro. This Is a Study of Journalistic Bias, Not A Comparison of the Efficacy of Traditional Versus Alternative Medications

A few days ago, my husband turned to me and asked how much the nation’s pharmaceutical companies were paying the Associated Press to trash alternative therapies. As a massage therapist who specializes in the treatment of cancer patients, he has reason to know that the benefits of so called complementary therapy are not easily quantified.

Now, I generally do not read AP stories, because I know that they have a high tolerance for journalistic bias disguised as objective reporting (e.g. articles by folks like John Solomon). Plus, as a physician, I am not in the habit of prescribing or using a lot of “herbal” remedies ----

On the other hand, I like to keep up with what the big pharmaceutical companies are doing, because I know how cut throat they can be. For instance, the manufacturer of Seldane petitioned the FDA to take its own mega-selling nonsedating antihistamine off the market---just before it was about to go generic. Then, they introduced their new, patent nonsedating antihistamine, Allegra, which was derived from Seldane. Seldane had to go, we were told, because it interacted with a few other medications. Funny, there were a lot of other drugs on the market that had even more medication interactions, and their manufacturers did not request that the FDA ban them. Makes you wonder if the makers of Allegra were more worried about competition than safety.

In the same vein, a few years ago the Bush FDA did something really unusual. It banned the use of several old medications---ergots for headaches, quinine for leg cramps---on the grounds that they were unsafe. By some strange coincidence, at the same time Glaxo Smith Kline was doing direct to the public marketing of its headache medication, Imitrex, and its nocturnal leg cramp medication, Requip, both of which also had significant side effects. If quinine and ergots were taken off the market, GSK would get more business. GSK was a big donor to Bush. Here is my Kos diary about the FDAs action.

http://www.dailykos.com/story/2007/3/2/14243/36440

There is a lot of money to be made from the sale of medication in the U.S. We spend an average of $7000 per year per person on health care. Pharmaceutical companies get 10% of that money. The folks who sell alternative therapies also take in billions. I know that drug companies will do just about anything to increase their profits. I expect the makers of herbal remedies are the same. When two titans clash over issues of money, the ensuing battle is seldom pretty. When journalists compromise their integrity to take sides in such a battle….

Oh, hell. I will let you judge for yourself. But before I get started, I want to make two points. One, the most important parts of any news article are the title, opening paragraphs and concluding paragraphs in that order. Those are the only things that many people will read. Often, they glance at the headline and file it away as if it is proven fact.

Second, you can tell if someone is fair by their consistency. If a writers seems to have two different pens, a nice blue ink one for one topic (say, Republicans or maybe traditional remedies) and an angry red one for the opposite topic (Democrats or alternative remedies), then everything he—or she—writes has to be taken with a grain of salt.

I. Marilynn Marchione of the Associated Press on Traditional Medical Therapies

This week, Marilynn Marchione of the Associated Press wrote a series of articles with a common theme. Alternative therapies suck. Since alternative therapies really can suck (if they are taken at the wrong time or for the wrong reason or if they are manufactured by the wrong folks), I am not going to comment on the overall substance of her articles. Rather, I want to dissect her journalistic style. How does she write about traditional (i.e. pharmaceutical company) therapies? How does she write about alternative therapies? Does she have a blue pen for one and a red pen for the other?

I decided to check out all the articles which she has written this year as listed on this website.

http://ap-283.newsvine.com/

First, I will describe the stories she has done about medical treatments and tests designed by physicians, drug companies---you know, traditional medical therapies. The kind that the FDA will be asked to approve so that insurance will pay for it.

http://www.newsvine.com/_news/2009/02/24/2472483-doctors-back-wider-consideration-of-prostate-drug



First impressions for the casual reader? Positive title, positive first paragraph, positive last paragraphs. While anecdotal reports mean nothing in medicine (the FDA is not going to give any new drug approval because one person says it saved his life) they are a very useful rhetorical tool for creating a reality effect (as opposed to actual reality). Most people who skimmed the above article would come away with the impression that Proscar is a great medication! Healthy men who do not want to get prostate cancer should definitely ask their doctors about it.

You have to read the middle of the article to discover that the board which recommends this new use for Proscar includes physicians with financial ties to the manufacturer and that its usefulness for this purpose is debatable and that there are significant side effects. But hey, people are more interested in stories that describe benefits of a treatment as opposed to stories that claim no benefits. So, if Ms. Marchione consistently approaches every therapy---alternative as well as traditional---by painting a positive picture at first glance and then putting the negatives in the middle of the article, she is being consistent. Which means that she is probably not biased.

http://www.mercurynews.com/nationworld/ci_12032778?source=rss


Another therapy that Ms. Marchione gives the kid glove treatment. As a physician, I know that some of the medications included in this one pill a day wonder sometimes have to be titrated (i.e. the dose has to be individualized). Therefore, I worry that such a pill would increase the tendency for doctors to do “one size fits all” medicine, treating the disease instead of the person. But hey, at least she is consistent. This women really likes informing people about new treatments that are on the horizon. And she will tell you which company is making them, in case you want to buy some stock.

http://www.newsvine.com/_news/2009/03/29/2614971-study-cholesterol-drug-lowers-blood-clot-risk


Sounds great! Very upbeat. But, just for fun, what would I discover if I decided to “pick apart” this article?

Oh may! I would discover that Dr. Stein has an undisclosed conflict of interest.



http://hcrenewal.blogspot.com/2008/01/who-decided-to-change-outcome-variable.html

Note that the AP article singles out Crestor.



And Crestor is made by Astra-Zeneca, which has given Dr. Stein funding. Oh well, if Ms. Marchione is comfortable allowing doctors with undisclosed financial ties to praise studies for traditional meds I am sure that she will do the same thing when she writes about alternative therapies.

More good news for medical consumers in the next article by Ms. Marchione, this time about Plavix. Note that someone must have told her that it is not a good idea to solicit expert opinions from people who have a financial stake in a drug company, because we get a little bit more information this time.

http://www.newsvine.com/_news/2009/03/31/2621897-study-plavix-plus-aspirin-helps-prevent-strokes


The manufacturers of Plavix must have been relieved at the good publicity (even if the study only recommends it for that small fraction of atrial fibrillation patients who can not take the greatly superior blood thinner coumadin). Because they get such a nice headline effect----Plavix plus aspirin reduces stroke---without any unpleasant qualifiers. And it helps undo the damage done to their product from some other studies about heart disease---studies which Ms. Marchione just happens to have written about. Since she is such a supporter of medical research (even preliminary studies whose results are open to debate) I am sure that she praised the results of the studies which were critical of Plavix, too….

http://www.cafepharma.com/boards/showthread.php?p=920139


Hmm. Interesting article. Rather than praising the study in question, Ms. Marchione seems to have a different agenda, here. It almost seems that she is trying to tell folks “nothing to see here, move along”. Note the use of the anecdotal report near the end---patient is bugged to stop Plavix by a family member who heard about the study, but everything turns out fine (for Plavix) when his doctor tells him he keep taking his meds. And it is so nice to see three physicians reassuring us that the medication is safe----

Except that Dr. Cannon has undisclosed ties to both Bristol Meyer Squibb and Sanofi-Aventis, makers of Plavix.


http://www.cvspectrum.org/cms/templates/editorial.aspx?articleid=6335&zoneid=2

And Dr. Richard Milani was accused of taking kickbacks from Bristol Meyer Squibb in exchange for including Pravachol on his formulary rather than a competitor.
http://tx.findacase.com/research/wfrmDocViewer.aspx/xq/fac.%5CFDCT%5CETX%5C2008%5C20080924_0001269.ETX.htm/qx



Note the above court case was thrown out----but not because anyone proved that the accusations against the doctor were false.

Dr. Ralph Sacco has also taken BMS Safoni money

http://www.aan.com/annualmeeting/search/index.cfm?fuseaction=disclosures.home&letter=S



Oh well, Ms. Marchione obviously thinks that health professionals can never be influenced by financial concerns. She must be a very nice person to trust others so much.

More good medical news.

http://www.newsvine.com/_news/2009/04/27/2736448-prostate-cancer-vaccine-extends-survival-in-study


Typical format. Glowing title, positive first paragraph, glowing testimonial at the end. The only problem I can see here is that the revolutionary new treatment gives four additional months of life and the current treatment gives three months of life. But you have to read the middle of the article to discover that.

http://www.newsvine.com/_news/2009/05/14/2818412-test-may-help-predict-colon-cancer-recurrence-risk


No one wants unnecessary chemotherapy, so this must be good news. Except that if you read further, you will discover the test is no good at telling us who will need chemotherapy. So, why is that doctor telling us that it will? I guess he is just being optimistic, too. Like Ms. Marchione.

http://www.newsvine.com/_news/2009/05/30/2880611-immune-system-taught-to-fight-deadly-skin-cancer


Sorry if folks are getting bored. I just want to show that Ms. Marchione has one way of writing of medical stories and she seldom deviates from it. If you want to know the bad stuff about this new treatment, click on the link above.

In the same vein

http://www.newsvine.com/_news/2009/05/31/2882567-immune-therapies-finally-working-against-cancer


Wow, this woman really trusts medical science. She only has two articles this year in which she discusses negative effects of prescription medication.

http://www.newsvine.com/_news/2009/05/30/2880173-hormone-pills-may-make-lung-cancer-more-deadly

Note that hormone supplements for women are widely available as generics. So, this article is not costing any major pharmaceutical companies money. Instead, it may help generate revenue for them, since women will be encouraged to switch to the new, patented osteoporosis preventing medication.

The same thing goes for the next article
http://www.newsvine.com/_news/2009/05/30/2880688-some-antidepressants-may-risk-breast-cancer-return



which talks about Prozac, Paxil and Zoloft, all available as generics, which compete with the newer, patented antidepressants that major pharmaceutical companies would prefer to see you buy.

II. Marilynn Marchione of the Associated Press on “Alternative” Therapies

By now, Ms. Marchione’s style is clear. We know that she believes that people who have a financial interest in a treatment can be trusted to talk about it honestly. We know that she praises all studies which say something positive about patent medications and dismisses studies that say something bad (although she is ambivalent about generic medications). She writes upbeat titles and tries to include some "real life success" story to make the cures seem more real. She will repeat any medical claim made by any expert (even one with a financial interest in the treatment) and she does not mind if the claims are unproven or even contradicted by current studies. This woman's weakness may be her gullibility, but her strength is her open mind. I am sure that she will approach the topic of alternative therapies with the same lack of prejudice (and judgment).


http://www.newsvine.com/_news/2009/03/30/2618950-fish-oil-pills-dont-boost-benefit-of-heart-drugs


That seems pretty clear. Fish oil does not help your heart. It is like eating a hot fudge sundae. How many people are going to take the time to read the whole article which also says



Is it just me, or did Ms. Marchione do a 180 degree turn? Where is the glowing title, full of optimism? Where is the patient testimonial? Up until now, she has put the good stuff in the title, first and last paragraphs and while hiding the bad stuff in the middle. But in the case of fish oil capsules, she buried the good news and put the bad news on display for any casual reader to note.

Oh look! She has something good to say about an herbal preparation, ginger.

http://www.newsvine.com/_news/2009/05/14/2818404-study-ginger-capsules-ease-chemotherapy-nausea


I am glad to see that she is not biased against alternative remedies. I am sure that the fact that a drug company is trying to get a patent to sell ginger capsules….



Has nothing to do with her decision to write this article and cast ginger therapy in such a positive light.

This week Ms. Marchione decided to do a four part series on unconventional treatments.

On Sunday, she gave us

http://www.newsvine.com/_news/2009/06/07/2905379-ap-impact-alternative-medicine-goes-mainstream



Was this written by the same woman? Where is the wide eyed enthusiasm for new, unproven treatments? Why did she write this



When we know that she thinks that health professionals with a financial interest in the treatment are the most reliable sources for unbiased information?

On Monday, we got this:

http://www.newsvine.com/_news/2009/06/08/2909030-60-pct-of-cancer-patients-try-nontraditional-med


And this, this and this:



http://www.newsvine.com/_news/2009/06/08/2909045-cancer-patient-learns-herbals-can-interfere


So alternative treatments are criminal. Stupid, even. Funny, I thought an (ineffective) new medical remedy that buys an extra month of life for a small number of prostate cancer patients was supposed to be good and an (ineffective) expensive colon cancer test that can’t tell you if you need chemo therapy was also good. So why are ineffective alternative therapies bad?

On Tuesday, Ms. Marchione wrote this:

http://www.newsvine.com/_news/2009/06/09/2912271-tests-show-many-supplements-have-quality-problems


Pardon me for laughing, but our FDA allows manufacturers to contaminate infant's formula with toxic plastics---melamine. And we feed melamine to our cows, too. And they did not test nut processors for diseases until folks got sick. If the FDA can not be bothered to ensure the safety of the stuff they are supposed to regulate, how are they going to find time (or interest) to test the ones that do not currently fall under their jurisdiction?


Love the way she attacks Red Yeast Rice for having the same active ingredient as Mevacor as if this is a bad thing. Mevacor also contains Mevacor. Does that make it dangerous, too? The truth is that Red Yeast Rice has been around for hundreds of years and a pharmaceutical company patented its active ingredient---and then got the FDA to ban the natural form of the medication on the grounds that Mother Nature was infringing on their patent.

On Wednesday, we learned that alternative therapies are a big fat waste of money.

http://www.newsvine.com/_news/2009/06/10/2915757-ap-impact-25b-spent-no-alternative-med-cures


Everyone wants to be informed. Note that Ms. Marchione again attacks medical experts who have a financial interest—in alternative treatments.



I could say a few words about someone’s ideology at this point. Except I am not sure. Is it ideology? Or is it ambition? Or is it money?

The final installment in the series:

http://www.newsvine.com/_news/2009/06/10/2915776-government-probes-chelation-heart-disease-study


How dare anyone conduct a study of a treatment that has side effects and which has not been proven! They should only study proven therapies. Or unproven ones that some drug company hopes to patent.

III. Conclusion: Ms. Marchione is For Anything that Big Pharm Can Patent and Against Any Remedy That They Can Not Patent

To be fair, I am sure that the doctors who are most willing to talk to her are the ones in the employ of drug companies. A journalist needs sources to do her work. This is the same reason why the New York Times was so biased in favor of the White House in the run up to the Iraq war. Call it the Judy Syndrome. Reporters will do their best to serve the interests of the people who make it possible for them to keep writing.

I will bet that there is a journalist somewhere who likes to trash patented "traditional" medications while singing the praises of "natural" remedies. Where there is money involved, you can always get someone to worship at your altar.

Thanks for posting, but a LONG read...

The AP article was shameless bended-keee propaganizing for Big Pharma & cronies...seems AP has turned its back on journalism is really in the corporate crankout tank lately. I just don't trust them anymore. Used to. But not after the last year or so, and this is just one more example...

Thank you McCamy.

The information you have generously provided gives us more than a hint of the insidious influence of the colossal forces which are now trying to prevent Americans from getting affordable effective health care.

Always comes down on the side of money. It would actually have been a surprise if they were doing otherwise. For many years, I've gotten much of my info on alternative therapies from a combination of Life Extension magazine and peer-reviewed med journal articles, first by researching at my nearby med school library, then from the 'net when they became available there, but I'm more fond of science than most. I've needed to reverse my opinions of their usefulness only very rarely, since they aren't usually hyped or have their side effects hidden like drugs do in the first place. Quite the opposite. BTW, Plavix flat out kills a % of users every year--just read the PDR. Especially disturbing when you find out that there are many really effective nutritional supplements that reduce excessive clotting, alone or in combination. It feels like a leap of faith at first for an MD to go from prescribing drugs to prescribing mostly nutritional supplements, but it must turn out alright, because there are quite a few MDs who talk about having made the conversion, but I've never read a story by MD who has said he/she had to go back relying on drugs as a first line of defense, because the patients had worse outcomes than they did with the doctor's previous style of practice.

They're also biased towards the theory that the holocaust happened.

Seriously. I do not see a problem with reporting negative things about any treatment, whether it be "big pharm", "natural", "western medicine", "alternative medicine", any of the categories involved with health and health care.

Anything can have side effects, or even be harmful in the wrong dose or the wrong person. "Big pharma" and hospitals are MANDATED by the government to report side effects, injuries, and deaths. Not so with "big supplement." In fact, as we've seen, deaths due to big supplement usually end up getting "credited" to hospitals because the individual is so damaged by the supplements, they are taken to the hospital where despite best efforts, they die. Thus they "count" towards hospital deaths.

Just wondering.