In Part 1 of this article (The JAMA Controversy: Arrogance AND Stupidity?), I detailed the recent media flap created by Wall Street Journal writer David Armstrong's two superbly researched articles (here and here). The articles revealed that this past February, JAMA (the American Medical Association’s official publication) unknowingly published the results of a study whose authors had financial ties to pharmaceutical companies related to (but not funders of) the study.
In my article, I also reported that, according to Armstrong’s articles, and also according to JAMA itself, the JAMA physician/authors vehemently denied that their financial ties were relevant to the study results, which were decidedly pro-pharmaceutical-company.
However, one week after JAMA’s editor in chief promised more stringent author guidelines -- but declined to ban authors from publishing in future issues of JAMA for not disclosing their pharmaceutical ties -- the Associated Press revealed that JAMA had once again been duped. Another study, this one reported on in the July 18th issue of JAMA, contained yet another case of pharmaceutical company/physician ties.
Once again, the physician/authors in question claimed that their financial ties were not relevant and therefore, need not have been revealed prior to publication.
In Part 2 of this article, I will take a hard look at how this kind of thing can happen –- how “news” can go so terribly wrong. I will do this by looking into the controversial way some (but not all) “news” is made; and how this method of “news making” (perhaps we should call it “news creating”), was used by JAMA to publicize these two studies whose authors had serious financial ties to pharmaceutical companies.
In his July 11th Wall Street Journal article, David Armstrong pointed out that “. . . many local television news stations broadcast, unedited, a 'video news release' put out by JAMA reporting on the study. That release featured Dr. Cohen and one of his patients, Lisa Kirshenbaum of Cranston, R.I., who was a part of the study.”
Spurred on by these two very important sentences, I decided to do a bit of sleuthing on JAMA’s online media site. There, I discovered some crucial information: In both of these controversial cases, JAMA had used Video News Releases (VNRs) -- which they call THE JAMA REPORT. (VNRs are known to PR/Advertising folks -- and called “fake news” by many critics.)
But first, before discussing the particular JAMA VNRs in question -- the JAMA REPORTS -- a short explanation of the VNR phenomenon.
What exactly are VNRs? And why are they often referred to as “fake news”?
It is becoming quite commonly known that many companies (including educational institutions and pharmaceutical companies) produce and disseminate VNRs, which are professionally produced, extremely slick video ads (disguised as news) for their clients. These VNRs are created by corporate public relations firms and are disseminated to media outlets. The hope is that the TV stations will play these VNRs, and that the stations’ audiences will think that they are actual (unbiased) news stories, produced by the stations themselves.
Are these VNRs played by the media? Yes, they are. VNRs provide an easy, ready-made way for TV stations to present "news" -- without having to actually produce it.
Do these VNRs “work”? Absolutely. Because most viewers have no idea that they are really watching slick PR-company-produced TV ads, rather than actual news. And, as we all know, ads are more highly suspect to viewers than is news.
What is not routinely known is that professional organizations, such as the AMA, hire firms to produce “fake news” for them. But they do. (So do medical research institutions such as Duke and Emory); and other professional health associations, such as the American Heart Association.)
Is there anything wrong with VNRs? Not if a station’s viewers are told that they are watching industry-funded advertisements, rather than unbiased, station-produced news reports.
Do the media that play these VNRs tell the public that they are industry-produced? Hardly ever.
VNRs have come under a great deal of attack in recent months. PRWatch.com, an online publication of the Center for Media and Democracy, recently published an article about VNRs, entitled Video News Releases: The Ball's in the FCC's Court. This excellent article points out that “current regulations mandate that viewers be told the source of a VNR only when stations are paid to air it, or when the VNR deals with a political matter or controversial issue.”
So, if stations are just GIVEN a VNR to air, they don’t have to attribute the source -– because they didn’t pay actual money for the VNR. This way, everyone is happy: The station has a piece of “news” that it doesn't have to produce. And the folks who produced the “news”/ad get free air time.
Who cares that the public is often fooled?
Digging deeper, I found an inside publication, produced by On the Scene Productions (OTSP), the PR company which produces the JAMA REPORT for the AMA. Called “Prescription for News”), it contains several fascinating bits of information.
First, a concise definition of what a VNR is:
“A VNR is a fully edited and narrated news package that fits easily into local and national TV news broadcasts.”
Then, a few company boasts:
“On The Scene Productions (OTSP) is the nation’s leading producer and distributor of health and medical news to consumers, patients and physicians.”
And another boast:
“Each week, we provide the television news media with the top medical stories for that week. As a result, On The Scene Productions has built a national reputation as a leading source of health and medical news.”
Among their “top health projects,” “Prescription for Health” boasts that one JAMA REPORT the company produced on Meat and Colon Cancer claimed 1045 “hits” and an “audience numbers” of 54,000,003.
Quite a few people got their “medical news” via JAMA VNR that week!
VNRs really do provide TV stations with more so-called “medical news” than we imagine. Another producer of VNRs, DS Simon Productions, Inc. issued a report of their own survey, in which they stated: “Eighty-eight percent of stations polled responded that they use healthcare VNRs. . . "
“Of the types of stories that stations are most likely to cover, an overwhelming majority responded that medical breakthroughs such as FDA approvals, Clinical Trials and Studies in Medical Journals are the most newsworthy. Seventy-two percent of stations responded that those types of stories are very newsworthy.”
Now, to the two JAMA VNRs (JAMA REPORTS) that were disseminated to the media prior to the publication of the two issues containing the now-controversial studies.
THE VNR PROMOTING THE STUDY EXPOSED BY THE WALL STREET JOURNAL
(For more information about both JAMA studies, please see Part 1 of this article.)
At http://pubs.ama-assn.org/media/2006j/0131.dtl#vnrscript, you will find the exact information -- word for word -- that was shared with the media, days before this controversial study’s February release in JAMA: (a) the press release, and (b) a written copy of the VNR, both of which were disseminated to the media in anticipation of the release of the results of this controversial study.
Directly above the VNR copy are two links to an actual JAMA video, called JAMA REPORTS (viewable in both Quicktime and Windows Media). By clicking on either of these links you will be able to watch and hear a professionally produced “news” video of a real patient, Lisa Kirshenbaum, and a real physician, Lee Cohen, MD -- the Harvard-based principal investigator of the story, who was revealed by the Wall Street Journal to have financial ties to several pharmaceutical companies.
Given the fact that JAMA -- and by extension JAMA’s VNRs -- have such an excellent reputation with the media, it is probable that this professionally produced video was aired as news on many, many stations around the country.
THE VNR PROMOTING THE STUDY EXPOSED BY THE ASSOCIATED PRESS
Now, by going again to the JAMA media site http://pubs.ama-assn.org/media/2006j/0718.dtl#vnrscript, you will see that, once again (just one week after the media flap surrounding the first study), JAMA was carefully poised to heavily publicize the other now-controversial study, which was exposed by the Associated Press as having physician/authors with previously-unclaimed pharmaceutical ties. At JAMA's media site, you will again find press releases, VNRs (which you can play) and a carefully-crafted script of the actual VNR. And as with the other study, you will see this study's physician/author, Harvard’s Tobias Kurth, MD being interviewed prominently in this video.
So, this is how JAMA put special publicity efforts behind these two, now-controversial studies/articles. According to their website, JAMA’s use of VNRs goes back to May, 2005. But we can’t tell for sure exactly how long they have been using VNRs. And it should be noted that JAMA publicizes a very small percentage of their articles/studies this way. In other words, JAMA carefully chooses which studies and articles it will heavily promote to the media. Therefore, it is almost certainly significant that it chose to promote these two. Although I cannot say for sure, my guess is that they suspected that, because of the controversial nature of the subject matter, the media would air them.
What can we learn from all this? A few things: First, at least until now, JAMA has had an extremely excellent reputation with the press and the public. If JAMA continues to produce and disseminate VNRs to the media, I strongly believe its staff must check the financial ties of their authors prior to publication –- especially in cases where they will be heavily promoting the results of a study to the public through the media.
I personally feel very strongly that JAMA has an obligation to check the ties of all their study/article authors. Unfortunately, this might be an impossible job. According to Julie Hatterer, MD, who wrote a letter to the editor on July 21st to the Wall Street Journal:
"While I agree that it was ethically wrong not to disclose these links, any health-care professional who has attended a conference on pharmacotherapy research knows full well that most, if not all, researchers these days have affiliations."
How sad. But unfortunately, there is evidence to say that Dr. Hatterer is right. If she is right, it is a shame. But, whether she is or not, doctors, the media and the public have a right to know the financial ties of the authors of the studies on which they are basing their healthcare directions and decisions.
In Part 3 of this article, I more fully explore the relationship between medical journal study authors and pharmaceutical companies.