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Prescription For Bias
Networks Downplay Drug Costs,
Treat Medicine as Entitlement
FULL
REPORT
By Ken Shepherd and Amy Menefee
See Executive Summary
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Introduction
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.
See Sidebar: Anxiety
over Ambien
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.
Methodology:
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.
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