The conflict of interest Tilt-A-Whirl continues at breakneck speed. Yet it's even more than a conflict of interest. After reading a few great posts by fellow bloggers recently, I've become somewhat discouraged at how dissenting voices are rarely heard amidst a buzz of industry-funded cheerleading.
What am I talking about?
Drug Wonks: The blog Drug Wonks frequently defends drug companies and their practices, while heaping derision upon those who challenge the drug industry. I'm not saying that Dr. Steve Nissen, of recent Avandia meta-analysis fame, is perfect, but MAN, the scorn they are heaping upon him is over the top. Here are a couple comments about Nissen made on their site:
- "Dr. Nissen was alternately defensive, evasive and hesitant" in Congressional hearings.
- "Diedtra Henderson interviews Steve Nissen who responds -- sort of-- to my blog calling him 'small and craven' as he shifts positions and engages in self promotion in a campaign to become defacto FDA commissioner"
- Drug Wonks blogger Robert Goldberg has also stated that Nissen's true interest is in becoming FDA commissioner, and that this current Avandia is essentially a publicity stunt to help him move up the ranks of FDA commissioner contenders.
The President of the Center for Medicine in the Public Interest, where Goldberg works, and which runs the blog called DrugWonks, is Peter J Pitts, whose day job is to be Senior Vice President for Global Health Affairs at the big public relations firm Manning, Selvage and Lee. Manning, Selvage and Lee has many big pharmaceutical accounts.Okay then. So drug companies hire a firm to help them manage their reputations. The president of the PR firm runs a blog on the side that just, by sheer coincidence, happens to cast dispersions on those who criticize the drug industry.
There is still more to the story. Robert Goldberg, who blogs regularly at Drug Wonks, was a fellow at the Manhattan Institute, and he is now Vice President of the Center for Medicine in the Public Interest. What is the Manhattan Institute? It is a thinktank that advocates for free-market reforms. It would be fair to say that the Manhattan Institute favors a more limited role for the FDA. So who funds this Manhattan Institute? They're not telling. But it would appear that they receive the lion's share of their funding from a variety of corporations and foundations that advocate for laissez-faire capitalism.
So it's like this... The Manhattan Institute advocates for the "free market" to save health care. But behind the scenes, the Manhattan Institute exists only because a variety of interests, from highly rich individuals to large drug companies, need to push their message. The Institute is created to give an outlet for their message. I don't know who funds the Center for Medicine in the Public Interest. I'm betting it's not the Tooth Fairy.
The Point: Because they have money, corporate interests can buy the time of people like Peter Pitts and Robert Goldberg, who can be counted on to reliably talk in a friendly manner about big corporations. I'm not saying that Goldberg, Pitts, and company advocate for reforms that happen to support the interests of their sponsors just because they are paid to do so. Far from it. My guess is that these folks had their free-marketeering views long before they signed on with any sort of thinktank. They likely honestly believe what they are writing, but it also can't hurt that they are being paid by these corporate interests -- most people won't offend their sponsors, as there can be untoward consequences for doing so (1, 2).
The Golden Rule of Speech: He/She Who Has the Most Gold Has His/Her Message Heard Most Frequently.
People from industry friendly thinktanks are frequently featured on TV newscasts, in newspaper stories, on on op-ed pieces. They are cited as "experts" -- why are they considered experts? Well, gee, the person came from an "Institute" -- he/she MUST be well-informed!
Those of us in the healthcare media world who are more skeptical of the behavior of drug companies are typically not nearly as well-funded. In fact, if you look around the healthcare blogosphere, you'll find that most of us ain't getting a nickel for our work (Rost, Dawdy, Jack Friday, myself, Roy Poses, Aubrey Blumsohn, and many more). Yes, Rost wrote a book, but nobody was paying him to say anything. Anyway, does our working for peanuts make us masochists? Maybe, but that's a topic for another day. It's great that Rost was featured in Fortune (as was PharmaGossip), but such publicity is rare. While the industry-funded folks are regularly featured in higher-profile media (1, 2, 3), the rest of us are left writing for a smaller (but growing) audience. Sure, folks at Public Citizen get press regularly, but as a general rule, the frequently-cited "experts" are those with some connection to industry or industry-related public relations. Is this going to change?
Additional Reading: If you really want your socks to be knocked off regarding the huge role of public relations firms in American society, you really should read Toxic Sludge is Good for You.
I'll be taking a "safe, gentle psychotropic" while I ponder how our small blogger voices can somehow reach maximum amplification.