Adam Cresswell, the health editor at The Australian, responds to recent comments at Crikey and Croakey, about the newspaper’s Health of the Nations series that was sponsored by Medicines Australia.
Adam Cresswell writes:
The most remarkable aspect of the criticisms of The Australian’s recent Health of the Nation series is that few of the individuals making the comments seem to have read a word of it.
Charles Ornstein, president of the US-based Association of Healthcare Journalists, does at least concede this. For most of the others, including Amanda Wilson, Wendy Lipworth and Gary Schwitzer, the omission is implicit in the points they make.
Does this matter? To borrow a phrase from Gary Schwitzer, you bet it does – for it allows a blurring of two quite separate issues.
On the one hand, there are the overall principles, and whether media organisations can insulate their coverage from the conflicts of interest such arrangements risk creating.
Secondly, there is the more specific question of whether the HOTN series did in fact pander to the commercial or other interests of the drug industry.
These questions appear to have been treated as one and the same. What results is a melange of speculative and unfounded commentary that wrongly implies The Australian and its journalists were either told what to write by Medicines Australia, or recognised on which side their bread was buttered and toed a corporate line without explicit instruction. These implications are completely false.
First, the basics. You would think that any fair discussion about whether a newspaper series had been compromised by sponsors would begin with an outline of what had been printed as part of the series. Strangely, Croakey did not attempt this.
For the record: 12 pages of coverage were published in the Inquirer section of The Weekend Australian for the HOTN series (selected elements of which were later reprinted in the HOTN magazine on 22 October.)
Of these, just one page (published on 27 August) addressed medicines policy. It contained an even-handed account of the affordability challenges created by expensive new drugs that, for all the hope they offered patients, often translated into very slender improvements in patient outcomes. This article was accompanied by a comment from an independent expert, chosen by myself, who argued taxpayers should be paying much less than current practice for a range of generic drugs on the PBS – a policy that is anathema to Medicines Australia, the series sponsor.
And as far as drugs and the Pharmaceutical Benefits Scheme are concerned, that was pretty much it.
The other elements of the series addressed various systemic strains: the rise of chronic disease and the altered balance of hospital and community care required to cope with this; areas such as mental and dental care that are currently not well provided for; the pressures linked to population ageing, and the difficulties with introducing electronic health records.
It’s not clear to me how any of that is advancing the interests of Big Pharma, yet Croakey is content to quote its various interviewees, many of whom appear not to have read any of it, to make all sorts of criticisms, even contradictory ones.
For example, it is hard to see how Gary Schwitzer could justify asking whether The Australian would continue to “aggressively report on future drug industry issues” had he been aware of what the paper has published. The matter is not in question, as The Australian has already proved it scrutinises the drug industry at least as much, if not more than any other paper. On 30 July, when the HOTN series was already under way (and long before the recent spate of stories on this topic), the paper ran a story that Pfizer, the world’s largest drug giant, was paying pharmacists $7 a time “to enrol patients in support programs in an effort to ensure they keep taking the pills the drug company makes” – potentially earning pharmacists $8000 a year.
This pursuit has continued. On Monday October 10, two days after the series ended, The Australian reported the drug industry had been “paying specialists up to $1500 to sell the benefits of new products to their peers… raising questions about the independence of the medical profession”; while on Thursday 20 October, we ran a story that drug giant GlaxoSmithKline was “leading a push to have drug companies name the doctors they pay to promote drugs”.
Several other claims need to be addressed. Schwitzer also asks this: “Since when do journalists partner with/collaborate with/have commercial agreements with … the drug industry they must cover?” The answer is simple: the journalists don’t. We never have, and we never will – the partnership, as with any advertising deal, was with the advertising department, and the journalists remained free to report as they saw fit. This is no cute hair-splitting, but a crucial distinction on which all newspaper newsrooms rely.
Similarly, Amanda Wilson asks if the series is “just another way to get around the legislation on direct to consumer advertising”. It’s not clear what product she thinks was being advertised, because there wasn’t one.
Finally, another interviewee, Christopher Jordens, wrongly refers to the HOTN series being described as “a consumer initiative” (in fact, the term consumer initiative was applied to the name The Australian Medicines Industry, which is a new moniker adopted by Medicines Australia) and then accuses me of trotting out “the same old story that Australia’s public health system is in ‘crisis’”.
Jordens adds that I’m “willing to tell that story even though the results of the Newspoll survey tell a different story if you view the figures differently”.
Well, lies, damned lies and all that. I can’t actually find a reference in anything I wrote for the series about the health system being “in crisis” – perhaps a headline did, or perhaps Jordens glanced a bit too rapidly at a reference (in the story published on 27 August) to the federal government having itself “fuelled a perception that a crisis is at hand” with regards to PBS sustainability.
Regardless of whether the word “crisis” was indeed used, or the meaning of that conveyed, it’s a stretch to suggest that by making the uncontroversial remark that the health system is under strain, The Australian was furthering a sponsor’s commercial agenda.
To concede the point requires us to accept that not only is The Australian in the drug industry’s pocket, so is anyone else who has described the system as being at crisis point – which would include all 10 members of the former National Health and Hospitals Reform Commission, and Federal Health Minister Nicola Roxon, to name just a few – a conspiracy that ought to be too daft even for Croakey.
Just like Croakey, which it should be noted is partly funded by the Public Health Association of Australia and other interest groups, newspaper pages are indeed for sale – that’s why it’s possible to buy advertising space on them.
But the news content is never for sale, and that remains true even when – especially when – the advertising is the result of a sponsorship deals such as this.
Welcome to my world Adam. That of the clinician researcher. Where one is assumed guilty until proven innocent and where any relationship whatsoever with a commercial entity is interpreted as tantamount to malpractice.
Likewise, clinical research needs to be organised and funded (especially in an environment where governments have abrogated this responsibility almost entirely) but that doesn’t mean clinical researchers have been bought.
The title of your article in the 24-page magazine is “Breaking Point”. Doesn’t this convey the meaning of a crisis? Also, it’s a bit glib to cite the figures from the Newspoll survey in your article and then dismiss them here as “damned lies”. Finally, I never argued that “anyone who describes the health system as being at crisis point is in the drug industry’s pocket”.
The aim of the HOTN series was to “stimulate consideration, discussion and debate about health issues in Australia”. This actually seems to be happening. Journalism is an important “health issue” because it is one of the main ways that the public gets “health information”.
A key point of contention seems to be that you (and some others contributing to this forum) seem to be arguing that the HOTN series is just “business as usual”, where advertisers pay for ads and journalists independently determine the news content and everything is fine so long as industry funding is disclosed.
Others in this forum see the arrangement as a new development – a new way of underwriting health journalism in which the advertisers fund the features in which their ads appear. You dismiss qualms about this as “speculative and unfounded”. But aren’t you concerned if the very arrangement raises doubts and suspicions?
As for my misattribution of ‘consumer health initiative’, you’re right. We’re supposed to believe that the Australian Medicines Industry is a “consumer initiative”. It’s still insidious spin.
Adam, you make a fair point about the commentators’ knowledge of the content of the articles.
As one of the commentators, I would, however, like to point out that I went to great pains *not* to conflate the issue of the content of the articles with that of industry-journalist relationships in general.
“From my perspective, this gets right to the heart of the issues of industry-media
relationships and the effects of even indirect financial ties on the content and tone of reporting.I would, therefore, be worried not so much about the content of reports in this particular series (which I am sure will be very carefully balanced if they discuss industry issues), but rather about the effect of the industry support for this series on subsequent reporting of industry-related issues.”
Similarly, my point about advertising appearing on the same page would apply irrespective of the specific content of the articles.
Wendy
I’m with Adam Cresswell on this one. His journalistic integrity as far as I’m concerned is beyond reproach and for people to even think about commenting without reading the journalistic content is, quite frankly, reprehensible. The sad reality is, advertising in newspapers pays journalists’ wages. As long as it doesn’t dictate news content, I don’t see it as a major problem. Would you all prefer that newspapers don’t have dedicated, experienced health reporters and medical stories were instead written by junior reporters with no experience in handling the constant barrage of calls from PR companies hired by big pharma companies? Without maintaining advertising revenue, that’s where, I fear, newspapers are heading. I respect Croakey for raising the issue. It IS worthy of debate. I just think it’s unrealistic to expect The Australian to knock back sponsorship dollars merely because it comes from Medicines Australia. Anyone working in the mainstream media at the moment knows the tight budgetary restraints we face. In my opinion, to have knocked back the Medicines Australia sponsorship, when there was clearly no attempt to dictate editorial content, would have been a mistake. Discussions like this, keep us on our toes. That’s great. I just think in this case, concerns are hugely misguided.
I think it’s important to clearly disinguish between a Drug Company having a role in content eg. Drug Company-sponsored lectures about a product made by them, under the guise of education, which I do object to, and financial sponsorship without any involvement in content in an independent mainstream or medical media discussing a range of health and medical isues in a forum context, which I would have no objection to.
Indeed, there’s a an exquisite twist of logic in the form of a question that I would raise here for the “purist, holier than thou” brigade. Why is it OK for any “opinion leader”, say a health analyst, leader of a recognised Health-related Group or a health professional to accept an Advisory Role, as they quite properly do, for an Advisory Committee, usually with some financial reimbursement, set up by Government, and yet no one would, nor indeed should, even think to question their impartiality when they offer objective criticism of some anti-Government health proposal concerning issues related to that advisory role?
Yet, if someone with specialised health expertise, be it journalism or health professional, uses financial resources resources from the Industry to fund a project in which they control the content, we immediately conjure up the “slippery slope” concern.
What’s the difference?
Adam Cresswell asked me to post this comment on his behalf:
“Thanks Chris. I did contact you trying to find out what you were referring to in saying I had portrayed the system as being “in crisis”, so I appreciate you taking the time to clarify that.
There are two points to make on that particular issue. The first is that the story you refer to appeared in two separate versions, and the “Breaking Point” headline appeared in the second of those, published on October 22 in the HOTN magazine. The HOTN series proper was published in The Weekend Australian over several months, between July 30 and October 15, and the magazine was a attempt to summarise some of its elements in cut-down form. So this particular story had been published in its original, full version in the Inquirer section of The Weekend Australian some weeks earlier (in this case, August 20-21). In this, if you like “proper”, newspaper version, the headline was “Your test results” – which I trust you will agree does not support your suggestion that I was determined to wilfully exaggerate the situation.
The second point is that the journalists who write the articles are almost never the same journalists who write the headlines. I was aware of, and had some insight into the production processes involved for the Inquirer pages, including the headlines, but the magazine was put together by a different team (ie not the news team close to where I work) and so I was not aware of the headlines until they appeared (it would have been unusual if I had been).
I realise the distinction between writers and sub-editors seems slight, even irrelevant to outsiders, and obviously as employees we all share a collective responsibility to get things right and to provide accountability when mistakes are made. But while I don’t think the “Breaking Point” headline was ideal by any means, I don’t think either that it was enough to damn the entire article, let alone the entire series. And I don’t think it’s fair to use these two words, which were written by somebody else and appeared only on a secondary version of the story (which would, therefore, already have been seen or read by most of the paper’s subscribers) to blame me personally, as you do, for what you take to be the underlying thrust of the entire piece – while ignoring the approximately 1500 words that followed, which were written by me. I don’t believe those 1500 words comprising the story itself painted a picture of a system “in crisis” as you suggest; I think it was quite moderate, and balanced, and addressed an important issue – that of cost and access. I invite interested readers to read the piece and decide for themselves. It can be found here: http://www.theaustralian.com.au/national-affairs/results-of-the-nations-health-check-are-back/story-fn59niix-1226117941727
Next, I didn’t “dismiss” the Newspoll figures as “damned lies”. You had challenged my interpretation of the figures, suggesting your own interpretation – that there is no crisis (again, I hadn’t said there was) — was the correct one. I then cited this well-known “damned lies” quote to acknowledge that statistics like this can indeed be framed in a number of different ways – and that each interpretation has its own claim to validity. You are perfectly entitled to contest my interpretation, but it’s not merely mine – the view expressed in the piece, that out-of-pocket costs (and waiting times) are posing a growing problem particularly for the less well-off, is shared by organisations such as the Menzies Centre for Health Policy, and has in the past also been championed by Croak