Bioethics Forum Essay

Deceptive Market Practices in the Marketplace of Ideas

Over the last four decades, conservative think tanks such as the Heritage Foundation, American Enterprise Institute, Cato Institute, Competitive Enterprise Institute, Hoover Institute, and Manhattan Institute have dominated the public policy debate on taxation, affirmative action, the military, and welfare reform. More recently, they have also dominated the debate over health care. Part of their strategy has been developing propaganda skillfully molded to mimic objective scholarly analyses and employing public relations techniques to mask their proprietary interests in the topic.

For example, the Center for Medicine in the Public Interest, a recently created front group for pharmaceutical interests, has been churning out industry-funded propaganda that demonizes evidence-based medicine, universal health care, the government, and all critics of pharma while attempting to portray industry as a selfless provider of cures and education.

CMPI’s pseudoscientific analyses, none of which would survive journal peer review, are usually released as reports. The most recent, Ignored Benefits of Drugs: Medicare Decision on Anemia Drugs Suggests That the Government Is Willing to Put Cost before Patient Care, protests Medicare’s decision to cease coverage of high doses of erythropoietin-stimulating agents, which have been shown to shorten cancer patients lives through both heart attacks and increased risk of cancer metastases.

Astoundingly, some of CMPI’s work has appeared in the mainstream press. In 2007, Peter J. Pitts, CMPI’s president, published a New York Times op-ed that accused the government of “an inherent conflict of interest” for a proposal testing new drugs against tried-and-true drugs. (New, expensive drugs often fail when tested by independent sources in head-to-head comparisons with classic drugs.)

CMPI’s most vicious attacks on critics occur in its poison-pen blog, run by CMPI’s vice-president Dr. Robert Goldberg. Pitts and Goldberg pen most of the vitriol. A recent Goldberg blog reproduces a story in a Wall Street Journal blog about a Congressional hearing regarding possible suppression of PTSD diagnoses at the Veteran’s Administration, but sandwiches the story with slams at both evidence-based medicine and Shannon Brownlee, author of the wonderful book Overtreated. The slam begins with, “In her book Overtreated, Shannon (There is no such thing as mental illness) Brownlee holds up the VA Health System as the gold standard for how to provide high quality care using the fewer [sic] resources possible though the adoption of evidence based medicine,” and the concludes with, “Shannoncare. Don’t diagnose, don’t treat. Don’t ask. Don’t tell. When challenged, attack funding sources.” Deliberately misrepresenting the work of critics and conflating unrelated issues to blame critics for All Bad Things is a classic tactic.

A letter by Pitts in the Washington Post (“Let the Doctors Decide,” Dec. 15, 2007) attacked a proposed education fund in D.C.’s Safe Rx Act, which would have provided prescribers reliable drug information to counter the biased information provided by pharmaceutical salespeople. Pitts invoked “budget analysts” and “bureaucrats” who will “insert themselves into the doctor’s office” to override physician’s decisions about drugs. Exaggeration and distortion is a common tactic; another is masking ones’ affiliations through partial disclosure. Pitts disclosed that his “organization receives funding from the pharmaceutical industry.” He did not mention, however, that he is also a senior vice president of Global Affairs at Manning, Selvage and Lee (MS&L), a leading PR firm for the pharmaceutical industry.

In op-eds, letters to the editor, and radio and TV appearances (including the “Infinite Mind” and the “PBS Newshour”), Pitts identifies himself either as a “former FDA Associate Commissioner” (for External Relations) or as the head of CMPI. Although he usually discloses the fact that CMPI receives money from the pharmaceutical industry, he never divulges his day job at MS&L.

When writing for industry publications, however, Pitts doffs the CMPI disguise. For example, in Pharmaceutical Executive, Pitts writes of critics of industry-written publications: “Their canard that ghostwritten articles denigrate the nature of the material is such a transparent and disingenuous attempt to discredit the pharmaceutical industry that it is – or should be – embarrassing.” The affiliation listed in that article? “Peter Pitts is senior vice president at Manning, Selvage & Lee.”

This lack of transparency is standard practice for CMPI. When Goldberg reviewed Melody Petersen’s book Our Daily Meds, on the New York Post’s website, he accused her of understating the benefits of drugs but neglected to mention his CMPI affiliation. Petersen responded in the Post: “Goldberg’s criticisms can be explained by the fact that he is not the disinterested commentator he appeared to be.” After noting his CMPI connections, Peterson wrote, “Goldberg’s review is an example of the pharmaceutical industry’s promotional practices that led me to write ‘Our Daily Meds’ in the first place.”

At HealthSpeak, Pitts’s blog at Manning, Selvage & Lee, the “Blogger’s Code of Ethics” states: “We will tell the truth. We will acknowledge and correct any mistakes promptly.” Truth, however, is an infinitely modifiable commodity in the PR industry.

According to CMPI’s 2006 IRS 990 filing, Pitts worked 40 hours a week at CMPI and was paid $156,251. Was the spinmeister working two full-time jobs, or is his entire assignment at MSL to head a pharma front group? CMPI seems to have only two full-time employees, Pitts and Goldberg, who was paid $200,000 in 2006. According to CMPI’s 2006 tax exemption filing, Michael Tew, CMPI’s treasurer, and Alexandra Preate, assistant treasurer “are principals of Capital HQ,” which “provides contract services for Center for Medicine in the Public Interest.” Capital HQ, however, is a business, led by Preate, that offers integrated PR, research, and management services (“Capital Events; “Capital Research”; “Political Capital”; “Capital Research”), with a decided tilt toward conservative organizations. Its managing director, Nicholas T. Terzulli, has worked at the Manhattan Institute and interned at GOPAC, a GOP political action committee once led by Newt Gingrich.

CMPI is well financed. When asked by journalists Brownlee and Jeanne Lenzer in a Slate article (“Stealth Marketers”) where CMPI gets its $1.4 million funding, Pitts stated, “I don’t want to go into that.”

Public relation firms and faux think tanks have played an important role in distorting public discourse for more than half a century. In 1945, Clem Whitaker – a former newspaperman who founded Campaigns, Inc., considered to be the country’s first professional campaign management/PR firm – was hired by the American Medical Association to describe President Truman’s national health care program as “socialized medicine.” Whitaker was hired because he had successfully undermined an earlier version of a health care program in California, introduced by Republican governor Earl Warren in the early 1940s.

Less often, PR has been used to promote social programs. In PR! A Social History of Spin, Stuart Ewen describes the Roosevelt administration’s use of public relations to make the case for its New Deal policies and programs. FDR’s “Fireside Chats” during the Depression, a PR gambit, were especially persuasive. However, the empire struck back. The business community, accused of being “economic royalists,” fearing its agenda and social position in jeopardy, began a massive counter-offensive PR campaign. The lead organization was the National Association of Manufacturers (NAM), the trade association representing large-scale manufacturers. NAM began its campaign, called “the American Way” in 1936. The campaign was coordinated with the U.S. Chamber of Commerce, largely made up of small businesses and professionals. The pharmaceutical industry was involved from the beginning: Lambert Pharmaceuticals (later Warner-Lambert, now a subsidiary of Pfizer) was one of the corporations represented on NAM’s PR Advisory Board.

The director of NAM’s PR department during the campaign was James P. Selvage, a former news reporter, who met Morris Lee, another journalist, at NAM’s anti-New Deal campaign. The two formed a public relations firm called Selvage and Lee in 1938. Selvage and Lee merged with Farley Manning & Associates in 1972 to create Manning, Selvage and Lee, a subsidiary of Publicis Groupe S.A., the largest PR firm in Europe and the third largest in the United States. Pfizer is a major client.

CMPI exemplifies the use of PR by industry to distort public discourse for industry advantage. In the permanent war for the public’s mind, transparency and truth are the first casualties.

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