Tuesday, 21 April 2009

Define PharmaScold

What's a PharmaScold??
The term pharmascold refers to prominent critics who “routinely vilify the medical products industry and portray academics working with it as traitors and sellouts” [1]. The verb form “to pharmascold’’’ means to engage in pharmascold activity. When it occurs in the mainstream press, pharmascolding is considered a form of tabloid journalism[2].
Pharmascolding differs from neutral criticisms of medical-industry/academic relationships in several ways. Pharmascolding is often self righteous in its condemnation of alleged corruption and inaccurate in its presentation of facts[3]. The pharmascold sensationalizes the issue of industry-academic relationships by focusing on topics that are likely to evoke emotions in readers. For example, child psychiatry is a frequent target of pharmascolding because doctors can be portrayed as harming defenseless children[4][5][6][7][8]. The pharmascold often will choose one or more individuals as [scapegoats] who they accuse of corruption and collusion with the medical industry[9].
Pharmascolding journalists typically uses methods akin to those used in yellow journalism and the tabloid press . Their use of undocumented accusations has been described as McCarthyism, especially when the accusations have been made by elected officials[10]. By using the selective citation of unverified “facts,” pharmascolds create a cloud of innuendo over their [scapegoats]. The reasons for pharmascolding have not been well studied. Pharmascolds may benefit personally, as in the case of a journalist who uses pharmascolding to attract readers because sensational articles can increase readership. Politicians use pharmascolding to satisfy a special interest group, shore up populist support, or distract the public from other issues.
The pharmascolding journalist publishes articles that criticize medical companies or their products. They highlight deficiencies of these products while ignoring their benefits. The pharmascold article does not have a neutral point of view and the “facts” cited are either invented or from a single source that has not been checked for accuracy. Pharmascolding is not limited to the tabloid press. A well documented example of pharmascold activity is in the New York Times. As an example, in 2005, one article reported that a drug commonly used to treat attention deficit hyperactivity disorder in children, might increase the risk for cancer later in life [11]. His report was based on a single, small study [12], which had been criticized [13]. When subsequent studies refuted the initial report[14][15][16], this was not reported by the [New York Times]. This type of selective reporting is characteristic of pharmascold activity. Another pharmascold feature of the article is the use of innuendo. It reports that Dr. Greenhill was skeptical about the study suggesting Ritalin causes cancer and then states he had been a consultant to the pharmaceutical industry. Althought this latter comment is true, its placement, through innuendo implies that Dr. Greenhill’s position might be influenced by pharmaceutical funding. In contrast, there is no discussion of the potential conflicts of interest of those who disagreed with Dr. Greenhill.
Additional pharmascold activity has been documented in criticisms of the drug Avandia [17], criticisms of Dr. Fredrick Goodwin’s relationships with pharmaceutical companies [18], criticism of RU-486 [19] and what Dr. Robert Goldberg refers to as “the McCarthyite Mugging of Joe Biederman” by the New York Times[20]. Dr. Goldberg describes the Times’ article as a form of McCarthyism because it repeats accusations against a U.S. citizen made by a United States Senator, without verifying the validity of the accusations using another source. In fact, Dr. Biederman had rebutted the criticisms of his work in a letter to the [New York Times] that the Times did not publish[21].
Each of these example shares core features of pharmascolding: they use innuendo and selective reporting and do not verify accusations. The New York Times’ articles about Joseph Biederman and Frederick Goodwin are notable for the pairing of an article on the topic with an Editorial implying that these doctors were shills for pharmaceutical companies [22]. This is accomplished by rehashing the accusations made in the news article under with an Editorial entitled “Expert or Shill?”.
Although pharmascold activity is rare in academic journals, it does occur. One example comes from Nature Neuroscience, which published an editorial which claimed there was a “credibility crisis” in child psychiatry because Dr. Joseph Biederman had been accused of not declaring over a million dollars in income he had received from pharmaceutical companies [23]. This article is instructive because it uses mere accusation to declare a “crisis” situation rather than seeking to determine if the accused is indeed guilty. Nature Neuroscience subsequently published Dr. Biederman’s response enumerating the errors made in their Editorial [24].
Scapegoats of pharmascolding are at a disadvantage because, by definition, pharmascolds are prominent placed critics who have access to media outlets denied to the scapegoat. The Biederman affair is instructive. The New York Times has pharmascolded Dr. Biederman on their front page and on their editorial page. His only option to respond would be a Letter to the Editor, which the Times requires to be 150 words or less [25]Nature Neuroscience’s pharmascolding editorial about Dr. Biederman [26] was prominently displayed but Dr. Biederman’s response [27] was published as a short letter in the back pages the publication. Pharmascolding can also be countered in the blogosphere but such responses may not be viewed as having the same credibility as prominent newspapers and academic journals.

Professional organizations can reduce pharmascold activity in the ethical codes they transmit to professionals and students. For example, the Code of Ethics of the 
Society of Professional Journalists(SPJ), warns against the use of innuendo when stating that journalists should "make certain that headlines, news teases and promotional material, photos, video, audio, graphics, sound bites and quotations do not misrepresent. They should not oversimplify or highlight incidents out of context." [28]. The SPJ Code of Ethics clearly prohibits scapegoating by stating that journalists should: “Show compassion for those who may be affected adversely by news coverage.” It also cautions journalists to “Test the accuracy of information from all sources and exercise care to avoid inadvertent error.” [29].
Because pharmascolding seeks to limit contacts between academic medicine and the medical industry is said to stifle innovation in the development of new therapeutics[30]. In this view, society benefits most from the free exchange of scientific and medical information. When medical experts are discouraged from working with industry, the best ideas may not always reach the public. Because innovation frequently improves care and reduces cost, it is also relevant tohealth care reform in the United States. Critics of this point of view argue that pharmascolding prevents conflict of interest situations in which doctors are paid by the medical industry for their ideas. The debate centers on the effects of these payments. Do they encourage innovation by attracting newer and better ideas into the medical industry? Or, do they unduly influence doctors to make wrong decisions? That is the crux of the debate.

^ http://online.wsj.com/article/SB123914780537299005.html
^ Sanders, K. Ethics and Journalism. SAGE Press, 2003 ^ http://online.wsj.com/article/SB123914780537299005.html
^ http://online.wsj.com/article/SB123914780537299005.html
^ http://www.nytimes.com/2005/07/01/health/01ritalin.html?_r=1&scp=4&sq=harris%20ritalin&st=cse
^ http://www.healthcentral.com/bipolar/c/15/50902/frederick-goodwin-ny
^ http://www.cjr.org/politics/partisan_infection_strikes_med.php
^ http://www.drugwonks.com/account_blog/row?_method=get&eid=789c52d2dc72851406c281b9eeab8ffc&id=6150
^ Greenberg, S. ‘’Tabloid Journalism’’. Greenwood Press, 1966 ^ Hargreaves, I. ‘’Journalism: Truth or Dare?’’ ^ http://www.nytimes.com/2005/07/01/health/01ritalin.html?_r=1&scp=4&sq=harris%20ritalin&st=cse
^ El-Zein, R. A., Hay, M. J., Lopez, M. S., Bondy, M. L., Morris, D. L., Legator, M. S. & Abdel-Rahman, S. Z. (2006). Response to comments on 'Cytogenetic effects in children treated with methylphenidate' by El-Zein et al. Cancer Lett 231, 146-8. ^ Preston, R. J., Kollins, S. H., Swanson, J. M., Greenhill, L. L., Wigal, T., Elliott, G. R. & Vitiello, B. (2005). Comments on 'Cytogenetic effects in children treated with methylphenidate' by El-Zein et al. Cancer Lett 230, 292-4. ^ Witt, K. L., Shelby, M. D., Itchon-Ramos, N., Faircloth, M., Kissling, G. E., Chrisman, A. K., Ravi, H., Murli, H., Mattison, D. R. & Kollins, S. H. (2008). Methylphenidate and amphetamine do not induce cytogenetic damage in lymphocytes of children with ADHD. J Am Acad Child Adolesc Psychiatry 47, 1375-83. ^ Walitza, S., Werner, B., Romanos, M., Warnke, A., Gerlach, M. & Stopper, H. (2007). Does methylphenidate cause a cytogenetic effect in children with attention deficit hyperactivity disorder? Environ Health Perspect 115, 936-40. ^ Holtmann, M., Kaina, B. & Poustka, F. (2006). [Methylphenidate-induced cytogenetic alterations?]. Z Kinder Jugendpsychiatr Psychother 34, 215-20. ^ http://www.stats.org/stories/2007/nyt_mislead_avandia_sept12_07.htm
^ http://www.healthcentral.com/bipolar/c/15/50902/frederick-goodwin-ny
^ http://www.cjr.org/politics/partisan_infection_strikes_med.php
^ http://www.drugwonks.com/account_blog/row?_method=get&eid=789c52d2dc72851406c281b9eeab8ffc&id=6150
^ http://www.nytimes.com/2008/11/30/opinion/30sun2.html
^ Editoral (2008). Credibility crisis in pediatric psychiatry. Nat Neurosci 11, 983. ^ Biederman, J. (2008). Credibility crisis in pediatric psychiatry. Nat Neurosci 11, 1233. ^ http://www.nytimes.com/ref/membercenter/help/lettertoeditor.html
^ Editoral (2008). Credibility crisis in pediatric psychiatry. Nat Neurosci 11, 983. ^ Biederman, J. (2008). Credibility crisis in pediatric psychiatry. Nat Neurosci 11, 1233. ^ [1]
^ [2]
^ http://online.wsj.com/article/SB123914780537299005.html 
Insider's view: nice writing - the style is familiar, is it yours Peter Pitts?

Oh, by the way Insider has the "PharmaScold Blog" in his portfolio: 

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