Sunday, October 28, 2007

The Funding of "the Mysterious Human Heart" and the Mysterious Financial Arrangements of its Medical Advisors

The US Public Broadcasting Service (PBS) television network just aired a three-part series called "The Mysterious Human Heart." One of our intrepid scouts suggested we should look into it, since it seemed to be funded by two companies which had commercial interests in the subject matter.

Indeed, the PBS Ombudsman was already involved in this case. In his column, Michael Getler wrote,

The main sponsors of the series ... [were] Medtronic, a medical technology firm; AstraZeneca, a pharmaceutical company....

Bruce Halford of Stockton, N.J., wrote to say:

'Medtronic’s role as a principal underwriter of ‘The Mysterious Human Heart’ seems to violate PBS’ perception test for program funding. In Episode 2 of the series, viewers are told that the best treatment for certain potentially deadly heart arrhythmias is an implantable pacemaker. Who’s the leading manufacturer of such devices? Medtronic, of course. But viewers are never told about potential problems with those devices.... In addition, viewers of the episode are not informed about possible financial ties between the series’ on-camera experts and Medtronic, or with another major underwriter, AstraZeneca, which markets a full line of drugs for cardiovascular problems. No question, securing funding for this kind of series is a major challenge. But what’s happened to PBS’ pledge to prevent a blatant corporate tie-in from compromising the editorial content of such a high-profile project?'

The next day, Jeffrey Chester, director of the Center for Digital Democracy, and an ever-vigilant observer of PBS funding arrangements, wrote to ask 'how PBS (and presenting station Thirteen/WNET in New York) sought and publicly promoted the involvement of Medtronic and AstraZeneca as underwriters? As you know, both Medtronic and AstraZeneca have major commercial interests involving heart disease related medical issues, through technology and pharmaceuticals respectively.'

Gettler asked William Grant, director of science, natural history and features programs at WNET [the station that produced the show] about all this, and he denied that specific Medtronic and AstraZeneca products were promoted in the series, or that the companies "had any editorial involvement whatsoever."

Gettler got a response from the program's producer, David Grubin, which included the statement that the program "was never meant to be an investigation of the pharmaceutical or medical device industry."

Gettler ended up concluding that "the responses, especially from PBS, did not address the real conflict, criticism, and questions at issue here" including "the seeming inappropriatement of funders for a number of programs and the residue of dobut that leaves in the mind of some viewers even though one may not see or sense any hint of influence."

In looking over the show's web-site, I discovered another issue not addressed yet by the Ombudsman.

The show's content advisers appear to be Peter Libby, MD, Chief of Cardiovascular Medicine at the Brigham and Women's Hospital in Boston, Massachusetts, Mallinckrodt Professor of Medicine at Harvard Medical School, and director of the D.W. Reynolds Cardiovascular Clinical Research Center at Harvard; and Douglas P Zipes MD, Distinguished Professor of Medicine, Pharmacology and Toxicology at Indiana University, and Director of the Cardiology Division and Krannert Institute of Cardiology. What the web-site, and probably the show did not mention is that

  • Libby has received grant support from, consulted for, and served on a speakers' bureau for AstraZeneca (see this link).
  • Zipes has received consulting fees or honoraria worth more than $10,000 from Medtronic (see this link).

Thus the show's content was influenced by people with significant personal financial relationships with AstraZeneca and Medtronic.

Again, as noted above, there is nothing to suggest that the show's content directly promoted particular products. But by increasing awareness and concern about cardiovascular disease, and emphasizing its treatability, the show could still have served a marketing purpose for companies that make drugs and devices used to treat cardiovascular disease.

Furthermore, although the show did apparently disclose its funding from Medtronic and AstraZeneca, it did not disclose the funding received by some of its medical advisors from the same company.

One can only wonder why the people who put the show together happened to pick for its two principle medical advisors people who had financial ties with the two sponsoring companies?

I will conclude with a quote from PBS guidelines for funding (as noted by Gettler):

Steps must also be taken to avoid the public perception that program funders have influenced professional judgments. Should a significant number of reasonable viewers conclude that public television has sold its professionalism and independence to its public funders, whether or not their conclusions are justified, then the entire program service of public television will be suspect and the goal of serving the public will be unachievable....

I would also add that at a minimum, physicians and researchers who are in a position to influence how the media discusses medicine and health care should, at a minimum, fully and completely disclose any financial arrangements they have with organizations with vested interests affected by such media discussions.

ADDENDUM (29 October, 2007) - See additional comments by Ed Silverman on PharmaLot.


Srihari Yamanoor said...

To start with, the program was of very poor quality. It was like an example of a documentary film that would win a failing grade, so it doesn't matter who sponsored it.

I told my friends about this program and eagerly awaited to watch it, only to be very, very disappointed.

Plus, with all those "messages" from people "providing generous support" made it worse than prime time TV.

Never going back to PBS crap again...

Anonymous said...

Not related to this, but please check out Grand Rounds today at Some moving and insightful stories about experiences in hospitals. Thanks.