The corporations behind WebMD’s friendly, free advice
After it was nailed for servicing BigPharma, WebMD, the
popular medical and health information/advice site, gave itself an ethical
makeover. Now, like a prostitute dressed by Talbot’s, WebMD is more subtle, if
not less whorish.
The precipitating event for WebMD’s touch-up was the furor
around a 2010 online questionnaire sponsored by Eli Lilly, one of WebMD’s
original partners. No matter how you answered the quiz, it diagnosed depression
and linked you to a river of pills.
Faced with Byzantine health insurance, or none at all,
people are increasingly going online to diagnose their real and imagined ills.
WebMD “reach[es] 95 percent of all adult Americans looking for health
information online each year, [and] 72 percent of physicians recommend
WebMD.com to their patients,” WebMD’s then-CEO Wayne Gattinella wrote to Sen.
Charles Grassley after the Lilly questionnaire sparked the Iowa Republican to
launch an investigation.
Gattinella, a marketing executive at various drug companies
before joining WebMD, was not coy about WebMD’s financial model. “We generate
revenues primarily through the sale of advertising and sponsorship programs to
pharmaceutical, biotechnology, medical device companies, and [health, diet and
fitness-related] consumer products, [as well as] licensing content to insurance
companies and health plans.”
It’s unlikely that WebMD’s new CEO, Cavan Redmond, appointed
on May 31, will end the insalubrious industry hookups. Redmond, who has also
worked at Wyeth and Sandoz, moved to WebMD from a senior executive position at
Pfizer’s marketing arm. That gig, the trade website Medical Marketing and Media
noted, will give him “a keen understanding of what [WebMD’s] advertisers want.”
What consumers want is sound, independent information. But
they, along with experts and doctors, are bombarded with manipulative
advertising and industry-funded drug and device studies that can incorporate
shady or even illegal tactics to obscure bad science and conflicts of interest.
Industry-funded, ad-reliant medical websites such as WebMD
reflect the same market pressures and biases. Some WebMD ads are annoying but
obvious. Others, barely set off by the word “advertisement” in minuscule pale
gray type, blend into edited news and features. More insidious is content
wholly generated by advertisers, which, despite being labeled “sponsored,” is
often set in the same font, colors and style as WebMD’s “independent”
information.
WebMD’s section “Close the Gap” offers one small example of
how the new “subtle” works. It examines the special burden of heart disease on
blacks, Latinos and other minorities. Although part of the WebMD site, the
section is actually created and sponsored by Boston Scientific, which sells
almost $8 billion annually in medical devices, especially those related to cardiac
surgery. You need to click on a link to reveal the disclaimer that content “is
not reviewed by the WebMD Editorial department for accuracy, objectivity or
balance.”
Visitors to “Close the Gap” who are concerned about heart
disease can also click to find a list of a few dozen featured doctors. These
physicians, the site notes, “are not paid any fees for inclusion to either
WebMD or Boston Scientific.” But that policy does not exclude other rewards:
Seven of the highlighted doctors are members of Boston Scientific’s 17-person
steering committee. (One, Cam Patterson, racked up more than $78,000 in
speaking and other fees from Pfizer in a little more than a year, according to
ProPublica’s Dollars for Doctors database.) WebMD “news” videos have also featured
six Boston Science steering committee members as experts on a variety of
topics.
Is it a coincidence that WebMD’s chosen experts are
affiliated with a major advertiser, Boston Scientific—which in turn just
happens to list members of its steering committee as go-to docs?
With its history of scandals and sleazy deals, Boston
Scientific has not earned the benefit of the doubt. In 2010, the U.S.
government fined Boston Scientific (which acquired Guidant in 2006) $22 million
for paying doctors to implant Guidant-manufactured devices, including
defibrillators and pacemakers, into heart patients. While the doctors incurred
no punishment for accepting these apparent bribes, Army cardiologist Maj. Jason
Davis faced a stricter ethical environment. He was found guilty of accepting
cash payments, extravagant meals and other gifts to use Boston Scientific
devices on, among others, wounded veterans.
Davis violated a “bright line rule,” said U.S. Attorney
Jenny A. Durkan. “Military doctors must owe their allegiance to the soldiers
and families they treat—not to drug companies or makers of medical devices.” As
part of the judgment, Boston Scientific is required to post all payments
to healthcare professionals. In 2011, the typical payout was $500 or less, but
some topped $10,000. The list that year had more than 48,000 names.
Other major WebMD advertising sources include the nutrition
and diet industry, along with processed-food manufacturers. Numerous WebMD news
videos and stories tacitly endorse fast food by posing misleading questions
such as “Fast-Food French Fries: Which Are Healthiest?” In “Fast Food
Survival,” the only quoted expert, “Jodie Worrell, RD, Chick-fil-A dietitian,”
praises the healthiness of her company’s chicken sandwich.
On WebMD’s U.K. site (called BootsWebMD after the pharmacy
chain that cosponsors it), a Kellogg’s-funded “advertorial” asserts that a
“panel of world health experts … concluded that a high sugar intake is not
related to the development of heart disease, diabetes, high blood pressure or cancer.”
And that Kellogg’s breakfast cereals, some packing more sugar than a Twinkie,
“do not increase the risk of tooth decay” when eaten with milk. (Insert British
dental joke here.)
The deeper problem is not the soundness of WebMD’s
information. Rather, the site’s often-useful material and reasonable blandness
promote trust that makes it easier to steer visitors to sponsors, and sometimes
to frighten them toward unnecessary testing, procedures and drugs.
WedMD’s extensive data mining provides another problematic
revenue stream. When visitors research embarrassing, or insurance- and
job-threatening conditions, that information—along with data from the site’s
many questionnaires and quizzes—is collected, used internally and sold. WedMD’s
privacy policy warns that the site collects “personal information” when you
sign up for its newsletters or use its many services, such as “Email a Friend”
or the “Ovulation/Pregnancy Calendar.” WebMD also collects “non-personal
information” from “external sources, even if you have not registered with or
provided any personal information to WebMD.” Although the site pledges privacy
for children, visitors who describe themselves as over 12 relinquish control
over how their information is used.
Meanwhile, WebMD is having its own health problems. Redmond
addressed “our declining revenues” in a July 31 company conference call. The
new CEO blamed the company’s failure to “anticipate the unprecedented reduction
in overall spending” by the biopharmaceutical industry, which has seen many of
its blockbuster drugs displaced by cheaper generics.
Redmond is looking to mobile apps, “diversifying our
customer base” and “consumer products” to cure what ails the company.
“As the biopharmaceutical commercial model continues to
evolve, WebMD can capitalize on these changes,” Redmond said in the company’s
June 1 press release announcing his taking the helm. “WebMD is driving
innovation in the rapidly changing healthcare market … for consumers,
physicians and healthcare companies.”
And therein lies the problem: the fundamental conflict
between a business model that is reliant on pleasing BigPharma and other
advertisers, and unbiased healthcare information that serves the public.
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