the neurotic covenants…

Posted on Friday 24 February 2012

BLOGSCAN – Television Advertising Revenue and the Anechoic Effect
Healthcare Renewal
by Roy Poses
February 21, 2012

We have often discussed the anechoic effect, how cases involving or discussions of the topics we address on Health Care Renewal, the concentration and abuse of power in health care, fail to produce any responses, or echoes.  Two recent blog posts discussed one way in which the anechoic effect might be generated.

A post by Dr Steven Greer on CurrentMedicine.TV, enlarged upon by Alison Bass on the Alison Bass blog, discussed a segment on 60 Minutes yesterday that dealt with the evidence that anti-depressant drugs may not be efficacious for mild to moderate depression.  Since this evidence is about four years old, the question is why it has only made it to the main-stream media now?  Both Dr Greer and Ms Bass think it may be because the patents on most of the newer, mainly selective serotonin reuptake inhibitor [SSRI] type anti-depressants have run out.  Therefore, their manufacturers may no longer be interested in using the clout they derive from paying millions for television advertising to keep programs critical of these drugs off the air.  The implication is that large health care organizations may often use threats to withdraw advertising to forestall criticisms of their products or their agendas in the media, hence increasing the anechoic effect.

I’m not much of a TV watcher, but when I saw that there was going to be a segment on antidepressants, I made a point to show up for 60 Minutes. I watched for a short time, then wandered back to my office. My wife inquired, "I thought you’d want to see that. Why did you leave?" "Very old news" was the answer. Don’t get me wrong, I really liked Irving Kirsch’s study [Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration] with this intriguing graph, but it was in 2008 and that’s when it should’ve been shown. Dr. Poses’ question, "Since this evidence is about four years old, the question is why it has only made it to the main-stream media now?" is an excellent point. It does seem that the public exposes do have a remarkable lag time. I’ve been thinking about that myself recently, but for a different reason. I’ve posted various versions of the graph I started with in the last post for a while:
It just comes up a lot, the patent life of drugs. So I thought I’d follow his links:

When Dr. Irving Kirsch published his meta-analysis in PLoS Medicine in February 2008 showing that antidepressants were no more effective than a placebo in treating mild or moderate depression, the national news media ignored his explosive findings, for the most part. And when I published Side Effects a few months later, exposing the deception behind the making of the bestselling antidepressant Paxil, they were similarly unresponsive. While my book received great reviews and a lot of attention from regional radio outlets, the national broadcast media pretty much ignored the story. Indeed, a studio interview I did with Kai Ryssdal on American Public Media’s Marketplace never aired, perhaps because of the pressure Paxil’s maker, GlaxoSmithKline, brought to bear on Marketplace’s producers.

So it was with some bemusement that I watched the 60 Minutes segment on antidepressants, which focused on Kirsch’s 2008 finding that antidepressants are no better than placebo in treating most forms of depression. In the segment, Kirsch, who is now associate director of the Program in Placebo Studies at Beth-Israel Deaconess Hospital, noted that the reason many patients feel better after taking antidepressants is not because of the drug’s effect, but because of the powerful placebo effect in making them feel better.

Why, I wondered, was 60 Minutes taking note of this now, four years after Kirsch published his meta-analysis and two years after he published his own book on the subject, The Emperor’s New Drugs?

Here is one very plausible reason, as articulated by Dr. Stephen Greer in a CurrentTV column today: because the patents for most of these blockbuster antidepressants [like Paxil and Prozac] have expired and the drug companies, who advertise heavily on television, are no longer pressuring the national media to stay mum…

The CBS news show “60 Minutes” made waves with a story asserting that the antidepressants taken by millions of Americans daily are actually no more effective than sugar pill placebos. Also recently, the national evening TV news reported on a research publication from Harvard that found a 50% increase in the chance of diabetes among women who took cholesterol lowering statin drugs like Pfizer’s Lipitor, and that cheaper generic statins were as effective as the more expensive branded statin Crestor. Those are just three examples of a new trend in mainstream media to expose controversies in blockbuster drugs that generate tens of billions of dollars in revenue for the drug industry.

It is quit rare for national TV news to report on any data critical of blockbusters despite plenty of research over the last several decades questioning the risk/benefit profile of numerous commonly used drugs. While one can only speculate, there might be many reasons for why the mainstream TV news is finally reporting problems. The most likely explanation is that the same drugs now being exposed as unsafe and ineffective have also lost patent protection, and therefore, are no longer generating the huge advertising revenue for the networks. A significant portion of the revenue for the broadcast networks is derived from pharmaceutical advertisements…

One wonders how this could ever be nailed down – the media shying away from this kind of news because of pressure from pharmaceutical advertisers. Alison’s story is certainly suggestive:
    While my book received great reviews and a lot of attention from regional radio outlets, the national broadcast media pretty much ignored the story. Indeed, a studio interview I did with Kai Ryssdal on American Public Media’s Marketplace never aired, perhaps because of the pressure Paxil’s maker, GlaxoSmithKline, brought to bear on Marketplace’s producers.
It’s really the same point as in the last several posts about the impossibility of conducting solid science when the investigators are all supplementing their incomes through financial ties with pharmaceutical companies. How can the networks who are paid big bucks for the direct-to-consumer ads by pharmaceutical companies be counted on to cover these important stories in a timely manner? The answer is, "They can’t."

We often envision such things as clandestine conversations that have actually occurred – some James Cagney-like character from the pharmaceutical company talking to an Edward G. Robinson-like doctor or media exec in a room filled with cigar smoke and the shades pulled. "So if you know what’s good for ya, youse gotta lay off with the kids getting suicidal, see. It don’t look good upstairs, see." I doubt such things happen, or happen very often. More likely, it’s like the neurotic covenants often seen in marriages. The husband puts up with exhorbitant spending and the wife looks the other way about daliances, for a loud example. The point is that the contract is unspoken. In fact, neither has really ever consciously articulated it. It just is. I expect that the same is often true for a KOL being paid as a speaker or advisor. It’s just assumed that the payee will ‘accentuate the positive, and eliminate the negative, and latch on to the affirmative, but don’t mess with mister in-between’ [to stick to the 40s metaphors]. The same situation likely happens with network executives. Alison’s interview just didn’t make the cut.

The only way to do anything about that would be to ban pharmaceutical companies from paying physicians altogether, ban direct to consumer advertising for prescription medications from the media. Fine by me, but pretty unlikely to happen. It’s a sticky problem, and very costly…
    Bernard Carroll
    February 24, 2012 | 6:44 AM

    The neurotic covenant as you describe it resembles the game of don’t ask don’t tell. The compromise of the KOLs is preconscious and heavily defended against awareness. I think that explains some of the anosognosia and also the affect with which they respond to probing criticism.

    February 24, 2012 | 5:15 PM

    Great point Mickey. You’ve gotten to the very reason why I was underwhelmed at the 60 MINUTES story. Yeah, it was a good story, but when you look at the big picture, it’s not that impressive. As long as these stories only air once the meds are safely off patent, we’ve missed the point entirely as a society. The pharma companies are still the puppet-masters.

    While we’re at it, here’s another unspoken contract: Scientists can do research and freely publish high-profile studies on the dangers of street drugs, but not so much with legal drugs. ESPECIALLY psych meds. Yeah, stimulants that millions of American kids take every day are essentially slow-acting cocaine and may negatively affect their brains in similar ways, but you can’t SAY that on tv/journals, now can you?

    February 24, 2012 | 6:22 PM


    When I first started following ‘medical’ blogs, Roy’s ‘anechoic effect’ sent me hauling out the dictionary. Think about your own blog, and David Healey’s, and Marion Nestle, and “Jack Friday” and many more. The echo is faint . . . but it is starting to reverberate. The 60 Minutes segment, as you said, was a day late and a dollar short . . . but then, they didn’t have to do it at all. And the fact that people were talking about it ’round the water cooler on Monday morning indicates that peoples’ ‘gut feelings’ were somehow more than that. Keep blogging . . . the echo is small, but I think it is growing.

    FWIW, I wish 60 Minutes would do a segment on Poses’ frequent works showing the ineptitude if not outright corruption of our prestigious hospitals and university medical centers. As educational costs continue to rise, the fact that the burden is placed on students, while those at the top who, despite being ‘the best and brightest’ can’t rein in costs but still merit serious compensation packages is another point that needs to shake up the echo chamber.

    February 24, 2012 | 6:41 PM

    My fantasy would be for Roy Poses to become the “Paul Krugman” of Medicine with a regular NYT slot. He’d be great…

    February 26, 2012 | 3:12 PM

    Thanks for the kind words.

    I’m afraid the “main-stream media” has not exactly been knocking my door down. My comments have been quoted a few times in news stories about particular cases, and I did a few op-eds for the local paper (the Providence Journal) some years ago, but that is about it.

    I have not submitted an op-eds “over the transom” to major media, based on the assumption that the likelihood of publication would be very low in the absence of an invitation to submit. Spending a lot of time writing things that are not published would be a waste. At least blogging offers the opportunity to self publish.

    If anyone reading this wants me, or any of the bloggers writing in a similar vein, including Mickey, Alison Bass, Howard Brody, Carl Elliott, etc to become major media fixtures, and knows someone influential in the media, maybe you should lobby for us.

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