Janine Wedel - Unaccountable - How Elite Power Brokers Corrupt Our Finances, Freedom, and Security

The CASEnergy Coalition site displays a jam-packed schedule of grassroots-style visits by its “members” across the country, and it’s hard not to notice how many seem to involve minority communities. Photos of these events are displayed on its website and Twitter feed, making it look as if there’s a wide range of regular people stepping up to support the growth of nuclear power.

But are they energized in large numbers? How can we know? It seems we should be dubious.

Pharma-Fed Patients

It’s hard to think of a more emotionally charged subject for a PR campaign than one dealing with our own health and well-being, or that of those we care about.

Pharmaceutical and medical-device companies play on these vulnerabilities. They have been aggressive—and early adopters—in astroturfing through patient advocacy groups. This can be particularly difficult to deal with because getting to the bottom of people’s and organizations’ motives is tricky. Patient groups, of course, attract sufferers and many sincere advocates, regular people plagued with often-debilitating diseases or conditions and their families and friends. But they also attract money from pharmaceutical companies. These companies try to push their preferred drugs on prospective patients, encouraging them to seek a particular medication or diagnosis. These groups can also serve as conduits of money and influence in advocating for legislation favored by drug-makers, all under the guise of grassroots advocacy.

Key Opinion Leaders, which we discussed in the previous chapter, often act in concert with patient organizations, as several scholars have noted. 22While I focus on the American context, the methods of influence here reviewed are also routinely employed in today’s European context.

Shannon Brownlee, in her book Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, discusses the astroturfing campaign waged by SmithKline in the late 1990s when it introduced the drug Paxil. To try to distinguish the drug from its competitors, SmithKline appeared to engage in “disease-mongering,” in which pharmaceutical companies try to create new classes of disorders or wider diagnostic criteria and thereby generate a fresh market for a drug. SmithKline began promoting Paxil as a treatment for social anxiety, which, as a full-fledged psychiatric condition, Brownlee points out, is considered quite rare. The PR push included the full complement of “press releases” made to look like reported stories; pre-produced video and radio news releases; academics, experts, and carefully chosen sufferers; and ads with slogans like “Imagine being allergic to people.” Without mentioning Paxil, the ads directed people to the “Social Anxiety Disorder Coalition,” and their “member” groups, including the American Psychiatric Association, the Anxiety Disorders Association of America, and Freedom from Fear. Not advertised, of course, was its sponsorship. As Brownlee writes: 23

In reality, three of the psychiatric organizations listed . . . receive significant funding from SmithKline and other drugmakers. The fourth, the Social Anxiety Disorder Coalition, existed only temporarily in the New York offices of [PR firm] Cohn and Wolfe, which fielded all media calls for a few months after the ad campaign began.

SmithKline, of course, has hardly been the only firm to seed money into patient-advocacy groups. The industry’s influence stretches far and wide.

In 2006, New Scientist magazine conducted an investigation of twenty-nine large patient-advocacy groups (ones with annual revenues of more than $100,000), as well as some “associated with bipolar disorder, restless leg syndrome and attention deficit hyperactivity disorder.” The magazine chose these because they had previously been flagged by a medical journal for possible disease-mongering. 24Only two out of the nearly thirty groups that New Scientist examined refused to accept drug-company money. About a quarter of the groups took more than twenty percent of their funds from drug companies, and these groups were concerned with relatively common conditions (that is, with a big market to be exploited) that require long-term medication.

What about when such groups get involved in policy-making? Several were especially active during the years leading up to the expansion of Medicare to include a prescription-drug benefit, passed in 2003. The pharmaceutical industry was concerned that the added benefit might include cost controls that would take a bite out of drug-company profits. To help make its case, it created the innocuous-sounding Citizens for Better Medicare. CBM spent about $65 million on issue ads during the 2000 election cycle in an effort to foil the drug benefit. 25

We’re not sure who the “citizens” were in Citizens for Better Medicare, but we do know that an elderly actress played “Flo,” CBM’s best-known “member.” “Flo” appeared in commercials warning other seniors by declaring “I don’t want big government in my medicine cabinet!”

Another CBM affiliate was United Seniors for America, which favored a subsidy for private prescription-drug coverage. According to the watchdog organization Public Citizen: “USA, which billed itself as having a ‘1.5 million activists network nationwide,’ reported to the IRS that it received more than $20 million from a single donor in both 2002 and 2003, accounting for more than 75 percent of its revenue.” 26

Senator Charles Grassley in 2009 went after Big Pharma advocacy groups as part of a broader fight he began two years earlier against the influence game’s impact on medical practice and policy. “These organizations have a lot of influence over public policy, and people rely on their leadership. . . . There’s a strong case for disclosure and the accountability that results.” 27

He helped expose the funding sources behind the National Alliance on Mental Illness (NAMI). Described by the New York Times as “hugely influential in many state capitols,” the organization had declined to reveal its donors. 28The Times uncovered that roughly seventy-five percent of NAMI’s funding over a two-year period came from the drug industry. This was an apparent surprise even to one of NAMI’s own board members, a physician who said he was “shocked” by the level of industry funding, and resigned as a result. From the Times : 29

Documents obtained . . . show that drug makers have over the years given the mental health alliance—along with millions of dollars in donations—direct advice about how to advocate forcefully for issues that affect industry profits. The documents show, for example, that the alliance’s leaders . . . met with AstraZeneca sales executives on Dec. 16, 2003.

Slides from a presentation delivered by the salesmen show that the company urged the alliance to resist state efforts to limit access to mental health drugs.

“Solutions: Play Hard Ball,” one slide was titled. “Hold policy makers accountable for their decisions in media and in election,” it continued.

The alliance’s own slides concluded by saying, “We appreciate AstraZeneca’s strong support of NAMI.”

Despite the shaming of NAMI (its website reports that in 2009 it began listing donations above $5,000), Grassley was unsatisfied with the state of disclosure from both patient-advocacy groups and professional medical societies that funnel influence through physicians, using lavish conferences and lucrative speaking and consulting jobs. These groups can have a big impact on the standards that get set, devices that are used or not, and decisions that can make or break the bottom line for medical manufacturers and drug companies.

In 2011, the senator demanded funding information from dozens of both kinds of groups, and as ProPublica reported, one professional society—the Heart Rhythm Society—turned out to be getting nearly half its money from the drug and device business.