Harold J. DeMonaco is the Assistant Chief Medical Officer for Care Transitions at the Massachusetts General Hospital and a long-time contributor to HealthNewsReview.org.

During the silly season of presidential politics, I read two online political news sites — The Hill and Politico — with a bit more frequency than usual. Recently, a headline (New drugs promise great gains in the fight against cholesterol) prominently positioned three stories down from the masthead of The Hill caught my eye. I admit that it took me a couple of minutes to understand that this was an infomercial produced by the the Pharmaceutical Researchers and Manufacturers of America (PhRMA), an industry lobby. Here’s the video that was embedded in the story:

This is the first time that I have seen what is in reality an advertisement embedded almost seamlessly within the flow of news. But it apparently is not unique. Defense contractors have taken advantage of this approach on The Hill (The Big Zap , To Print a Missile) and the folks at PhRMA have previously done so as well (Hope for Alzheimers, Rewriting History to Beat Cancer)

When I clicked on LEARN MORE, here’s the text that came up:

Sponsored Content The Hill’s Sponsored content program is designed to allow your company or association to promote itself and the issues it cares about within the flow of our award-winning journalism. The content is produced by The Hill’s advertisers, allowing them to highlight their brand in a new and effective way. The Hill’s editorial staff has no involvement in producing the sponsor-generated content, just as it has no involvement in the creation of other advertising content. Sponsored content will appear, labeled, on The Hill’s homepage and on inside pages to which The Hill will drive visitor traffic. Terms and Conditions The Hill’s editorial team has no role in the creation of sponsored content; however, The Hill reserves the right to refuse any submitted advertisement and can do so to any sponsor-generated content if it fails to meet our advertising policy and editorial standards.

The program is “…designed to allow your company or association to promote itself and the issues it cares about WITHIN THE FLOW OF OUR AWARD WINNING JOURNALISM” (emphasis mine).

Really?

If my experience is any guide, the purpose seems more to confuse readers as to whether the content is journalism or an advertisement — possibly with the goal of attracting sponsors who are looking for an edge over their competition.

The sponsored content in this case profiles a single patient, provides some interesting statistics about cholesterol and cardiovascular disease, and promotes two newly approved and very expensive drugs (the PCSK9 inhibitors Repatha by Amgen and Praluent by Sanofi and Regeneron Pharmaceuticals) without actually naming them. Both drugs work by blocking a protein called PCSK9, resulting in an increase in LDL cholesterol elimination. These drugs have an annual price tag of $14,000, whereas the annual cost of a statin is $600 to $2,400 depending on drug choice and dose. The FDA approved both PCSK9 drugs for use in patients with heterozygous familial hypercholesterolemia (a genetic condition causing very high cholesterol levels) and those who either cannot tolerate or cannot reach appropriate levels of LDL cholesterol with statins. These drugs do have a legitimate place in the treatment of hypercholesterolemia.

Heterozygous familial hypercholesterolemia is a disease that causes high levels of LDL cholesterol early in life and an increased risk of heart attack and stroke. Patients with the disorder require rather aggressive drug therapy to reduce these risks. Repatha and Praluent are welcome additions to the treatment options for these patients and others with difficult-to-control elevations of LDL cholesterol. Whether these drugs reduce cardiovascular risk is unknown at the moment however.

With prescription drug costs garnering interest in the media and on the campaign trail, the economic impact of these two drugs should be a major part of any discussion (though cost, perhaps understandably, is not addressed in the sponsored content). The Institute for Clinical and Economic Review has completed a draft economic analysis of the use of Praluent and Repatha. Here’s their summary:

Our draft report therefore suggests that $2,177 is the price that should serve as an alarm bell –if the cost is more than $2,177 a year, drug companies, doctors, insurers, and other parties may need to work together to determine ways to limit the use of these drugs, find savings in other parts of the health care system, or adopt other measures to help make these drugs more affordable.

Remember that the cost of each of these drugs is $14,000 annually and according to the CDC, there are about 75 million Americans with hypercholesterolemia. Are the alarm bells going off yet? As is noted in the sponsored content, only about 1 in 3 patients have well controlled cholesterol levels. The reasons for treatment “failures” are multiple and include inadequate dosing, non-compliance and non-adherence as well as inability to tolerate statin side effects.

Kaiser Health News recently reported that Express Scripts, one of the largest pharmacy providers in the United States, has decided to cover both drugs (having received an unannounced reduction in price) but will restrict access presumably to patients who meet the FDA approved indications. The report goes on to say, “Express Scripts said in the first month the new drugs were available, it saw thousands of prescriptions for it – and blocked about half because information on the patients’ cholesterol levels wasn’t provided or no proof was given that a patient had previously tried a statin.”

Why is any of this important? As I have said on many occasions, I am not a journalist and I perhaps should not be commenting on the propriety of infomercials embedded in journalistic content. But I find it sad that a media outlet would need to resort to these tactics in a formal and organized way to generate revenue. The Hill’s otherwise excellent and balanced content is, I believe, tainted in the process. To be fair, The Hill has previously covered issues related to cholesterol and the PCSK9 inhibitors, pointing out the benefits and challenges they bring to the table. And I have no issue with advertisements when they are clearly delineated.

PhRMA has every right to present its point of view to policy makers. But let’s remember that when it comes Medicare, the deck is already heavily tilted in favor of the drug industry. Unlike Express Scripts, Medicaid, pharmacy benefits companies and others, Medicare is not allowed to negotiate for pricing of pharmaceuticals. Congress specifically prohibited Medicare from doing so with the passage of Medicare Part D legislation. The Obama administration has proposed legislation to allow Medicare to negotiate pricing for high cost drugs covered under Part D. This must be approved by Congress — the very folks the sponsored content is aimed at.

There is an irony to all of this if you are a routine reader of The Hill. An August 13, 2004 article in The Hill spoke to the issue of ads disguised as news sites. The article notes, “ And traditional news sites themselves have come under scrutiny from media critics for sponsor-generated content, essentially paid advertising that looks like a news story. The Federal Trade Commission announced last fall that it would begin examining the practice.”

Eleven years later, it looks like that investigation didn’t go anywhere.

Addendum:

Here is some previous HealthNewsReview.org coverage of issues related to sponsor/media partnerships and the blurring of lines between advertising and editorial content.

Questions about Mayo Clinic deal with Minneapolis TV station

Journalists as tour guides at the institutions they cover: a troubling NY Times precedent for the future of health news

Many old ethical questions arise about new St. Louis TV news-hospital partnership

How health product advertising is creeping (leaping?) into editorial content