Healthy Skepticism Library item: 6403

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Oransky I.
Bloggers beware: conflicts of interest and diabetes
Lancet 2006 Nov 10368:(9548):1641 - 1642
http://www.thelancet.com/journals/lancet/article/PIIS0140673606696803/fulltext

Notes:

Ralph Faggotter’s Comments:

Blogs are a mixed blessing.
Superficially benign, occasionally they may have a hidden agenda.

Full text:

My search for the word “diabetes” on www.technorati.com, which tracks 55 million blogs, returned more than 480 000 results. Of course, only a fraction of those blogs focus exclusively on the disease. Still, there are many active bloggers whose raison d‘être is that they have diabetes. Take, for example, Six Until Me, Kerri Morrone’s blog. The title refers to the age at which she was diagnosed with type 1 diabetes; she’s now 27 years old and works as an editorial assistant at dLife, a magazine for people with diabetes. Many of her posts are poignant notes about her experience of diabetes: “I thought about not writing about this on the blog because I’m scared to see it actually written down”, she wrote in September, 2006, in an account of her appointment with an ophthalmologist. “I’m not sure if I’m ready to really face how scared I am of this sometimes. And I know that it’s just a little smudge in my eye and it may correct itself and all I have to do is work harder, but to have someone regard it almost as what is expected to happen to me…I don’t want what is expected.”

Like many of her posts, that one generated dozens of comments. That is, of course, what keeps many bloggers going, and allows more voices to be heard; Morrone often comments on these responses to her blogs. Many of her posts resemble a diary, chronicling nights out in New York City, near her home in Connecticut, or taking a tour of local wineries. Even those posts, however, usually include some mention of packing her insulin pump or how diabetes affects her daily life.

Morrone is part of a community of diabetes bloggers, or “d-bloggers”, as they refer to themselves, many of whom link their blogs to each other. Puns and uses of diabetic terminology abound in the blog names: Cyber Pancreas, Pumping Insulin, and Sugar and Spice. There seem to be fewer doctors blogging about diabetes, which could reflect a lack of time, a fear of a blog post ending up in a court case, the fact that doctors don’t tend to be early adopters of technology, or something else. Still, there’s no question the diabetes blog community is growing. As it does, the voice of patients with diabetes is amplified, and diabetes blogs increase in potential influence.

So it comes as no surprise that conflicts of interest are becoming an issue among d-bloggers. This summer the blogger of Diabetes Mine, Amy Tenderich, was awarded a LillyforLife Achievement Award for journalism. She and the other winners received US$1500, which they were encouraged to donate to charity. Tenderich donated $1000 to Children with Diabetes, an online community for children, adults, and families with diabetes, and kept $500 to offset the costs of publishing her blog and of her continuous glucose monitoring system. The winners were also given a trip to Eli Lilly and Company headquarters in Indianapolis, IN, USA, which Tenderich described on her blog in September. That post elicited a response from a reader calling on Tenderich to “fully disclose to your audience to what extent you are recompensed, both financially and with products”.

So she did: “Until now, I have not received one single penny from any pharma or medical device company for writing this blog, nor any free supplies whatsoever-except a few glucose meter models that companies were distributing for promotional purposes at the ADA Conference or elsewhere.” Curious, I asked Tenderich for a clarification, and it turns out that her day job is as a technology writer, and some of her clients make medical devices. Based on her and others’ comments on the blog in response to her disclosure posting, the prevailing view in the blogosphere seems to be that as long as the money comes without any strings attached, it’s OK to accept it. And disclosure is not universal.

That points out a critical difference between traditional journalists and bloggers. Journalists’ ethics generally preclude them from accepting funding from any source they are likely to write about. That includes people or companies who are likely to compete with those they cover, and holding stock in such companies. By contrast, bloggers who haven’t worked or trained as journalists don’t necessarily think accepting such funding is a problem. I met a surgeon-turned-medical technology blogger last year who saw no conflict in accepting free devices that he ended up promoting on his site, sans disclosure.

That difference between bloggers and journalists creates an unfortunate opportunity for industry. It has become clear to those who follow clinical trials that despite the lack of official strings attached to research funding, studies sponsored by a particular company are more likely to show a benefit of that company’s drug over others. That, of course, is in medical-centre settings that at least have mechanisms to keep those influences in check. Individual bloggers don’t have institutional review boards or ethics committees looking over their shoulders, so the possibility that bloggers funded by health-care concerns and industry-even with disclosure-will produce blogs that are biased is real.

What could also occur is the kind of “Astroturfing” of blogs that has been seen in other areas. There’s a history of such efforts among disease-advocacy groups before blogs were even an entity; drug companies throw a lot of funding at supposedly “grassroots” organisations whose messages just happen to start sounding like ones that benefit the company. And there’s a history of fake blogging-now referred to as “flogging”. A recent example is Wal-Marting Across America, a blog by Laura and Jim, who travelled around the USA taking photographs of happy employees, which they then posted with a travelogue on their blog. (All but two of the posts have now been removed.) It turns out, however, that the trip was paid for by Working Families for Wal-Mart, a “grassroots” group created by Wal-Mart at the suggestion of the leading PR firm Edelman. Then, in a development that further reinforces the difference between bloggers and journalists, Jim turned out to be Jim Thresher, a Washington Post photographer. He was forced to remove his photographs from the site and pay back the expenses. The good news is that the response to the Wal-Mart story was swift; the blog was taken down as the outcry gathered momentum.

I don’t have any knowledge of Astroturfed medical blogs. A few PR innovators I asked didn’t either, but one, ComBlu’s Steve Hershberger, said he was working with three pharmaceutical companies and a leading device manufacturer to set up word-of-mouth marketing and consumer-generated media programmes. Such programmes, which can rely on blogs and other non-traditional campaign approaches, are “a major paradigm shift” for companies. Hershberger says that any such campaigns, as they are developed, must comply with FDA criteria, Federal Trade Commission regulations, and, in his mind, the Word of Mouth Marketing Association code of ethics (http://www.womma.org). I would certainly want to see more safeguards if drug companies and other players decide to use blogs to market themselves and their products, including transparency. If companies create dishonest blogs, such as Wal-Mart’s, I hope they are exposed quickly. I don’t expect to believe everything I read on the Web, but increasing the likelihood would be a good thing.