Doctor Who?

The corporations behind WebMD’s friendly, free advice

Terry J. Allen August 28, 2012

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 Web​MD​.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.

Ter­ry J. Allen is a vet­er­an inves­tiga­tive reporter/​editor who has cov­ered local and inter­na­tion­al pol­i­tics and health and sci­ence issues. Her work has appeared in the Guardian, Boston Globe, Times Argus, Harper’s, the Nation​.com, Salon​.com, and New Sci­en­tist . She has been an edi­tor at Amnesty Inter­na­tion­al, In These Times , and Cor​p​watch​.com. She is also a pho­tog­ra­ph­er. Her por­traits of peo­ple sit­ting in some of the 1900 cars lined up out­side a New­port, Vt., food drop can be seen on www​.flickr​.com/​p​h​o​t​o​s​/​t​e​r​r​y​a​l​l​e​n​/​a​lbums. Ter­ry can be con­tact­ed at tallen@​igc.​org or through www​.ter​ry​jallen​.com.
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