Blurring Sponsorship, Advertising Disclosures

Many companies sponsor things, and in the world of mental health and psychiatry, those companies tend to be pharmaceutical. Sponsorships help promote a company’s brand (and, indirectly, the products they sell). Since I believe — like most mental health professionals — that most people benefit from a combination of both medications and psychotherapy in the treatment of serious mental disorders, I see the value of many pharmaceutical companies’ products.

However, as we putter along in this age of the Internet, I’ve seen a disturbing trend toward blurring the line between editorial content and advertising.

And now I see, thanks to a blog entry this week by Dr. Danny Carlat, that this trend is being promulgated by one of the very organizations responsible for overseeing and accrediting continuing medical education, the Accreditation Council for Continuing Medical Education (ACCME).

Every week, we get at least three to four offers here in the Psych Central offices to help better “monetize” our content (e.g., make more money off of it). Most often these offers are for what’s called “inline advertising,” where keyword text in an article is automatically turned into the potential for an advertisement.

We reject all of these offers, because they are an intentional effort to obfuscate the line between our editorial content — the article itself — and advertising. While we need advertising to pay our bills, we don’t need to confuse our users into clicking on an advertisement when they didn’t mean to.

On some other sites, I notice that the word “Advertisement” is no longer displayed next to advertisements, with the ads being bunched up together right next to some of the website’s boxes of similar size and layout of content. The point is to again blur the line between editorial content and advertising, to make it appear the advertisement might actually be a part of the site’s content.

We’ve done a few sponsored areas on our sites in the past (we have none running right now), and we’ve always been very clear when you are in a sponsored area — the sponsor’s name and logo is prominently displayed at the top of every page and there was a header that clearly stated the area was sponsored content (not editorial content). We do these things to make it perfectly clear to users that they are reading content sponsored by a pharmaceutical company, and so that content may be more biased toward a certain type of treatment or what-not.

Medical and mental health professionals also read sponsored content in their professional lives. They do this, most often, in order to gain continuing education credits — credits required to keep their license in good standing. Pharmaceutical companies often sponsor content in these courses because the courses can be subtly (and sometimes not-so-subtly) biased to encourage the use of a certain class of medications (which includes the sponsor’s medication).

Today, sponsors names and logos are usually quite prominently displayed in continuing education course literature or on the sponsored articles themselves. This is often a requirement of the organizations that oversee the continuing education market, in this case an organization called ACCME.

But, as Dr. Carlat notes, they now want to remove sponsor’s logos from appearing on sponsored content — even thought prominently displayed logos are a very easy visual sign that one is reading sponsored content. Instead, they recommend that the sponsorship should now be buried in the course’s or article’s fine print.

Dr. Carlat goes one step further in suggesting disclosure for sponsor, and here’s where it gets interesting:

In my opinion, the supporter should be required to provide more information, including:

• The name of the product(s) marketed by the supporter that might be relevant to depression (in this case, Cymbalta and Symbyax.) Disclosing this is crucial, because many doctors do not know exactly which products a particular company markets, and therefore may not realize how the company has a financial stake in the CME program.
• The amount of money the supporter has paid the educational company to create the CME course. The more money that is at stake, the larger is the incentive for a company to bias the program in favor of the supporter’s drug. Did Lilly pay Medscape $100,000 or $1,000,000 for this course? If it was $1,000,000 (and I’m guessing this figure is closer to the true amount), a learner would reasonably become even more skeptical about the scientific validity of the course.

Indeed, why not provide readers with more information about the nature of the sponsorship in order to help professionals make the most informed choices possible about the content they are consuming?

The first point proposed by Dr. Carlat is helpful and public knowledge anyway (it just requires a little research to tie the pharmaceutical company’s product to a specific name). And the second point could be implemented in tiers or categories, to get away from naming specific amounts (which could provide a competitive advantage to other companies). For instance, Tier 1 sponsorship could be $1+ million, Tier 2 could be $500,000 to $1 million, Tier 3 could be $250,000 to $500,000, and so on.

I might also suggest that such information could be rolled out across all sponsored content, everywhere online — not just continuing education courses and articles. Why not? Wouldn’t such information also be helpful to consumers to help gauge the influence of the sponsor on the material being presented?

Read the full blog entry from Dr. Carlat: ACCME Seeks to Hide Drug Company Disclosures in the Fine Print