If the invisible ties between pharmaceutical companies and their public relations companies are what underpins the power of the “third party technique,” what can be done to allow doctors and citizens to make informed decisions? How can the imbalance between the growing marketing and public relations budgets of the pharmaceutical industry and disparate doctors, consumers, citizens, and journalists be made more equal?
Much of the success of the “third party technique” relies on the lack of a requirement for medical opinion leaders, non-profit groups, or journalists with financial ties to drug companies to proactively disclose them. Most journalists have, at best, a sketchy idea about how the public relations industry works, and by failing to ask the people they interview to disclose funding sources or potential conflicts of interest they reinforce the effectiveness of the third party technique.
Worse still is the invisibility of the public relations industry in mainstream media reporting. Outside of the public relations industry's trade press, we know of no mainstream journalist in the English speaking world who is dedicated to covering the public relations industry.
Nor do the self regulatory codes of ethics of the public relations industry offer much hope. At best they require passive disclosure of who their clients are: they must be asked before they need to disclose the information. Even then, there are few grounds for optimism. The most recent iteration of the code of ethics of the Public Relations Society of America—the country where half the global drug sales are made—has abandoned any enforcement role for the professions' peak body.
In a media age of fewer journalists and shrinking budgets, a reliance on good journalism alone as an antidote to spin doctoring would be misplaced. Heightened awareness of the strategies of the public relations industry is essential but is, at best, one strand in a multilayered defence against spin.
Peter Mansfield argues that the Achilles' heel of the medical public relations sector is the money trail paved by taxpayers and insurance companies: “We give them rewards for increasing the sales of more expensive new drugs regardless of the impact on health care. So we shouldn't be surprised if they do whatever works to fulfil the objectives that we are currently paying them for.”