The Eggshells of Pharma-Sponsored Content in Health Journalism

January 3, 2014

When The Atlantic ran an article in January 2013 that was actually a Scientology ad, it received a lot of criticism for blurring the lines between conventional journalism and advertorial content. The magazine had published the ad in a style that made it look like a regular article on its website, with only subtle clues that it was paid content. The Atlantic was forced to pull the article, issue an apology, and tighten its advertorial content policies.

Over the holidays I noticed the Huffington Post Canada ran sponsored content entitled “What Does A Nasal Spray Do?”.[1] The only indication that the article was paid content is the “sponsored feature” titlebar which appeared on the front page and on the article page. I could only assume that it was sponsored by Novartis, the makers of Otrivin, whose ads were displayed in all the ad spaces on the article page.

huffpo-otrivin

Given the sparse information, it’s difficult to tell whether this was written independently by a Huffington Post writer or by Novartis itself. Transparency is an essential component of both good health information and good journalism. The lack of a byline and no clear indication of who the sponsor is are the first red flags to any health information content online.

The article discusses saline sprays, decongestants, and antihistamines, but does not even mention that nasal corticosteroids are also available for those suffering from chronic sinusitis. It’s a serious omission given that nasal corticosteroids are among first-line therapy for moderate to severe or persistent allergic rhinitis.[2] Notably, Novartis makes saline sprays (Salinex, Otrivin Saline) and decongestant products (Otrivin). We might expect biased omission of information in an ad, but I am not as forgiving if it’s staff journalist at a major media outlet. Without knowing who commissioned the article, it’s unclear who to hold accountable for oversights, mistakes, deliberate omissions and biased representation of information.

Sure enough, the article has numerous inaccuracies. It begins in the second paragraph.

A nasal spray is a quick way to deliver medication into your body, or if you’re using a salt water spray, a quick way to decongest your nose.

There are nasal sprays which deliver medications systemically to the whole body, but saline sprays, decongestants, and antihistamines are all designed to act locally. The error is repeated later on.[3]

The article also tries to describe how nasal decongestants work.

Unlike salt water sprays, you are limited to the number of times you can use decongestants in a 24-hour period. These sprays can temporarily decrease swelling of the tissues in your nose and sinuses, opening your nasal passages and allowing you to breathe easier.

But decongestants don’t decrease swelling of the tissues. Instead, they work by constricting blood vessels, which reduces fluid leakage into the nasal passages. That effectively shuts off the tap of nasal discharge which leads to a runny nose, or which can accumulate and cause sinus congestion.

It gets worse. The author seems to think that viruses and bacteria are the same thing, a mistake which no health professional or seasoned health journalist would ever make.

Don’t assume that because salt water is a mild disinfectant, you don’t have to keep your nozzle clean. You’re dealing with a virus, which means bacteria — so, clean your tools.

But perhaps the most e.g., regious errors come when the author tries to explain how to use a nasal spray. It begins with the second image in the slideshow, which improperly depicts a person using a nasal spray without closing one nostril — a strange discrepancy given that the article does instruct patient to do so. The third image does have the patient closing a nostril, but using what seems to be an eye dropper, not a nasal spray.

After giving a detailed, somewhat technical description of how to use a nasal spray (but without mentioning to tilt away from the midline), it then provides a very unorthodox method of how to use a nasal spray.

With a saline nasal wash, the process is different. Because of the high volume of liquid being sent through your spray, you should lean sideways over a sink and use the solution until you feel sweet, sweet relief.

As a pharmacist, I’m not sure I would recommend using a nasal spray this way. It sounds more like how you would use a neti pot, not a nasal spray. It’s a strange error considering that the author seems to drawn from an article from American Family Physician, which does not describe this as an accurate way to use a nasal spray. Moreover, the Canadian Otrivin website doesn’t describe using saline sprays this way either. One can only assume that the author drew on his own experiences or didn’t do enough research — which is again bad journalism.

Health professionals tailor their information to the patient in front of them. The AAFP patient handout, for example, would likely only be given to patients who were prescribed a medication consistent with the information that was presented therein. Simply regurgitating the information can cause patient confusion or even cause them to use their medications incorrectly. The backlash from The Atlantic Scientology article was a litmus test for the importance journalistic integrity. If the Huffington Post and other media outlets hope to educate patients through pharma-sponsored content such as this one, they jeopardize losing that integrity in the interests of generating revenue. Moreover, if this kind of advertising is to become more prevalent, oversight by the PAAB may be necessary.[4]


  1. The date in the URL suggests it has been running since November 14, 2013, but the date on the article states September 12, 2013. As of publishing this article, the last “deploy date” was December 19–20, 2013.  ↩

  2. I also couldn’t figure out the author meant by an “antihistamine” spray, because as far as I could tell, no such product is marketed in Canada or the US. I can only assume that the author is referring to sodium cromoglycate sprays (Cromolyn), which are better classified as mast-cell stabilizers.  ↩

  3. The author states:

    With a medicated spray, the goal is have the medication absorbed into the body via the lining of the nose (remember those blood vessels), not draining down your throat.  ↩

  4. The PAAB is actually run the pharmaceutical companies and really only regulates pharmaceutical advertising in Canada to the strict letter of the law. A more arms-length body would better serve Canadians to ensure proper direct-to-consumer advertising and information.  ↩