What’s hiding behind the bias in the Tom Marino coverage
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What’s hiding behind the bias in the Tom Marino coverage

October 17, 2017

The Raw Data

Unspun and unbiased. These are the facts.

Trump discusses US opioid abuse, Marino withdraws director nomination for Office of National Drug Control Policy

On Monday, President Donald Trump held a Q&A in the White House Rose Garden, in which he discussed issues including opioid abuse in the U.S., the 2016 Ensuring Patient Access and Effective Drug Enforcement Act, and the nomination of Rep. Tom Marino (R-Pa.) as director of the Office of National Drug Control Policy. Last week, CBS’ 60 Minutes and The Washington Post published a joint report about the 2016 bill, which was co-sponsored by Marino. The report claimed the bill curtailed the Drug Enforcement Agency’s (DEA) ability to stop opioids from entering the black market.

On Tuesday morning, Marino withdrew his nomination.

Trump on opioid abuse in the U.S.

Trump said, “This country and, frankly, the world has a drug problem,” and, “We’re going to do something about it.” In August, Trump had said he would declare a national opioid emergency, and at Monday’s news conference he said, “We’re going to be doing that next week.”

By declaring a national emergency, the government will be able to direct funding to the issue, which could be used to expand drug treatment facilities and supply police officers with naloxone, a remedy for opioid overdose.

About the Ensuring Patient Access and Effective Drug Enforcement Act

The DEA has the authority to register manufacturers, distributors and dispensers of controlled substances, including opioids. The 2016 Ensuring Patient Access and Effective Drug Enforcement Act amended the 1970 Controlled Substances Act, which consolidated “numerous laws regulating the manufacture and distribution of narcotics, stimulants, depressants, hallucinogen anabolic steroids and chemicals used in the illicit production of controlled substances.” The 2016 act defined phrases related to the DEA’s authority. It also revised and expanded what the DEA was required to do to issue an order denying, revoking or suspending registrations. Prior to the 2016 act, the DEA could suspend a company’s registration “to prevent imminent danger to the public health and safety.”

The 2016 act was supposed to protect law-abiding drug distribution companies and pharmacists. According to the Post, the legislation has instead limited the DEA’s authority to prevent drug distribution companies from shipping pharmaceuticals to doctors and pharmacists who sell opioids on the black market.

The bill was originally introduced to the House on Jan. 22, 2015, and was sponsored by Marino, and co-sponsored by Rep. Marsha Blackburn (R-Tenn.), Rep. Judy Chu (D-Cal.) and Rep. Peter Welch (D-Vt.). The final version was negotiated by Sen. Orrin G. Hatch (R-Utah) with the DEA, and the bill passed the Senate with a unanimous vote on Mar. 17, 2016. The House passed the amended bill on Apr. 12, 2016 and then-President Barack Obama signed the bill into law a week later.

According to the 60 Minutes-Post report, the Healthcare Distribution Management Association spent more than $106 million lobbying for the bill between 2014 and 2016.

When asked about the report on Monday, Trump said, “We’re going to look into the report. We’re going to take it very seriously.”

Marino’s nomination

The White House nominated Marino for director of the Office of National Drug Control Policy on Sep. 5 this year. No date had been set for his confirmation hearing by the Senate Judiciary Committee, as Marino had some standard paperwork outstanding. On Tuesday, Trump posted on Twitter that Marino had withdrawn his name from consideration for the position.

Marino has not commented on the 60 Minutes-Post report.

Distortion Highlights

  • The news we analyzed on Tom Marino’s nomination for the Office of National Drug Control Policy is biased.
  • It implies he’s to blame for a bill that reportedly curtails the DEA’s ability to keep opioids off the black market, contributing to the issue of opioid abuse in the country.
  • This bias is problematic given it potentially hides bigger issues: exploring the role of government in regulating addictive behaviors in society.

Show Me Everything

The Numbers

See how the articles rate in spin, slant and logic when held against objective standards.

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The Distortion

The Knife’s analysis of how news outlets distort information. (This section may contain opinion)

Top Spin Words

  • Ravaged

    Both their states have been ravaged by opioids. (BBC)

    Senator Joe Manchin III, Democrat of West Virginia, a state that has been ravaged by opioid abuse, sent a letter to the president urging him to withdraw Mr. Marino’s nomination. (The New York Times)

  • Deadly plague

    Earlier, West Virginia Sen. Joe Manchin, whose state has been among the hardest hit by a deadly plague of overdoses that has killed tens of thousands of Americans, demanded that Trump shelve Marino’s nomination. (NBC News)

  • Defang

    But what it actually did, according to the report, was defang the DEA by curbing their power to stop drug distributors from sending millions of opioids to doctors and pharmacies suspected of supplying addicts. (NBC News)

  • Aggressive

    The law was the crowning achievement of a multifaceted campaign by the drug industry to weaken aggressive DEA enforcement efforts against drug distribution companies that were supplying corrupt doctors and pharmacists who peddled narcotics to the black market. (The Washington Post)

    Rannazzisi ran the DEA’s division responsible for regulating the drug industry and led a decade-long campaign of aggressive enforcement until he was forced out of the agency in 2015. (The Washington Post)

  • Stem the wave

    Even as the president promised to announce a major initiative to stem the wave of opioid abuse as early as next week, Mr. Trump said he would consider scuttling the nomination of Representative Tom Marino as director of the Office of National Drug Control Policy. (The New York Times)

  • Handcuffed

    President Donald Trump said Monday that he would “look into” a report that his pick for drug czar championed a bill that effectively handcuffed federal agents from going after the Big Pharma firms that flooded with the country with addictive opioids. (NBC News)

  • Went to bat

    The legislation he went to bat for was spearheaded by the drug industry-funded Healthcare Distribution Management Association, which spent more than $106 million to lobby for the bill, according to the report. (NBC News)

  • Ugly

    “It will be ugly” if Trump continues with the nomination, Blumenthal said. (The Washington Post)

The coverage we analyzed on Tom Marino’s nomination conveys three points: One, opioid abuse is a problem in the U.S. that needs to be addressed (read more here). Two, last year’s legislation, the Ensuring Patient Access and Effective Drug Enforcement Act, limits the DEA’s ability to stop opioids from entering the black market. And three, Tom Marino, who sponsored the bill in the House, is to blame and he should be barred from any position that would enable him to further contribute to the problem.

That last impression encompasses the bias in these articles, and if you buy it, you might miss the elephant in the room. How did the outlets create it? By emphasizing Marino’s role compared to everyone else who made it possible to enact the legislation. Here’s the BBC’s lead sentence, for example.

US President Donald Trump’s nominee for drug czar is accused of helping relax enforcement on pharmaceutical firms blamed for fuelling the opioid crisis.

This singles out the lawmaker, directing our attention to him and away from other parties. The four outlets do mention Marsha Blackburn, who co-sponsored the bill, but most of the coverage focuses on Marino and his nomination for the Office of National Drug Control Policy.

By keeping the focus on Marino and the fate of his nomination, it’s easy to overlook the bigger issue: if this legislation effectively did a disservice to the American public, how did it happen?

The articles mention a number of individuals and groups who signed off on the bill, including the House, the Senate, congressional aides who are responsible for tracking drug policy, the DEA, the Justice Department and former President Obama. The Washington Post adds:

Besides the sponsors and co-sponsors of the bill, few lawmakers knew the true impact the law would have. The White House was equally unaware of the bill’s import when President Barack Obama signed it into law, according to interviews with former senior administration officials.

Marino did have responsibility by leading the bill through the House, and directing our attention to the processes that authorized the bill and the apparent lack of awareness in them doesn’t lessen his role. On the contrary, the shift in focus can set us in a direction to better understand what happened, hold all lawmakers responsible, and figure out how situations like these might be prevented in the future.

Exposing the bias also allows us to consider the problem differently and the role government restrictions should play in its resolution. The law in question may have contributed to adverse effects during the last months, but it’s a leap to assume the current situation would be considerably better if it hadn’t been enacted. Drug abuse is a complex societal problem, in which the individual is ultimately responsible for the use or abuse of any substance or tool. What should be the reach of government on issues such as drug abuse? Would higher levels of regulation ultimately solve the problem? Might there be other, more efficient measures outside of government and law enforcement that could help society address this and other addictive behaviors?

Is it fact or fiction? Which outlet presents the most spin?

  • 58% Spun

  • 59% Spun

  • 67% Spun

  • 67% Spun

Fiction
or
Fact

The Washington Post

“In April 2016, a handful of members of Congress … prevailed upon the DEA and the Justice Department to agree to the more industry-friendly legislation, undermining efforts to stanch the flow of pain pills …”

The Ensuring Patient Access and Effective Drug Enforcement Act became law in April 2016, due in part to work by Marino, Welch and then-DEA head, Chuck Rosenberg. The Act revised and expanded the requirements for the DEA to issue an order denying, revoking or suspending a registration to a manufacturer, distributor or dispenser of controlled substances.

The New York Times

“[West Virginia] has been ravaged by opioid abuse.”

According to Center for Disease Control and Prevention information compiled by Vox, West Virginia has the worst opioid overdose death rate in the country: 33.7 deaths per 100,000 people.

NBC News

“Trump also said that he would formalize his Aug. 10 national emergency declaration by signing it and sending it to Congress this week.”

During the Rose Garden press conference, Trump mentioned he’d have a “big announcement” about the opioid issue next week, not this week. And when a reporter asked when he’d declare a “written national emergency,” Trump again said, “next week,” but he didn’t mention signing anything or sending anything to Congress.

NBC News

“[The bill] effectively handcuffed federal agents from going after the Big Pharma firms that flooded with (sic) the country with addictive opioids.”

The act revised and expanded the DEA’s requirements to issue an order denying, revoking or suspending a registration to a manufacturer, distributor or dispenser of controlled substances. In the U.S. there has been an increase in opioid use since the 1990s.

Fact Comparison

  • Facts in only 1 source
  • Facts in 2 sources
  • Facts in 3 sources
  • Facts in all sources

[Formalizing a national emergency declaration] would enable the executive branch to direct millions of federal dollars toward things like expanding drug treatment facilities and supplying police officers with the anti-overdose remedy naloxone. (NBC News)


While all the outlets analyzed mention Trump’s plan to declare the opioid issue a national emergency, only NBC News tells us what that declaration may actually do, which may help people better understand its significance.

Headlines

An article’s headline can direct how the news is understood. Compare and contrast how different outlets present the story through their headlines.

Blames Marino for the result of the bill he sponsored.

BBC doesn’t say how Marino “hindered” the opioid crackdown, which could leave his involvement open to the imagination. It would be more exact to specify that Marino sponsored a bill.

Makes a negative and inaccurate statement about the issue.

This headline inaccurately references Trump’s “new drug czar,” even though no one has been confirmed in the position. It also suggests Marino has done something that requires “explaining,” but MSNBC doesn’t “explain” what the issue is.

Leaves out that Marino withdrew himself from consideration.

CNN’s headline could be misinterpreted to mean Trump revoked Marino’s nomination.

Balance

Get the full picture! Don’t buy into cherry-picked information.

The media’s slant:
  • Tom Marino is a bad pick for running the Office of National Drug Control Policy (ONDCP) because he pushed the bill in question, which in turn fueled America’s opioid crisis.
  • Choosing Marino for this position shows Trump has bad judgment.
  • Trump hasn’t yet carried out his stated intention to declare a national opioid emergency, which is evidence that he’s failing to address the issue.
  • This is a very serious crisis that’s affecting the U.S. and the rest of the world.  Lawmakers like Marino and pharmaceutical companies conspired to pass legislation that allows drugs to be distributed illegally, and the government must step in.
What the media doesn’t explore:
  • His role in passing this legislation is only a piece of Marino’s background and experience, and he isn’t the only person responsible for its passage. Other qualifications may have made him a good candidate for the position.  
  • Trump made his choice before the report was released, and the law was passed before Trump took office — his nomination may not have been irresponsible.
  • There may be reasons why Trump hasn’t yet made the declaration, but that isn’t addressed in these articles.
  • Going after “Big Pharma” may limit the distribution of drugs, but it may also be effects management. Perhaps this issue can bring awareness to the opioid epidemic and to finding solutions that address the real cause: people choosing to use drugs for reasons other than pain management.

Context

Access information and historical data that provides a more comprehensive understanding of the story.

Understanding opioid abuse in the U.S.

When media outlets refer to opioid abuse as a “crisis” or “plague,” people may wonder about the extent of the problem and why it’s being described in such dramatic terms. Let’s take a look at some data on the issue.

When did this start?

The U.S. Center for Disease Control and Prevention (CDC) says doctors began prescribing opioids for non-cancer-related “chronic pain,” such as back pain and arthritis, in the late 1990s.

A recent lawsuit filed by Ohio’s Attorney General Mike DeWine argues that pharmaceutical companies began advertising the benefits of prescription opioids in the 1990s, creating promotional materials that denied or “trivialized” the risks and “overstated” the benefits of opioid use. The Atlantic notes similar lawsuits filed by attorneys general in Illinois, Mississippi, four counties in New York, the Cherokee Nation and Santa Clara and Orange Counties in California.

In a separate case in 2007, drug company Purdue Pharma, makers of OxyContin, pleaded guilty to misleading the public about the drug’s addiction risk. During that case, U.S. Attorney for the Western District of Virginia John Brownlee argued that Purdue directed its sales representatives to falsely claim that OxyContin had less potential for addiction and abuse than other painkillers, after the company learned from focus groups with physicians in 1995 that doctors had concerns about patients misusing the drug.

How much has opioid use increased?

The number of opioids prescribed per person in 2015 was three times higher than the amount prescribed in 1999, per the CDC.

Information compiled by Vox shows an increase in opioid-related deaths from drug overdoses since 1999:

 

1999

2007

2016

Natural and “semi-synthetic” opioids

2,749

8,158

14,550

Heroin

1,960

2,399

15,564

Fentanyl and other synthetic opioids

730

2,213

19,547

According to Vox, the numbers for 2016 are preliminary estimates, and some deaths may overlap if they involved multiple drugs.

Vox also reported CDC data that indicates more than 64,000 people died of drug overdoses in the U.S. last year. Of these, synthetic opioids, heroin and common opioid painkillers “topp[ed]” other causes of overdose. Vox adds, “That’s a higher death toll than guns, car crashes, and HIV/AIDS ever killed in one year in the US, and a higher death toll than the entirety of US military casualties in the Vietnam and Iraq wars combined.”

Why has opioid use increased?

Many factors may contribute to the increases. The aforementioned articles say that pharmaceutical advertising, third-party groups advocating for pain management, healthcare costs, a lack of access to pain management alternatives (such as physical therapy and acupuncture), and limited funding for rehab programs may have contributed to the increase in opioid use. The articles do not mention the individual motivations that drive substance abuse.

What has the U.S. government done?

The CDC advocates several ways to reduce opioid abuse, such as only prescribing them when the so-called benefits outweigh the potential risks, prescribing only enough to cover the expected duration of pain, and starting with a low dose of “immediate-release” opioids. The CDC says a dose of 50 “morphine milligram equivalents” or MME doubles the risk of opioid overdose death, compared to a dose of 20 MME.

In 2014, the DEA relabeled “hydrocodone combination products” (HCPs), which are considered opiates, from Schedule 3 to Schedule 2. Drugs categorized as Schedule 2 are considered substances with “the highest potential for harm and abuse,” that also have accepted medical uses. The DEA defines Schedule 3 drugs as having “moderate to low potential for physical and psychological dependence.”

The 21st Century Cures Act, signed into law in December 2016, provided funding for states affected by opioid use. According to Vox, the funding is intended to help monitor prescription drug use, increase opioid abuse and overdose prevention training, change prescribing practices and increase access to addiction treatment.