Armstrong worked at the Wall Street Journal from 2000 through 2009. He was among the first journalists to report on the influence of pharmaceutical and medical device companies, as well as other businesses, on the practice of medicine and the resulting harm to patients. He reported on a range of other topics as well. He was part of the Journal team awarded the 2002 Pulitzer Prize for coverage of the September 11 terrorist attacks.
A series of reports revealed the harm caused by a novel and much touted spinal surgery product and the role of doctors paid to promote it. These payments took the form of everything from consulting arrangements to trips to resorts to entertainment at strip clubs. In the wake of the Journal stories, the Department of Justice launched an investigation of the spine product’s maker, the big medical device company Medtronic.
In a front-page story and several ensuing stories, Armstrong showed how the Cleveland Clinic, its chief executive and some of its doctors invested in companies whose medical devices were being tested and used on its own patients. One patient’s death was blamed on a heart-lung machine that the clinic touted in press releases – without mentioning its financial ties. Nor did the clinic and some doctors reveal to patients their financial interest in a device that the federal Food and Drug Administration has three times rejected for use in heart patients, and that has been linked to several deaths in other hospitals.
The articles – followed and cited by many prominent media outlets, including a column by Paul Krugman in the New York Times – stirred so much outrage that the clinic overhauled its conflict of interest policies and became one of the first institutions in the country to publicly list the financial ties of its doctors to drug companies and device makers.
In A Surgeon Earns Riches, Enmity By Plucking Profitable Patients, Armstrong examined the phenomenon of doctor-moguls who start their own niche hospitals offering only selective, lucrative procedures, in competition with existing non-profit community hospitals that treat all comers. The article focused on neuro-surgeon Larry Teuber, who realized a $9 million payday by opening a hospital for orthopedic and neuro-surgery in Rapid City, S.D. Meanwhile, the nearby community hospital struggled to staff critical areas like child psychiatry as it lost patients and revenue to its for-profit competitor.
This story – How Some Doctors Turn a $79 Profit From a $30 Test – showed how doctors manipulated the reimbursement system for simple tests.
For many of his articles in this area, Armstrong was able to unearth closely guarded documents, financial reports and confidential contracts that had never come to light. So secretive are many of the arrangements he exposed that major insurers, fraud investigators and government overseers were unaware they existed. As a senior fraud investigator for Blue Cross Blue Shield wrote to Armstrong, “Thank you for your articles and keep them coming…Your articles have proven to be a welcome exercise to challenge my thinking and ensure that I am approaching every angle of an investigation.”
The industry itself recognized the value of Armstrong’s reporting. The National Health Care Anti-Fraud Association organized a conference to discuss the issues raised in his article, MRI and CT Centers Offer Doctors Way to Profit on Scans.The article documented that physicians were profiting from deals to steer patients to centers conducting tests in the booming medical imaging field. In California, one company told a group of doctors they could clear $525,200 a year for referring just two patients a day for an imaging test known as a PET scan. If they referred 10 patients a day, the profit increased to $2.6 million.Citing the Journal article, federal health officials moved to crack down on PET scan referrals, creating a new rule to prevent doctors in many cases from profiting from these arrangements.
Armstrong has also unveiled a troublesome side to the staid world of medical journals that results in the promotion of biased findings, the publication of incomplete information and a lack of disclosure about important conflicts of interest. In some cases, these shortcomings resulted in the promotion of potentially dangerous drugs or treatment regimens, or advocated costly approaches that are no better than less expensive alternatives.
In a front-page story,Financial Ties to Industry Cloud Major Depression Study, Armstrong uncovered the financial relationships of the researchers behind a groundbreaking study that warned pregnant women who stopped taking anti-depressant medication were at a greater risk of relapsing into depression. The findings overturned a long-held notion that hormonal changes during pregnancy protected women from depression. What the researchers didn’t disclose was that almost all of them were on the payrolls of the companies that make the drugs highlighted in the study. In all, the doctors from institutions like Massachusetts General Hospital, UCLA and Emory, failed to disclose more than 60 different financial relationships with drug companies. After the story, the Journal of the American Medical Association published a correction to the study and changed its policy to demand more information from researchers about their conflicts of interest. A week later, Armstrong broke the story of an important omission at another medical publication, the journal Neuropsychopharmacology. In that case, the journal published a favorable review of a controversial new treatment for depression in which a small device is implanted in the patient’s chest. The journal failed to note that the eight academic researchers who authored the review were consultants to the company making the device. One of those consultants – noted psychiatrist Charles Nemeroff – was also the editor of the journal. After the article, he resigned that position.
Armstrong’s reports on these matters were picked up and carried in newspapers and medical journals across the country. On July 23, a New York Times editorial called for medical journals to ban authors who fail to disclose their conflicts, citing “two disturbing cases…described in detail by the Wall Street Journal in recent weeks.” The reports also prompted the ranking member of the House committee overseeing the Food and Drug Administration to urge that “decisions impacting the health care marketplace must be based on objective information devoid of conflict of interest.”
Armstrong also delved into the operations of the world’s foremost medical journal, the New England Journal of Medicine. In How the New England Journal Missed Warning Signs on Vioxx, Armstrong exposed how the publication moved to discredit a study it published on the painkiller Vioxx only after it became clear embarrassing details about its handling of that matter were about to become public. Among the details: The journal was paid hundreds of thousands of dollars by Vioxx maker Merck & Co. to reprint copies of the controversial study. In addition, the New England journal knew early on that the study was flawed, but waited several years to publicly express concern about the work. Armstrong’s report prompted international reaction, including an editorial in the Journal of the Royal Society of Medicine that said the New England Journal’s handling of the Vioxx matter “raised doubts about its integrity and dovetailed with a growing anxiety about the ethics of medical journals.”
In reports on another famous medical journal, Armstrong revealed how the the editors of JAMA threatened a researcher who exposed the failure by the author of a study in the medical journal to report he had been paid by a drug company. JAMA later sought a probe of its own actions.
Armstrong has also reported extensively on how expert witnesses defending corporations exploit medical and scientific journals to create a record that supports the positions of their clients. The story headlined Hard Case_ When Academics Double as Expert Witnesses detailed how a law firm defending siren makers from hearing loss claims by firefighters worked with a university researcher to get a study published downplaying a link between the sirens and hearing problems.
In Amid Suits Over Mold, Experts Wear Two Hats, Armstrong revealed how defense experts took the lead in drafting a scientific statement from a medical society denying a link between mold and many health ailments.
Armstrong’s work at the Journal goes beyond the healthcare industry.
He has written several of the newspaper’s famed ahed columns – such as these: Olympic Torchbearer_ an Honor Reserved for the Worthy — Mostly and Prep Schools Getting Slam Dunked Want Easier League of Their Own.
He has investigated abuses of vulnerable persons, such as disabled air travlers – Discrimination by Airlines Remains A Problem for Disabled Travelers; autistic children – Lauded School for Autism Draws Charges of Abuse, and disabled workers – Malingerer Test Roils Personal-Injury Law.
In Suit Batters Penney Shares, But Serves Short-Sellers Well, Armstrong showed how the stock of big department store JC Penney was manipulated by a carefully orchestrated lawsuit whose allegations proved false.
The work of a low-profile Dutch bank in helping U.S. companies like General Electric Co., Merck & Co save huge sums on their taxes through questionable shelters was exposed in Netherlands bank funded tax shelters for U.S
Some of the first doubts about the muched hyped Segway scooter were raised in this front-page story – Lobbying Campaign Could Seal Fate of Kamen’s Hyped Scooter.
This story –What Does a Noncompete Pact Truly Bar_ Nasty Row Sorts It Out– reveals how big records storage company Iron Mountain employed private detectives and an indicted businessman to go after a former board member it suspected of starting a competing business.
Another story looked at the big pharmacy chain CVS Caremark, which solicited donations from pharmaceutical suppliers like GlaxoSmithKline and Barr Laboratories to support a charity event favored by the CVS chief executive. The donations raised conflict of interest concerns, with some employees saying companies who contributed to the event were favored over those who didn’t.
For a complete index of my work at the Wall Street Journal, click here: Wall Street Journal – Complete List