What do the US Food and Drug Administration, the advocacy group Corporate Accountability International, and the investigative journalism outlet ProPublica have in common? All three have used crowdsourcing, a technique for gathering information from multiple sources using a variety of new media, to monitor health-related practices of corporations. In this article, CHW reviews these efforts, and explores the advantages and challenges of using crowdsourcing to gather information about corporate practices.
The Food and Drug Administration’s Bad Ad Program
In May 2010, the Food and Drug Administration (FDA) introduced its “Bad Ad Program” in which doctors are trained to identify misleading or untruthful pharmaceutical ads, and then report them by email or phone to the FDA. Until now, FDA’s enforcement effort relied on a few dozen staffers to review hundreds of pharmaceutical ads, brochures, and presentations voluntarily submitted by companies or reported to the agency by drug industry personnel. Upon discovery of misleading or untruthful information, the FDA sends warning letters to companies, but given the burden of review and the limited staff, letters have often not been sent until long after the ad has reached its market.
“The Bad Ad Program will help health care providers recognize misleading prescription drug promotion and provide them with an easy way to report this activity to the agency,” said Thomas Abrams, director of FDA’s drug advertising division. Pharmaceutical Research and Manufacturers of America (PhaRMA), the lobbying group that includes the many of the world’s largest drug manufacturers, including Pfizer, Merck & Co. and GlaxoSmithKline, said in a statement that it supported the effort as “another step to help educate—and receive feedback from—health care providers about prescription drug advertising and promotion.”
Drug makers spend about $20 billion per year to promote their products in medical journal ads, information booths at medical conferences and multimillion dollar TV ad campaigns. About $4 billion of industry spending is used for direct-to-consumer advertisements. These campaigns have been associated, in some cases, with heavy use of what were later found to be dangerous drugs, such as Vioxx, a pain reliever, and Avandia, a drug used to control diabetes.
Corporate Accountability International’s Retire Ronald Campaign
In its recent campaign to persuade McDonald’s Corporation to retire Ronald McDonald and its advertising specifically targeting children, Corporate Accountability International (CAI) used crowdsourcing to encourage members and advocates to report sighting of Ronald to help CAI analyze how and where the company was using Ronald and also to engage and motivate parents and advocacy groups to join their campaign. The responses showed that Ronald was appearing in schools, hospitals, and community centers around the country, often mixing philanthropy, public relations, and marketing, and gave CAI “a better sense of just where and how he was hooking kids on unhealthy food.”
ProPublica’s Distributed Reporting Project
After BP promised to create a $20 billion fund to reimburse individuals, businesses, and others damaged by its oil spill,ProPublica, the online investigative journalism outlet, decided to investigate whether BP was living up to the commitments it had made to reimburse claims quickly, fairly, and transparently. Those who had filed a claim with BP were asked to complete an online survey, widely distributed by a variety of print and online media. Later, when Ken Feinberg took over the administration of the reimbursement fund, ProPublica expanded its investigation to monitor his activities. In 2010, ProPublica received a Knight-Batten Award for Innovations in Journalism for its Distributed Reporting Project that had systemized “the process of crowdsourcing, conducting experiments, polishing their process and tasking citizens with serious assignments.” When the group created its Reporting Network in 2009, ProPublica writer Amanda Michel explained, “By collaborating directly with the public, we aim to deliver a greater range of information. E-mail, cell phones, instant messenger, ProPublica.org and social networking sites such as Facebook are our tools. Questions that hold public figures and those in power accountable are our guides.”
The Advantages and Challenges of Using Crowdsourcing
Crowdsourcing has its origins in corporate America. In 2006, Jeff Howe and Mark Robinson first wrote about crowdsourcing in Wired magazine. Howe defined it as “the act of a company or institution taking a function once performed by employees and outsourcing it to an undefined (and generally large) network of people in the form of an open call. This can take the form of peer-production (when the job is performed collaboratively), but is also often undertaken by sole individuals. The crucial prerequisite is the use of the open call format and the large network of potential laborers.” In recent years, companies have used crowdsourcing to design ad campaigns, choose winners in corporate contests, and conduct market research.
For health researchers, advocates, and regulators, crowdsourcing has some distinct advantages. For researchers, it can provide access to a wider range of sources and respondents than traditional survey or focus group research. It can also reduce participant burden by using familiar technologies and media such as the Internet, cell phones, or social media to elicit responses, and by allowing participants to respond when and how they choose. For advocates, as illustrated by the Retire Ronald campaign, crowdsourcing can help to describe a phenomenon and to mobilize people to take action. Those who reported sightings of Ronald were contacts for community action in subsequent phases of the campaign. For regulators, as the FDA’s Bad Ad Campaign shows, crowdsourcing can help to overcome limited staff and resources, and give an agency a wider sample of problem practices. Crowdsourcing allows all users to apply mapping and other techniques to analyze data. Moreover, reported data can be posted online, allowing corrections or amplifications, or triggering additional responses from those who have encountered similar problems, a digital snowball sample.
Crowdsourcing may be especially relevant to monitoring corporate practices because it can help level the playing field—adding new eyes and ears to organizations that seldom have the resources of their corporate targets. Imagine a system in which consumers who purchase faulty products, community witnesses to violations of pollution laws, or viewers of misleading or untruthful advertisements could send an email or text message, or make a phone call to a readily available site that could display all reports geographically and by topic in real time?
Like any method, crowdsourcing also poses challenges. The results can vary from a collection of anecdotes to systematic data; each has its purposes but collectors of crowdsourced information need to determine the valid uses based on the purpose and the response. In addition, some reports may come from disgruntled but not wronged customers or from businesses trying to gain an edge on their competitors by filing false charges. However, any reporting system has these perils and police and other agencies have developed strategies to assist in distinguishing between valid and bogus reports. Finally, crowdsourcing is a complement to, not a substitute for, other investigative strategies. Researchers still need to collect systematic data from a defined sample, organizers still need the face-to-face encounters that lead to political mobilization, and regulators still need full-time enforcement agents to ensure that reports of wrongdoing are investigated and prosecuted as needed. At best, crowdsourcing can become a new tool to expand and deepen other forms of investigation.
In the last few decades, multinational corporations have led the world in finding new applications for science, technology, and emerging media. Viral marketing, neurocognitive research to understand and influence consumer choices, and data mining of public databases to gain commercial insights are all examples. If public health researchers, officials, and advocates want to protect population health, they will need to master these technologies. Such mastery is a prerequisite both to regulate their use by corporations and to find new uses to advance public rather than private interests. By learning about crowdsourcing and applying it to monitor corporate practices, the public health community can fulfill its professional mandate of promoting the health of the public.
Nicholas Freudenberg is Founder and Director of Corporations and Health Watch and Distinguished Professor of Public Health at Hunter College, City University of New York.