A frustrated listener asked if NPR had a financial deal with a supplement-testing group mentioned in a story about the health benefits of red rice yeast.
Consumer Health reporter Allison Aubrey's July 1 story looked at how the dietary supplement, red rice yeast, contains an active ingredient which can "naturally" lower cholesterol and may work as well as prescription statin drugs.
Aubrey relied on cardiologist Dr. David Becker who had done a study with a small sample of people. The study was published in the peer-reviewed journal Mayo Clinic Proceedings. Becker gave the prescription drug Zocor to 35 patients and a medically certified dose of red rice yeast to a similar size group.
The goal of the study was to compare the cholesterol-lowering effects of Zocor versus red rice yeast.
"And after 12 weeks, the results were virtually indistinguishable," said Becker.
"Meaning patients in both groups significantly reduced their cholesterol levels, especially the bad type of cholesterol called low-density lipoproteins (LDL)," said Aubrey in her piece.
The LDL in both groups dropped about 40 percent. But patients who took red rice yeast didn't have leg cramps, a common side effect with statin drugs. The results suggested that instead of consumers buying prescription drugs, they may have a less expensive and easier way to deal with cholesterol problems.
"If you were very anxious to avoid cholesterol medications or if you had side effects from those medications, then this might be an alternative," said Becker.
But Becker's study does not provide conclusive proof that switching from statin drugs to red rice yeast is the answer for all, or even most, people who need to reduce their cholesterol. And making that switch is not simple.
The potency and purity of red rice yeast varies depending on the manufacturer. Since dietary supplements are not regulated, consumers have no way of knowing if the supplement has enough of the main active ingredient to be as effective as a statin drug. The story made these problems clear.
But here's where NPR listener Wendell Cox saw a problem.
To judge the purity of the supplements, Aubrey turned to a new study by the for-profit website, ConsumerLab.com. The supplement-testing company evaluated 10 brands of red rice yeast and found "shocking differences in concentrations of the main active ingredient called lovastatin," said Aubrey.
Cox, of Bethesda, Md., wanted to know which manufacturer had the purest amount of lovastatin. He went to the ConsumerLab.com website. But he had to pay $30 to subscribe to get study results.
"I find the piece by Allison Aubrey on red rice yeast sets the listener up to enroll as a paid member at ConsumerLab.com to get the 'answer' regarding the manufacturer of a quality product," wrote Cox. "This is a hustle and Ms. Aubrey should be busted. Shame on you!"
Cox raises a complex issue. Should Aubrey just have said that commercial testing of red rice yeast indicates inconsistent amounts of lovastatin and not mentioned ConsumerLab.com?
"The point of introducing Cooperman's quality data is to point out to the consumers that you can't trust all supplements," said Aubrey in an email. "Sometimes they don't contain what the bottle says they contain. This is a long-standing problem with all supplements since they're not regulated the way pharmaceuticals are regulated by the FDA. That's why independent analysis by groups like Cooperman's can be helpful."
Should Aubrey have told listeners that it would cost money to find out which manufacturers in ConsumerLab.com's study tested best?
"In response to [the listener's] concern that we should have pointed out that it's a fee-service, I take his point," noted Aubrey. "But it's a bit of damned if you do, damned if you don't. If you come out and tell listeners they can pay for the information on ConsumerLabs.com, then it can feel like an advertisement. If you don't mention it, then it can feel to some as an error of omission."
An option might be for NPR to provide the link to the ConsumerLab.com study. But that's not possible for two reasons. First, the for-profit company sells its information and has strict rules about sharing results after a report is purchased. Second, Neel said NPR has a policy against providing a direct link to any subscription services.
I asked Joe Neel, the Science desk's deputy senior supervising editor about what to do when proprietary websites are mentioned on air. He said that in the past NPR has occasionally mentioned that ConsumerLab.com is a fee-based service, but he also agrees with Aubrey that it is a no-win situation.
He noted that it is analogous to medical journals often cited in NPR's science stories.
"Most of the time, when we say something has been published in Science magazine, that article is available by subscription only," Neel wrote in an email. "We don't provide links to Science magazine (or other journals) unless it's a situation where the journal is making the information publicly available. So a listener like this one, who wants to check us out, will have to pay to do that."
So what is the solution? As much as possible, NPR should err on the side of transparency. Tell the listener upfront that the cited information comes from a fee-based website, and that NPR cannot share the results because it is proprietary.
The key information in the red rice yeast story is that consumers cannot trust the manufacturer's label. It would have been helpful if NPR could have provided which brands are most effective. But if listeners really want the information, then they will have to pay for it.
It's not unlike Consumer Reports. NPR may do a story during this time of extraordinarily high gas prices and mention that the magazine has a top-five list of the most-fuel efficient cars. You may be able to get the cars' names but if you want detailed information, you must pay $5.95 for a report.
Following NPR's policy, the Ombudsman too will not link to ConsumerLab.com.