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For the small health care company, it sounded almost too good to be true: James Earl Jones would introduce a short educational video about its work, which would be distributed to public television stations and could be viewed by as many as 60 million Americans.

“It was gonna go out into the PBS community, and we [were] gonna get all of this visibility, and millions of people were gonna see it,” said Denise Kalos, the chief executive officer of the company, Affirmativ Health, which develops personalized care plans for patients with Alzheimer’s.

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It didn’t pan out like she had hoped.

The arrangement worked this way: The Florida production company organizing the deal, Education Alliance, would produce the segment for public television at no charge for a series called “Front Page,” one of several public television series it produces. Affirmativ Health would serve as a “content expert” for the public television video, according to a contract reviewed by STAT.

As a “special thanks,” the production company would also create a five-minute corporate video with interviews, graphics, and narration, and a one-minute “commercial segment” that would be broadcast twice during prime-time hours on a big-name network and hundreds more times with regional airings during prime-time on networks including CNN, CNBC, and the Family Channel.

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That part had a price tag. The corporate video and commercial came with an “underwriting fee” of $23,900, which included the cost of placing the commercial on TV — plus an extra $3,500 “location fee” to shoot at Affirmativ’s California headquarters.

“It all sounded very exciting,” Kalos told STAT.

The contract said the “short-form documentary” would be distributed to public television stations across the country in late 2017. Stations could air the segment “for unlimited broadcast” — but that decision was at each station’s discretion.

But after Affirmativ Health taped its segment, when Kalos tried to figure out which public stations had aired it — or whether those 60 million Americans had actually tuned in — the production company wasn’t able to provide those details, Kalos said. And the introduction from James Earl Jones turned out to be more generic than Kalos imagined.

A STAT examination found that producers for shows created by Education Alliance persistently pitch health care and biotech businesses, as well as startups and established companies in other industries, touting sky-high viewership numbers and implicit celebrity endorsements from the likes of James Earl Jones, Laurence Fishburne, and Rob Lowe, all of whom have hosted such public television segments created by the company.

But several of the health care companies who spoke with STAT said their experiences didn’t live up to their hopes. Some, like Kalos, aren’t sure who saw the public television segments. Others said they didn’t see any spikes in traffic to their websites, or any sales come their way from people who had seen the segments.

Education Alliance didn’t respond to a request for comment, but lawyers for “Information Matrix with Laurence Fishburne” — one of the shows Education Alliance produces — said they’re clear with potential clients about which parts of their work are paid and which aren’t, and what the potential return on their investment will be.

Nearly all of the companies that spoke with STAT, some of whom worked with Education Alliance and some that worked with others, said they would not participate in the shows again. Several said their money might be better spent on more targeted marketing efforts.

“I can’t say that I’ve ever seen it done and [heard someone] say, ‘Here was the [return on investment] on this, and it was worth it,’” said Jennifer Wlach, a public relations professional at Mercury, a firm that advises health companies. Wlach was speaking broadly about a litany of pitches from different shows, including some produced by Education Alliance.

Shows that produce paid content and free educational programming for the same clients have been around for years.

The shows produced by Education Alliance generally take a multipronged approach: A single project with a company might include an “educational” short-form public television segment, along with a “value added” components such as a one-minute commercial that will air on network television, a 5- to 6-minute corporate video the company can use, and an email campaign to target its audience. The “value added” components come with an “underwriting fee” or a “production fee.”

The public television part of the deal is technically unpaid, in accordance with standards for public television. But some PR professionals said it’s not always clear from producer’s pitches whether a company needs to do a “value added component” if they want to get on public TV. The initial emails from some producers sometimes “disguise the ask,” as one PR professional put it — the first feelers don’t make it clear that there’s a cost involved.

“It shouldn’t be portrayed as a news segment when there’s a cost involved. There’s something that muddies the water when you say, ‘I work for a news program and I wanna tell your story for the low, low fee of $59,000.’” said Wlach, again speaking broadly about her sense of pitch emails from more than one production company.

Traditional journalism outlets do not pay sources for interviews or their expertise, or charge experts money for the chance to be featured in a program or a story. PBS, which acquires and distributes content for public television, says its “policies prohibit producers from requesting fees or accepting cost reimbursement from the subjects of its programming.”

Not every company that works with shows that produce both educational programming and paid content pays for those “value added” components. A lawyer for “Information Matrix” said that the show also works with companies who only take part in segments that are akin to public service announcements. In those cases, the work is pro bono, the company said.

Shows that have both a public television segment and paid components are careful to delineate in contracts that the two are totally separate, even if some of the initial pitch emails reviewed by STAT are not so clear.

“Information Matrix is an educational documentary-style program which runs on public television, is broadcast as educational news breaks on CNN, CNBC, FOX Business, Discovery, etc. and is distributed on the Internet via narrow-casting,” an “Information Matrix” producer writes in an email to a preclinical company.

Others are clearer about the multipronged approach, but not as direct about what the underwriting cost supports.

“Our team produces a three pronged approach for each educational series. The piece for Public Television runs for one year, reaching 60 million households. The second segment runs nationally primetime on CNBC and the third is an online video email campaign laser targeted to an opted in audience of up to 1,000,000 people by demographics. The underwriting cost is $23,500,” an assistant to a producer for “Information Matrix” writes in another email to a preclinical cancer company.

The pitch emails frequently play up the “educational” aspect of the deal — and the sets of the public television segments, too, emphasize that point. During the introduction for an “Information Matrix” public television segment, Fishburne strolls onto a dark set and takes a seat in a velvety wingback chair, a bronze globe and a stack of old (or at least old-looking) books on a side table next to him.

Behind him, on a big screen, blares a single word: Health.

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It’s difficult to determine how likely it is that a given educational segment will air on public television. Though the segments can run on public television stations if the stations choose to pick them up, the actual production companies aren’t affiliated with PBS. The public broadcasting service has even put out a string of statements over the years to correct that misconception, and hosts a page on its website about the lack of a connection.

In the contract reviewed by STAT, “Front Page” said that by “using the A.C. Nielson [sic] formula of averages,” it estimates that each segment “receives multiple airings” on public television stations.

It’s not clear how often health care companies get pitched on the programs — or how often they end up paying to be a part of them. Some biotech and health care PR professionals said they might only see a pitch or two every few months, while others said clients pass on the pitch emails as often as every week. One said she had two clients working in two different industries receive nearly identical pitches in the same day.

Dorrian Horsey, the lawyer representing “Information Matrix,” said the show “conducts extensive research into story development to avoid blindly sending out ‘cold’ emails” and that “most new clients are secured through referrals and word of mouth from other satisfied clients.”

In some cases, other production companies with a similar approach have aggressively pushed back on perceived criticism of their marketing tactics and business models. In 2008, Vision Media, a Florida production company that created public TV segments with former news anchor Hugh Downs, sued a blogger for $20 million after she called its business model “a scam.” The company ultimately dismissed the complaint, and the blogger took down her posts.

The shows are part of a broader landscape of paid programming on television, from infomercials to paid interviews. They don’t all operate in both the public television and commercial spaces. Some shows, such as “Worldwide Business with Kathy Ireland,” operate solely as branded content, in which a company simply pays to be featured on a television program.

Health care companies are also pitched on the opportunity to go on paid shows like Ireland’s, which airs as sponsored content on Fox Business Network and Bloomberg. Ireland enthusiastically interviews guests, expressing excitement over their products or progress. The website for Ireland’s show touts a “global distribution” that has “a potential of over 275 million households across the world.” Worldwide Business with Kathy Ireland did not respond to multiple requests for comment.

When Wise Hospice Options decided to pay for a segment on “Worldwide Business with Kathy Ireland,” it was told the potential audience was in the millions, according to Zach Williams, a business development manager at the hospice consulting company.

The company monitored its social media accounts and website for an uptick in followers or page views after the segment aired in December 2018, but didn’t see any dramatic spikes. And there was no way to tell if the message reached the company’s ideal audience: the key decision-makers for hospice systems.

“We didn’t get the response we were hoping for,” Williams said. He added that the company had not received much “specific sales traffic” from the video.

But the company enjoyed working with the show’s producers, he said. And it wasn’t a wash — Wise Hospice Options put out a press release about the segment’s airing to build brand recognition and regularly uses the video for conferences.

Some companies said the experience came with the option for upcharges. Williams said the show’s staff asked Wise Hospice Options if they’d like to pay more to secure a better airtime or a longer interview, but the company didn’t take them up on the offer.

Another health care company executive told STAT he had barely wrapped up his interview with Kathy Ireland when he was whisked to a backstage room where he said Champagne flutes and a bottle of Champagne were waiting. The executive — who asked to remain anonymous to speak openly about his experience — said his company had already paid for a 12-minute spot. But now, the show’s staff told the executive that there was so much good material, the segment deserved more time — which would, in turn, cost more money.

“It was like we were buying a Rolls Royce. It was the hardest close I think I’ve ever experienced,” said the executive.

Though her contract with “Front Page” didn’t promise a specialized introduction from James Earl Jones about Affirmativ Health, Kalos was under the impression the star would mention her company — and was disappointed to find the segment received only a generic lead-in from the star, she said. The production company later repackaged the same segment online with a new introduction from Laurence Fishburne, which was similarly vague, and posted it on the “Information Matrix with Laurence Fishburne” website.

“The field of health care is constantly changing and improving. … It takes the vision of determined thought leaders to determine the next big breakthrough, as we’re about to see,” Laurence Fishburne says in the introduction to the Affirmativ Health public television segment posted on the show’s website.

Despite her frustration with not being able to get information about who saw the segment, Kalos said she has been able to use the corporate video to promote the company. But she said that money might have been better spent on other marketing efforts.

“I’m glad I have the video. It’s up on YouTube. It wasn’t a $23,000 video,” Kalos said.

For other companies, the experience was well worth the cost. Louise Morland, communications and marketing director at Translational Research Institute in Australia, said the email from producers for a show that is also produced by Education Alliance couldn’t have come at a better time. The institute — which connects clinicians and researchers — had been hoping to do a corporate video.

The producers would provide not just that, but also a segment that would be distributed on public television and air twice on major news networks.

“The email was pretty incredible, a million households or something like that,” Morland said. She said the company paid roughly $32,000, which Morland said “wasn’t bad,” given that the institute might expect to pay the same amount to have a corporate video filmed and edited. Morland said she and her colleagues were happy with the final product and have rolled out the segment frequently at conferences. They also saw a spike in traffic to the TRI website in June 2016, when the segment aired on Fox Business Network.

Morland said that the decision to go on the show came down to a simple cost-benefit analysis. It was less about being featured on a public television segment, and more about the value of having a highly produced company video.

“Even though they sort of approach you with the documentary thing, [that it’s] education, it’s still a company that’s producing these things for a cost and marketing them,” she said. “If you went into it thinking this was some sort of philanthropic or goodwill gesture, you probably had the wrong idea.”

Public relations professionals said it’s up to each company to decide whether taking part in segments that come with a fee is worth their time and money. But some said they advise their clients against doing so, largely due to the costs and concern about whether that investment will pay off.

Some who work in the health care industry told STAT they don’t expect the pitches to slow down as health care and biotech startups proliferate — and as more funding floods the industry.

“When you have that amount of investment happening and that amount of movement and progress, everyone wants to talk about their story,” Wlach said. “So people are going to come out and say ‘I can help you tell [your] story.’”

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