Since I’m on the topic of Big Pharma, here’s another eye-opener, this time from the WSJ Blog, about a physician who was offered sole authorship of an abstract for research she never even conducted.
In fact, she had never heard of the drug until receiving the email pitch…“We can draft the abstract, offer our editorial support in developing the content of the abstract and help with the submission process on your behalf,” wrote Liz Burtally, who identifies herself in the email as a medical writer “for the nebivolol team working with Forest Laboratories.”
Sealey asked a lot of questions. Would she be the only author? Yes, she says she was told. When Sealey asked if she would have access to the raw data, the phone went dead. Burtally never called or emailed again.
It’s called Ghost-Writing, and it’s much more common than you think. (Via Hooked: Ethics, Medicine and Pharma. A blog by Howard Brody, MD, author of a book with the same title.)
For those interested in the topic, here’s a little primer on Ghost-Writing from Health Care Renewal Blog,
… ghost-writing practice is common, perhaps accounting for as many as 10% of journal articles. Moreover, stealth marketing campaigns that emphasize ghost-writing may create a bolus of articles that may be enough to dominate the literature on particular topics.
According to a recently published scholarly review on the subject –
In the three years that Healy and Cattell examined, approximately 57% (55 of 96) of all published articles on Zoloft in the peer-reviewed medical literature had originated from Current Medical Directions (A Medical Communications Company engaged by Pfizer – TBTAM) . Not only did the articles from Current Medical Directions outnumber the traditionally authored articles, they appeared in higher-impact journals. Perhaps most significantly, the citation rate for athe articles produced by Current Medical Directions was over five times higher than the citation rate for the traditionally authored articles.
And finally, from Plos, a free article on the topic by Sergio Sismondo –
… during key marketing periods as many as 40% of published articles focusing on specific drugs are ghost managed [24]. Even if the more typical figure is half that, ghost management exerts a huge force on the shape of scientific opinion on new drugs, and does so in the service of marketing.
Makes reading the literature a real challenge these days. I’ve personally taken to looking at the conflict statements before I even read an abstract. But it’s almost impossible to know if an article has been ghostwritten. Peer review does not pick it up. We have to rely on the journal editors to get stricter about forcing disclosure of every single person who contributes to a manuscript.
Maybe it’s time to call in the big guns. Let’s sing together, shall we?
In the research study
Who we gonna’ call?
GHOSTBUSTERS!
If the meta analysis
Don’t look quite right
Who we gonna’ call?
GHOSTBUSTERS!
I ain’t afraid of Big Pharma
I ain’t afraid of Big Pharma…
The parody is GREAT – one suggestion though…who ya goin’ call? T-B-TAM!
If there is something strange
in the data points
who ya goin’ call?
T-B-TAM!
On some level, to greater or lesser degrees, patients are aware of this kind of skullduggery (and it is skullduggery). It’s part of patients’ increasing distrust of their doctors, part of much of the noncompliance with treatment, and part of patients turning to woo (alternative medicine).
Of COURSE, most doctors aren’t sold out to the drug companies (why do the journals sell out so easily?), but how are we to know? Even if not, then are our doctors influenced by the skullduggery when it is published in journals they rely on for information?
I have had the good fortune to be blessed with mostly truly excellent doctors over the decades of my life and my children growing up. Those doctors deserve, as we patients deserve, honest research and honest published reports on research. Those who participate in the dishonesty do no one any real service at all.
As a practicing physician, this revelation is revolting. It is much more upsetting than a drug rep giving me a free lunch/dinner or a few pens with the drug name on it to use. I know ahead of time to take whatever information they give me with a grain of salt. MD’s rely on journals ( esp well known reputable ones) for a scientific evaluation of various treatments and diagnostic tests. One of the first things I do is look at the author affiliations before I examine the abstract and methods. I usually assume that the authors listed have had some real input into the study design, data collection, and analysis. Now knowing that may not be the case is tantamount to ” poisoning the water”. I will be reluctant to drink from the ” wells drilled by the journals”, so to speak, ever again. It is so sad, medicine ( and American life in general) has become dominated by multinational corporations that have no real regard for the populace as a whole. I took an oath to help my patients, now I don’t know if the info I’m getting to help them is real or bogus.
Schruggling 🙂
Anonymi – You both have it right. And Anonymous#2 says it best – this is just so sad for all of us.
But how does one practice ethically in a profession whose ethics seem to be dissolving?
Your profession needs to take a forward look at this and force vetting on each publication and physician. I recommend some kind of third party vetting process or certification process related to the quality of data and conclusion. Similar to the ISO program for industry, you can be subject to third party audits to maintain acreditation.
If a doc is accreditted for publication, that should carry a lot of weight with respect to ethics…
Just a thought.
Schruggling-
You bring up good points, as always. Ghostwriting is a two way street between big pharma and docs who are willing to let their names be used on publications they did not write.
Both sides should be ashamed.
Whatever you do, don’t cross the streams. What happens when you cross the streams. You don’t want to know.