By Dr. Mercola
One of the more flagrant offenses committed by pharmaceutical companies and the medical profession is the practice of "ghostwriting" medical articles.
A new cross-sectional survey found that more than 20 percent of articles published in six leading medical journals during 2008 were likely written by honorary- and/or ghost writers.
This is lower than it was in 1996, but still far too common for comfort.
For medical journals, ghostwriting usually refers to writers sponsored by a drug or medical device company, who make major but uncredited research- or writing contributions.
The articles are instead published under the names of academic authors.
Such "inappropriate authorship" leads to a lack of transparency and accountability, which has become an important concern for the academic community.
According to the article in the British Medical Journal:
"Inappropriate authorship (honorary and ghost authorship is an important issue for the academic and research community and is a threat to the integrity of scientific publication.
Our findings suggest that 21 percent of articles published in 2008 in the general medical journals with the highest impact factors had an inappropriate honorary author, and that nearly eight percent of articles published in these journals may have had an unnamed important contributor.
The highest prevalence of both types of inappropriate authorship occurred in original research articles, compared with editorials and review articles.
...Both honorary and ghost authorship are unacceptable in scientific publications, and each form of inappropriate authorship has important consequences.
...Honorary authorship has implications for scientific integrity... Likewise ghost authorship has important implications and consequences. If un-identified authors are involved in the work and manuscript preparation, readers not only will be unaware of the contributions, perspectives, and affiliations of these individuals, but also may not appreciate the influence or potential underlying agenda these individuals may have on the reporting of material in the article (such as may occur with ghost authors employed by industry)."
Ghost Writing in Medical Journals
According to the featured BMJ article, previous studies have found the prevalence of honorary authors to be as high as 39 percent, and the prevalence of ghost authors as high as 11 percent in a range of biomedical journals and types of articles.
Why exactly is this practice so bad?
While hiring a ghost writer to add flair to your prose is not a major problem in most writing situations, hiring professional wordsmiths to ghost write a medical study or drug review is a whole different ballgame.
In this case, the pharmaceutical company hires a medical education and communications company or MECC, which is a company paid almost exclusively by pharmaceutical companies to write articles, reviews, and letters to editors of medical journals to cast their products in a favorable light. (Since they pay substantial amounts to have these articles written, it automatically implies that it will be written to their specifications.)
Once the article is written to their satisfaction, the pharmaceutical company then starts "shopping around" for an academic physician or physicians that are well known in the field, encouraging them to put their name on the article.
From there, they "massage" the article past peer review in one of the more prestigious medical journals, preferably one that strongly influences practicing doctors. Once the article is published, the pharmaceutical company then purchases tens of thousands of reprint copies to be distributed to doctor's offices by their pharmaceutical representatives. The unsuspecting doctor thinks the study is reliable since it clearly appears to be written by a leading name in the field, and has been published in a prestigious peer-reviewed medical journal.
Why would medical journals play along with this apparent sham? Why aren't they doing more to ferret this practice out?
Perhaps the primary incentive to play it loose is that it's very lucrative for them, as the reprints purchased by the pharmaceutical companies for distribution are quite expensive. And medical journals are, after all, for-profit businesses.
How Ghostwritten Medical Articles Can Impact Your Health
Unfortunately, the practice of employing ghostwriters can have very serious ramifications for your health. For example, an August 4, 2009 New York Times article reported how Wyeth Pharmaceutical Company used this ghostwriting practice to successfully peddle hormone replacement therapy in women. Physicians prescribed these drugs based on 26 studies published in the medical literature, affirming the benefits and downplaying the risks of hormone replacement.
As a result, sales of Premarin and Prempro soared.
However, all the papers turned out to have been written by ghostwriters hired by Wyeth, and many women have since sued the drug maker for health problems suffered from these drugs.
By now many of you will be well aware of the fact that there's a big difference between industry-funded research and independent research. The source of funding tends to play a major role in the final outcome of any study. Needless to say, if a pharmaceutical company pays to have research written up, you can be fairly certain they're going to want their drug portrayed in a favorable light. When your doctor bases his prescribing decisions on such biased (or worse) information, your health can clearly be at risk...
Other examples of pharmaceutical companies paying authors to write up favorable articles for their wares include:
- Parke-Davis (acquired by Pfizer in 2004)—Neurontin. Parke-Davis contracted with a medical education communication company (MECC) to write articles in support of the drug to the tune of $13,000 to $18,000 per article. In turn, MECC paid $1,000 each to friendly physicians and pharmacists to sign off as authors of the articles, making the material appear independent.
Last year, Pfizer was found guilty of violating U.S. racketeering laws by illegally promoting off-label uses of Neurontin, and were fined more than $142 million in damages.
- Pfizer—Zoloft. A document was written that included 81 different articles promoting Zoloft's usefulness for everything from panic disorder to pedophilia. The only problem was, for some articles, the name of the author was still listed as "to be determined," even though the article was listed as already completed.
- Wyeth-Ayerst—Redux. Wyeth paid $20,000 for an article on the "therapeutic effects" of their diet pill, Redux (dexfenfluramine). As detailed in the book Our Daily Meds, Dr. Richard Atkinson, a professor at the University of Wisconsin was to receive $1,500 in return for putting his name to the finished piece. An excerpt from Our Daily Meds reads:
"When the article was complete, Dr. Atkinson sent a letter to Excerpta, praising the ghostwriter's work. "Let me congratulate you and your writer on an excellent and thorough review of the literature, clearly written," the doctor wrote. "... Perhaps I can get you to write all my papers for me! My only general comment is that this piece may make dexfenfluramine sound better than it really is."
A year later, the drug was pulled from the market as doctors began reporting heart valve injuries in as many as one-third of patients taking the drug. Redux, Pondimin (a similar drug), and fen-phen (of which dexfenfluramine was a part) were later linked to dozens of deaths.
- Merck—Vioxx. This deadly drug, which was eventually blamed for some 60,000+ deaths, was also linked to a number of shameful scandals relating to fraudulent studies and the use of ghostwriters to boost sales. The New England Journal of Medicine admittedly published an erroneous and biased Vioxx study, and the Annals of Internal Medicine found itself in similar hot water when one of the "authors" of a 2003 Vioxx study confessed he had little to do with the research.
Is Modern Medicine Backed by Scientific Principles?
One of the biggest complaints the conventional medical industry has against alternative medicine is the lack of scientific research to support their practices.
Ironically, much of the research on conventional medicine has also raised speculations over validity issues, such as the use of ghostwriters, or worse, purposely withholding negative studies from publication, while republishing the same study in multiple journals—another industry no-no that happens quite frequently.
While it is commonly believed that modern medical treatments, including drugs, are "scientifically proven," in reality nothing could be further from the truth. Last year, Dana Ullman published an excellent article on this misconception, stating:
"The British Medical Journal's "Clinical Evidence" analyzed common medical treatments to evaluate which are supported by sufficient reliable evidence (BMJ, 2007). They reviewed approximately 2,500 treatments and found:
- 13 percent were found to be beneficial
- 23 percent were likely to be beneficial
- Eight percent were as likely to be harmful as beneficial
- Six percent were unlikely to be beneficial
- Four percent were likely to be harmful or ineffective.
- 46 percent were unknown whether they were efficacious or harmful"
I have enormous respect for the scientific method, and I think when it is done properly it can clearly provide us with profound and valid truths that can guide and direct our understanding of nature and help us improve our health. However, the primary challenge is to confirm that the study in question is free of any conflict of interest that would pervert the results and the meaning of the analysis. And ghostwriting can be particularly troublesome as that financial tie is rarely ever disclosed.
It's unfortunate, but the conventional medical model, from start to finish, is pervasively corrupted with massive conflicts of interests that make it exceedingly difficult to make a rational decision in health matters. The scientific method works but it has been so perverted by corporate interests, that it becomes very difficult to find the truth. This is why it is all the more important to do your own research, and to take control of your own health and return to the basics of disease prevention.