Another Clue on Ghostwriting Frequency

Danny Carlat's psychiatry blog (http://carlatpsychiatry.blogspot.com/, Sept. 1) recently pointed us to a New York Times article on industry CME practices:

http://www.nytimes.com/2009/09/02/business/02drug.html?_r=1&adxnnl=1&adxnnlx=1251838845-J5/IxNnWvo4N2o82Oz1ICQ

In turn, Dr. Carlat provided the link to the document that had been circulating in U.S. Senate committee on which the Times article had been based--the secret Forest Labs Lexapro marketing strategy report for FY04:

http://www.nytimes.com/packages/pdf/politics/20090831MEDICARE/20090831_MEDICARE.pdf

Now, I have not had time to study all the 88 pages of this document, and if I do, I may have more to report on CME and other issues (remember, I do have a day job). But in giving it a quick skim, I was struck by one passage that might be pertinent to the debate over ghostwriting that we've been attending to in recent posts. The questions we want to ask include: is the incidence of ghostwriting going down recently as new rules and regs come into play? Is the incidence of ghostwriting really as high as some claim (David Healy, the Welsh psychiatrist, saying that just about every paper on psychopharmacotherapy is ghostwritten until proven otherwise)?

Here is a brief snippet from the Lexapro marketing plan (p. 24 of the PDF on-line file; pages in the original are not numbered):

"Bylined Articles. Bylined articles will allow us to fold Lexapro messages into articles on depression, anxiety and co-morbidity developed by (or ghostwritten for) thought leaders. We will identify a Lexapro thoughtleader to place 2-3 bylined articles in trade journals, consumer publications and on the Internet. ... Budget: $100,000"

The way I read this passage is that on the one hand, the list of publications does not include medical professional/scientific journals, and so one could defend the company by saying they have a different policy for those publications. On the other hand, the suggestion I am forced to from this passage is that the ghostwriting of articles, and giving them to thought leaders to sign their name to, is a completely everyday, unremarkable, ho-hum practice within the company, not worth a second glance. Which in turn seems to suggest that as recently as 2004 we could have expected ghostwriting to be a major part of the marketing campaign for any drug from this company.

Incidentally, just a quick reminder about what drug we are talking about. Forest's older drug, Celexa, was about to go off patent. Lexapro is the active stereoisomer of Celexa--meaning that chemically it is virtually identical. It is the "me too" drug par excellance. The big marketing push for Lexapro was primarily aimed at getting those who wrote for Celexa prescriptions in the past to switch their brand loyalty to the new, and much more expensive drug rather than start writing prescriptions for cheaper, but equally effective generics. In other words, a massive rip-off.