What we have been calling "Medical education and communications companies" (MECCs) on this side of the pond seem to be called "publication planning agencies" in the UK, but other than that there does not seem to be any trans-Atlantic difference.
The Guardian blogger discovered a considerable degree of what some would call chutzpah among the "publication planners" he spoke with. They talked about providing a real service and moving their activities from the realm of marketing into the realm of science. (Remember the drug rep's, and the physician apologist's, chorus: "It's not marketing, it's education"?) They spoke of a new level of openness in their activities.
All of which was quickly debunked by various expert commentators. The replies included:
- Dr Leemon McHenry, medical ethicist at California State University: "They've just found more clever ways of concealing their activities. There's a whole army of hidden scribes. It's an epistemological morass where you can't trust anything."
- Alastair Matheson, British medical writer: the planners' claims to having reformed are "bullshit...The new guidelines work very nicely to permit the current system to continue as it has been. The whole thing is a big lie. They are promoting a product."
So just what is going on here? My interpretation: Demands for disclosure appear in this case actually to have backfired, to some degree. The ghostwriters and their handlers used to work strictly in the dark. It then became obvious to them that the very fact that they operated out of sight gave credence to charges that they were up to no good. So they decided that the wiser strategy was to pretend to come out into the daylight. They talk more openly about what they do and crow about what a valuable service it is, thereby creating an aura of transparency.
But there is still no real transparency. They say that they simply "help" the academic guest author to write the paper, when in actuality, it's the same ol' same ol'--the company-directed ghostwritwer writes a detailed draft and if anything, the academic (who's of course "too busy" to be bothered with the whole thing, except to pocket his fee) maybe changes a few words here and there to keep up appearances. And what ends up published is the company's chosen spin, with the academic credibility of the supposed author and his institutional affiliation pasted on. What is never disclosed is the actual amount and type of work on the manuscript that the "ghost" and the "guest" each contributed, or what each was paid by the drug company for their deeds.
Two lessons here--first, demanding disclosure, rather than an end to nefarious practices, may not be a half-way step toward a solution but actually a regressive step. Second, when enough money is involved, expect quick adaptation to new realities, but no basic change in behavior or attitudes.