Tilting at Straw Windmills: Medical Writers Defend Pharma

I'm grateful to Dr. Michael Altus, a frequent contributor of thoughtful comments, for sending me a copy of the December 2013 issue of Medical Writing, the journal of the European Medical Writers Association (available to members only according to the website). The major theme of the issue is "Good Pharma" and the various authors, most of whom express pride in working for the pharmaceutical industry, want to defend that industry from the unfair slings and arrows recently aimed in its direction. I'll focus on just a few of the articles, which sadly suggest that these folks would rather defeat straw men, or tilt at windmills, or choose your cliché, than take on seriously the criticisms raised by us pharmascolds. (I'll mention one possible exception at the end.)

Two editorials, by Adam Jacobs and Wendy Kingdom, set the tone. The points they jointly make should be very familiar and by now quite threadbare:

• The drug companies have admittedly committed some misdeeds, which no person of good character would want to defend.
• On balance these misdeeds are heavily outweighed by all the good done by the industry.
• A few bad apples work for the industry, but most of the employees are decent, hardworking people.
• The tight regulations under which the industry functions leave little room for any of the misdeeds alleged by critics.

Perhaps the most ridiculous would-be defense of the industry is this, from Kingdom: "In the particular case of the pharmaceutical industry, the company's medical director is at personal risk of criminal prosecution for any breaches of the advertising code, which is an effective incentive (if one were needed) for ensuring that any claims made in marketing materials can be substantiated."

Now, as Dr. Roy Poses over at Health Care Renewal has gone blue in the face repeating, and as this blog in its own humble way has tried to confirm, count up all the times in the last decade that a drug firm has been found to be criminally responsible for marketing practices. Then count up the number of individual executives in those firms that have suffered any criminal penalties whatsoever, personally. (Hint: You don't need the fingers of any hands to do this.) So whence comes this nonsense that drug execs run any personal risk of punishment for false marketing? Mostly they seem instead to be at risk for higher bonuses.

Another straw man thrown into the mix is that maybe it's just that we pharmascolds are ignorant of basic human biology. We apparently don't realize that it's the case that drugs have possible side effects. So when, unfortunately, a patient suffers from one of these side effects, we decide immediately that the industry is evil.

Now, it's one thing to say that unfortunately, good prescription drugs have occasional, ideally rare, side effects. It's quite another thing, as we've recently discussed, to address the sobering data suggesting that prescription drugs, taken correctly, might be the 4th or even the 3rd leading cause of death in the U.S. That latter possibility is nowhere addressed or even hinted at by these highly skilled medical writers.

To add a bit of scholarly heft, the issue includes a piece by a professor of English in the U.S., Robert Blaskiewicz, who has studied conspiracy theories. He characterizes the current wave of attacks on the drug industry as a typical conspiracy-theory exercise. I read through the piece looking for evidence of conspiratorial thinking from any of the prominent pharmascold writers that I've had occasion to quote in this blog, but found none. Eventually Prof. Blaskiewicz gets around to giving a concrete example of what he has in mind--the claim that the industry has actually discovered cures for dread diseases like cancer, but has suppressed these cures so that they can go on selling today's generation of expensive, imperfect drugs. I agree that such thinking counts as conspiracy theory, but I cannot recall any legitimate pharmascold ever making any such claim. To find fault with today's drug industry, you hardly need to go to such lengths.

I promised that I'd get around to something a bit more substantive. An article by Art Gertel accuses those of us who complain about ghostwriting of medical journal articles being simply out of date--he claims that these practices have effectively been dealt with and essentially are no more. I can see a potential justification for such a claim. Since drug firms don't exactly take out ads to announce ghostwriting, the way such practices commonly come to light is through legal discovery of company insider documents during litigation, and such litigation commonly addresses activities that were carried out several years earlier. If, in fact, ghostwriting is now a thing of the past, it would probably take the rest of us a while to find out that this was so--especially if we are inclined, for what I believe are solid reasons, to distrust the public proclamations of the industry as to its own bona fides.

As an apparent counterpoint to Gertel's piece, the magazine reprints the only true pharmascold, scholarly paper in the collection--one we reviewed previously, by Stern and Lemmens proposing legal remedies for ghostwriting (http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001070). Now, if what Gertel says is true, then Stern and Lemmens, who presumably looked into the issue at some length, would have had no reason for writing their paper. Be that as it may, I will try to contact Gertel and see if he can provide any backup for his claims, and if so will pass the word.