Saturday, August 22, 2009

Read 'Em and Weep: Wyeth Ghostwriting Documents Released by Journal

In previous posts I referred to documents released as a result of the lawsuits against Wyeth for their hormone replacement therapy, that showed the concerted campaign that company used to place ghostwritten articles praising HRT products in medical journals. Up till now, thanks to a couple opf media sources, we had ready access only to some of the pile of documents. The journal PLoS Medicine has just released the entire stock of documents, said to be about 1500 pages: Sadly these are as yet unindexed so anyone trying to sort through them will have to do so manually, though there are plans to create an index.

In an accompanying editorial,, the journal pulls no punches:

What’s clear is that ghostwriting can no longer be considered one of the “dirty little secrets” of medical publishing that nothing can be done about. While editors, medical schools, and universities have turned a blind eye to, or at the least failed to tackle head-on the pervasive presence of ghostwriting, drug companies and medical education and communication companies have built a vast and profitable ghostwriting industry. Recruitment of academic “authors” appears, within some academic circles, to have come to be considered acceptable, and marketing campaigns are no longer orchestrated around paid display advertisements but instead center on “evidence” provided by seemingly respectable academic review articles, original research articles, and even reports of clinical trials. What, a cynical reader might ask, can I truly trust as being unbiased? The answer is that, sadly, for some or even many journal articles, we just don’t know.

Till now, when the topic of ghostwriting comes up, journal editors mostly wring their hands and pass the buck. Of course it's unethical, egregious, and generally horrible, but what can we do? We can't play private eye and investigate every paper that's submitted to us. We are helpless if the academic institutions at which the "ghost authors" work fail to take strong action and allow these transgressions to continue. Not so fast, says PLoS Medicine:

But journal polices should also include enforceable sanctions. For example, if nothing is declared on submission but inappropriate involvement of a medical writer subsequently comes to light, any papers where this breach is substantiated should be immediately retracted and those authors found to have not declared such interest should be banned from any subsequent publication in the journal and their misconduct reported to their institutions.
In the case of the documents deposited here, a good start, and a signal of the seriousness of journals’ intent, would be the formal retraction of all the papers mentioned in which ghostwriting has been conclusively shown. Institutions whose academics are shown to be involved should investigate as a matter of urgency.

It's scary, isn't it, to think that even in the past when ghostwriting has been proven, the journal has not even gone so far as to retract the paper formally? (Not that that justifies the inaction of the academic institution who either does nothing or else slaps the hand of the ghost author, who's usually locally revered for having brought all that drug company cash into the med school coffers.)

The editorial ends with some observations that are pondered all too seldom (especially the last sentence):

Whatever the reasons, as the pipeline for new drugs dries up and companies increasingly scramble for an ever-diminishing proportion of the market in “me-too” drugs, the medical publishing and pharmaceutical industries and the medical academic community have become locked into a cycle of mutual dependency, in which truth and a lack of bias have come to be seen as optional extras. Medical journal editors need to decide whether they want to roll over and just join the marketing departments of pharmaceutical companies. Authors who put their names to such papers need to consider whether doing so is more important than having a medical literature that can be believed in. Politicians need to consider the harm done by an environment that incites companies into insane races for profit rather than for medical need. And companies need to consider whether the arms race they have started will in the end benefit anyone. After all, even drug company employees get sick; do they trust ghost authors?

(Thanks to Dr. Adriane Fugh-Berman for this tip.)

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