More from Carl Elliott, on Crybaby Companies

In case you haven't had your daily serving of Carl Elliott, here is a recent piece on the Bioethics Forum blog from the Hastings Center:
http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=4931&blogid=140#ixzz12IGpz6PB

Target for Elliott's ire is Wyeth, whose practices were in turn the target of a recent article by Adriane Fugh-Berman in PLoS Medicine (addressed in the post, http://brodyhooked.blogspot.com/2010/09/new-review-of-ghostwriting-for-selling.html). Wyeth sent a nasty letter to the journal taking righteous umbrage at Dr. Fugh-Berman's failure to disclose fully her own conflicts of interest. She stated that she had been paid as an expert witness in anti-Wyeth litigation. The letter's accusation: that she failed to say that she was still being paid as an expert witness.

Elliott adds up Wyeth's known misdeeds--first off, working as hard as it did to conceal the risks and harms related to its diet pill combo, Fen-Phen; and more recently, the ghostwriting of papers promoting hormone therapy--and compares them to Fugh-Berman's track record--using the wrong verb tense--and finds that the scales of justice tip over pretty heavily against Wyeth.

I myself might not have been quite as quick with the verbal barbs as my esteemed colleague Carl. Those of us who throw stones in the conflict-of-interest arena need to be prepared to receive similar missiles hurled back at us, and must do our level best to be squeaky-clean, both to maintain needed credibility and also to serve as good examples of ethical behavior. (Anyone old-fashioned enough to remember what that was all about?) Dr. Fugh-Berman quite appropriately admitted the use of incorrect verb tense and corrected the record in response to Wyeth's letter:
http://www.plosmedicine.org/annotation/listThread.action?inReplyTo=info%3Adoi%2F10.1371%2Fannotation%2F9615f3f1-520f-43cd-a825-8afcab3c26d4&root=info%3Adoi%2F10.1371%2Fannotation%2F9615f3f1-520f-43cd-a825-8afcab3c26d4

Open Letter to a Medical School Dean: Do You Condone Ghostwriting?

TO: Peter S. Amenta, MD, PhD
Dean
Robert Wood Johnson Medical School

Dear Dean Amenta:

I am forced to write to you as a result of the New York Times article today in which a member of your faculty--a department chair in fact--is quoted as taking a position on the ghostwriting of medical journal articles that I hope you'll feel obligated to repudiate:

http://www.nytimes.com/2009/08/05/health/research/05ghost.html?_r=2&hp=&pagewanted=all

The Times article states that court-released documents list 26 Wyeth ghostwritten papers that were published in 18 journals. Ideally I would be addressing a letter such as this to the deans of all medical schools involved. However, a search of the web as of midday today did not yield access to the full list of putative authors, and so the name of your faculty member is currently the only one that I know.

Do I enjoy pointing fingers at my colleagues in academic medicine in public? Hardly. Do I have any personal animosity against you or any member of your faculty? Not at all. But I am forced to write this for two reasons, one general and one specific.

The general reason is that, while academic medical leaders and journal editors continue to condemn ghostwriting as an ethically indefensible practice, it remains virtually impossible to discover a single academic physician who has been caught putting his or her name to a ghostwritten article, and then suffered any adverse consequences whatsoever. If this is a crime without any punishment attached, how can the general public possibly take us seriously when we proclaim our ethical stance? So much as we shrink from making examples of some of our colleagues, how else are we to establish that this truly is a serious business and that we mean what we say?

There is a more specific reason in this case. Dr. Gloria A. Bachmann, professor and interim chair of your department of Obstetrics, Gynecology and Reproductive Sciences, was reported by the Times to have affixed her name to a paper written by a PR firm hired by Wyeth, and published in 2005 in the Journal of Reproductive Medicine. Copies of e-mails from 2003, released with other documents by the court overseeing lawsuits against Wyeth for the marketing of their hormone replacement therapy, show that Dr. Bachmnn agreed to affix her name as sole author to the paper after making one correction only to the manuscript.

Dr. Bachman, on being contacted by the Times, might have said many things. She might have apologized for her lapse of good ethical practice. She might have noted how common ghostwriting has been among her circle of academic physicians, and how recent have been vocal objections to the practice--so that the standards of behavior in 2009 might not be the same as in 2003.

Dr. Bachman said none of these things. Instead she staunchly defended her behavior:
“There was a need for a review article and I said ‘Yes, I will review the draft and make sure it is accurate,’ ” Dr. Bachmann said in an interview Tuesday. “This is my work, this is what I believe, this is reflective of my view.”

So I am now forced to ask you for your position as Dean of the medical school. Do you agree with Dr. Bachmann, that it is perfectly all right for your faculty to attach their names to articles in medical journals that they did not write, so long as the article is accurate and they agree with the views expressed therein? Do you believe that would be the position of the journal editor? Do you intend to advise Dr. Bachmann that her publicly stated position is at odds with the ethical values of your medical school? (I attempted to consult your school's conflict of interest policy to see if there were specific provisions about ghostwriting, but your policy appears to be password protected to exclude non-RWJMS readers.)

Those of us who believe that some degree of public trust in medicine hangs in the balance are concerned to hear your answers.

Sincerely,
Howard Brody, MD, PhD