Carole
Revealed: how drug firms 'hoodwink' medical journals
http://www.guardian.co.uk/medicine/story/0%2C11381%2C1101706%2C00.html
Pharmaceutical giants hire ghostwriters to produce articles
- then put doctors' names on them
Antony Barnett, public affairs editor Sunday December 7,
2003 The Observer
Hundreds of articles in medical journals claiming to be
written by academics or doctors have been penned by
ghostwriters in the pay of drug companies, an Observer
inquiry reveals. The journals, bibles of the profession,
have huge influence on which drugs doctors prescribe and the
treatment hospitals provide. But The Observer has uncovered
evidence that many articles written by so-called independent
academics may have been penned by writers working for
agencies which receive huge sums from drug companies to plug
their products.
Estimates suggest that almost half of all articles published
in journals are by ghostwriters. While doctors who have put
their names to the papers can be paid handsomely for
'lending' their reputations, the ghostwriters remain hidden.
They, and the involvement of the pharmaceutical firms, are
rarely revealed.
These papers endorsing certain drugs are paraded in front of
GPs as independent research to persuade them to prescribe
the drugs.
In February the New England Journal of Medicine was forced
to retract an article published last year by doctors from
Imperial College in London and the National Heart Institute
on treating a type of heart problem. It emerged that several
of the listed authors had little or nothing to do with the
research. The deception was revealed only when German
cardiologist Dr Hubert Seggewiss, one of the eight listed
authors, called the editor of the journal to say he had
never seen any version of the paper.
An article published last February in the Journal of
Alimentary Pharmacology , which specialises in stomach
disorders, involved a medical writer working for drug giant
AstraZeneca - a fact that was not revealed by the author.
The article, by a German doctor, acknowledged the
'contribution' of Dr Madeline Frame, but did not admit that
she was a senior medical writer for AstraZeneca. The article
essentially supported the use of a drug called Omeprazole -
which is manufactured by AstraZeneca - for gastric ulcers,
despite suggestions that it gave rise to more adverse
reactions than similar drugs.
Few within the industry are brave enough to break cover.
However, Susanna Rees, an editorial assistant with a medical
writing agency until 2002, was so concerned about what she
witnessed that she posted a letter on the British Medical
Journal website.
'Medical writing agencies go to great lengths to disguise
the fact that the papers they ghostwrite and submit to
journals and conferences are ghostwritten on behalf of
pharmaceutical companies and not by the named authors,' she
wrote. 'There is a relatively high success rate for
ghostwritten submissions - not outstanding, but consistent.'
Rees said part of her job had been to ensure that any
article that was submitted electronically would give no
clues as to the origin of the research.
'One standard procedure I have used states that before a
paper is submitted to a journal electronically or on disc,
the editorial assistant must open the file properties of the
Word document manuscript and remove the names of the medical
writing agency or agency ghostwriter or pharmaceutical
company and replace these with the name and institution of
the person who has been invited by the pharmaceutical drug
company (or the agency acting on its behalf) to be named as
lead author, but who may have had no actual input into the
paper,' she wrote.
When contacted, Rees declined to give any details. 'I
signed a confidentiality agreement and am unable to
comment,' she said.
A medical writer who has worked for a number of agencies
did not want to be identified for fear he would not get any
work again.
'It is true that sometimes a drug company will pay a medical
writer to write a review article supporting a particular
drug,' he said. 'This will mean using all published
information to write an article explaining the benefits of a
particular treatment.
'A recognised doctor will then be found to put his or her
name to it and it will be submitted to a journal without
anybody knowing that a ghostwriter or a drug company is
behind it. I agree this is probably unethical, but all the
firms are at it.'
One field where ghostwriting is becoming an increasing
problem is psychiatry.
Dr David Healy, of the University of Wales, was doing
research on the possible dangers of anti-depressants, when
a drug manufacturer's representative emailed him with an
offer of help.
The email, seen by The Observer, said: 'In order to reduce
your workload to a minimum, we have had our ghostwriter
produce a first draft based on your published work. I
attach it here.'
The article was a 12-page review paper ready to be presented
at an forthcoming conference. Healy's name appeared as the
sole author, even though he had never seen a single word of
it before. But he was unhappy with the glowing review of the
drug in question, so he suggested some changes.
The company replied, saying he had missed some 'commercially
important' points. In the end, the ghostwritten paper
appeared at the conference and in a psychiatric journal in
its original form - under another doctor's name.
Healy says such deception is becoming more frequent. 'I
believe 50 per cent of articles on drugs in the major
medical journals are not written in a way that the average
person would expect them to be... the evidence I have seen
would suggest there are grounds to think a significant
proportion of the articles in journals such as the New
England Journal of Medicine, the British Medical Journal and
the Lancet may be written with help from medical writing
agencies,' he said. 'They are no more than infomercials paid
for by drug firms.'
In the United States a legal case brought against drug firm
Pfizer turned up internal company documents showing that it
employed a New York medical writing agency. One document
analyses articles about the anti-depressant Zoloft. Some of
the articles lacked only one thing: a doctor's name. In the
margin the agency had put the initials TBD, which Healy
assumes means 'to be determined'.
Dr Richard Smith, editor of the British Journal of Medicine,
admitted ghostwriting was a 'very big problem' .
'We are being hoodwinked by the drug companies. The articles
come in with doctors' names on them and we often find some
of them have little or no idea about what they have
written,' he said.
'When we find out, we reject the paper, but it is very
difficult. In a sense, we have brought it on ourselves by
insisting that any involvement by a drug company should be
made explicit. They have just found ways to get round this
and go undercover.'
http://www.guardian.co.uk/medicine/story/0%2C11381%2C1101706%2C00.html
Pharmaceutical giants hire ghostwriters to produce articles
- then put doctors' names on them
Antony Barnett, public affairs editor Sunday December 7,
2003 The Observer
Hundreds of articles in medical journals claiming to be
written by academics or doctors have been penned by
ghostwriters in the pay of drug companies, an Observer
inquiry reveals. The journals, bibles of the profession,
have huge influence on which drugs doctors prescribe and the
treatment hospitals provide. But The Observer has uncovered
evidence that many articles written by so-called independent
academics may have been penned by writers working for
agencies which receive huge sums from drug companies to plug
their products.
Estimates suggest that almost half of all articles published
in journals are by ghostwriters. While doctors who have put
their names to the papers can be paid handsomely for
'lending' their reputations, the ghostwriters remain hidden.
They, and the involvement of the pharmaceutical firms, are
rarely revealed.
These papers endorsing certain drugs are paraded in front of
GPs as independent research to persuade them to prescribe
the drugs.
In February the New England Journal of Medicine was forced
to retract an article published last year by doctors from
Imperial College in London and the National Heart Institute
on treating a type of heart problem. It emerged that several
of the listed authors had little or nothing to do with the
research. The deception was revealed only when German
cardiologist Dr Hubert Seggewiss, one of the eight listed
authors, called the editor of the journal to say he had
never seen any version of the paper.
An article published last February in the Journal of
Alimentary Pharmacology , which specialises in stomach
disorders, involved a medical writer working for drug giant
AstraZeneca - a fact that was not revealed by the author.
The article, by a German doctor, acknowledged the
'contribution' of Dr Madeline Frame, but did not admit that
she was a senior medical writer for AstraZeneca. The article
essentially supported the use of a drug called Omeprazole -
which is manufactured by AstraZeneca - for gastric ulcers,
despite suggestions that it gave rise to more adverse
reactions than similar drugs.
Few within the industry are brave enough to break cover.
However, Susanna Rees, an editorial assistant with a medical
writing agency until 2002, was so concerned about what she
witnessed that she posted a letter on the British Medical
Journal website.
'Medical writing agencies go to great lengths to disguise
the fact that the papers they ghostwrite and submit to
journals and conferences are ghostwritten on behalf of
pharmaceutical companies and not by the named authors,' she
wrote. 'There is a relatively high success rate for
ghostwritten submissions - not outstanding, but consistent.'
Rees said part of her job had been to ensure that any
article that was submitted electronically would give no
clues as to the origin of the research.
'One standard procedure I have used states that before a
paper is submitted to a journal electronically or on disc,
the editorial assistant must open the file properties of the
Word document manuscript and remove the names of the medical
writing agency or agency ghostwriter or pharmaceutical
company and replace these with the name and institution of
the person who has been invited by the pharmaceutical drug
company (or the agency acting on its behalf) to be named as
lead author, but who may have had no actual input into the
paper,' she wrote.
When contacted, Rees declined to give any details. 'I
signed a confidentiality agreement and am unable to
comment,' she said.
A medical writer who has worked for a number of agencies
did not want to be identified for fear he would not get any
work again.
'It is true that sometimes a drug company will pay a medical
writer to write a review article supporting a particular
drug,' he said. 'This will mean using all published
information to write an article explaining the benefits of a
particular treatment.
'A recognised doctor will then be found to put his or her
name to it and it will be submitted to a journal without
anybody knowing that a ghostwriter or a drug company is
behind it. I agree this is probably unethical, but all the
firms are at it.'
One field where ghostwriting is becoming an increasing
problem is psychiatry.
Dr David Healy, of the University of Wales, was doing
research on the possible dangers of anti-depressants, when
a drug manufacturer's representative emailed him with an
offer of help.
The email, seen by The Observer, said: 'In order to reduce
your workload to a minimum, we have had our ghostwriter
produce a first draft based on your published work. I
attach it here.'
The article was a 12-page review paper ready to be presented
at an forthcoming conference. Healy's name appeared as the
sole author, even though he had never seen a single word of
it before. But he was unhappy with the glowing review of the
drug in question, so he suggested some changes.
The company replied, saying he had missed some 'commercially
important' points. In the end, the ghostwritten paper
appeared at the conference and in a psychiatric journal in
its original form - under another doctor's name.
Healy says such deception is becoming more frequent. 'I
believe 50 per cent of articles on drugs in the major
medical journals are not written in a way that the average
person would expect them to be... the evidence I have seen
would suggest there are grounds to think a significant
proportion of the articles in journals such as the New
England Journal of Medicine, the British Medical Journal and
the Lancet may be written with help from medical writing
agencies,' he said. 'They are no more than infomercials paid
for by drug firms.'
In the United States a legal case brought against drug firm
Pfizer turned up internal company documents showing that it
employed a New York medical writing agency. One document
analyses articles about the anti-depressant Zoloft. Some of
the articles lacked only one thing: a doctor's name. In the
margin the agency had put the initials TBD, which Healy
assumes means 'to be determined'.
Dr Richard Smith, editor of the British Journal of Medicine,
admitted ghostwriting was a 'very big problem' .
'We are being hoodwinked by the drug companies. The articles
come in with doctors' names on them and we often find some
of them have little or no idea about what they have
written,' he said.
'When we find out, we reject the paper, but it is very
difficult. In a sense, we have brought it on ourselves by
insisting that any involvement by a drug company should be
made explicit. They have just found ways to get round this
and go undercover.'
