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Cognitive Dissonance on Pharma Ghostwriting

April 17th, 2008 @ 5:37 pm

1 Comment

Tags: Physician, Agent, Health Care, Health Care Facility, Vertical Industries, Benefits, Healthcare, Real Estate, Enterprise Software, Software

Yesterday’s news on Merck’s prolific use of ghostwriters to produce medical-research articles yielded lots of coverage, much of it highly critical. Still, there was a fair bit of cognitive dissonance in the media, which couldn’t seem to decide if Merck’s actions amounted to venial or mortal sins.

Nowhere was the gulf wider than between two national, New York-based papers, one of which is effectively at war with the other. From the NYT:

NYT on Merck Ghostwriting

And from the WSJ:

WSJ on Merck Ghostwriting

Hmm. Was Merck corrupting medical science or merely possessed of questionable “publishing ethics”? Gosh, that is a tough call.

Meanwhile, the WSJ Health Blog today also flagged the fact that two “heavy hitting” Harvard doctors blasted a Massachusetts bill that would ban drug-industry gifts to physicians. Should the ban pass, it would be the first of its kind in the U.S. To its credit, the WSJ noted that one of the docs, Massachusetts General Hospital chief of medicine Dennis Ausiello, holds a seat on Pfizer’s board, so he’s not exactly disinterested. What the blog doesn’t mention is that the other, blood-cancer specialist Thomas Stossel, is also a longtime critic of any attempt to regulate doctors’ ties to industry. (For a sample, see his 2005 Forbes essay, titled “Free the Scientists!“)

To make their case, which appeared in the Boston Herald, these worthy academics were reduced to thoroughly misrepresenting the Massachusetts bill. To Stossel and Ausiello, the “real intent” of the bill is to “curtail strictly or even eliminate all contacts between physicians and private industry.” Of course, the bill says no such thing, and in fact its relevant passages are brief enough to quote in their entirety:

            Section 2.  No pharmaceutical manufacturer agent shall knowingly and willfully offer or give to a physician, a member of a physician’s immediate family, a physician’s employee or agent, a health care facility or employee or agent of a health care facility, a gift of any value and no physician, a member of a physician’s immediate family, a physician’s employee or agent, a health care facility or employee or agent of a health care facility shall knowingly and willfully solicit or accept from any pharmaceutical manufacturer agent, a gift of any value.

Section 3.  A person who violates this chapter shall be punished by a fine of not more than $5,000 or by imprisonment for not more than 2 years, or both.

Ausiello and Stossel argue that banning gift-giving — which, by the way, skews doctor prescribing behavior as well as potentially corrupting medical care and research — would eliminate the flow of information between drugmakers and physicians. But no one is saying communication should stop, just that deep-pocketed companies shouldn’t get to grease the skids with unrestricted “educational” grants, free meals, sports tickets, trips and the like.

Should the gift ban become law, drug reps would remain free to make a case for their products on the merits. Whether docs would still want to listen to them is the truly interesting question.

A 14-year veteran of the Wall Street Journal, David P. Hamilton is BNET's Industries editor. Prior to coming to BNET, David founded the LifeScience section of VentureBeat, a news site for the innovation and venture business.

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    More Than GhostWriting

    Published on www.brainblogger.com

    The Human Injury of Lost Objectivity

    If I were to rate the corruptive tactics performed by big pharmaceutical companies during my intimate experience with them , the intentional strategy of implementing fabricated and unreliable results of clinical trials performed by others possibly top the list, as they often were sponsored by a pharmaceutical company. By this atrophy of the scientific method absent of authenticity, harm and damage is possibly done to the health of the public. Most would agree that the science of research should be sound and as sterile and aseptic as possible- completely free of interference. However, it appears, money and increased profits can be a catalyst for reckless disregard for human health that is largely unregulated. This is particularly a factor on post-marketing studies of various pharmaceutical companies because others seem to be deliberately ignorant.
    Decades ago, clinical trials were conducted at academic settings that focused on the acquisition of knowledge and the completely objective discoveries of meds and devices to benefit mankind. Then, in 1980, the Bayh-Dole Act was created, which allowed for such places with their researchers to profit off of their discoveries that were performed for pharmaceutical companies and others in the past. This resulted in the creation of for-profit research trial sites, called Contract Research Organizations that are often composed of primarily community patient care clinics absent of any research training compared with the former. Because of this structure, investigators of these pharmaceutical sponsored trials are likely void by sponsor design of necessary research experience or quality regarding their research purpose and ability to ensure its sterility, yet benefit it’s supporter. These quite numerous CROS are in fact for- profit, with some CROs making billions of dollars a year.
    The trials conducted at such places again are sponsored by pharmaceutical companies that control and manipulate all aspects of the trial being conducted involving their particular med being studied in the trial. Etiology for their deception regarding this manipulation is because the pharmaceutical company that sponsors such a trial is basically creating a marketing tool for this studied drug of theirs. This coercion is done by various methods of deception in subtle and tacit methods. As a result, research in this manner ensures favorable results of the sponsor’s medication after the trial is complete. Their activities are again believed to be absent of true or applied regulation, and therefore have the autonomy to create whatever they want to benefit what may be a collusive relationship between the site and the sponsor; as such sites are largely unregulated.
    Guest authorship has been known to be aggressively recruited by sponsors and usually the sponsors seek investigators to be recruited for this function in addition to being the lead investigator of their fabricated clinical trial. The trial manuscript and protocol design is prepared by those employed by the pharma sponsor upon specific direction of this pharma sponsor. The medical program coordinator of a particular sponsored trial is an actual employee of the sponsoring pharma company and also acts as the publisher, manuscript version reviewer and trial director who works with their pharma company’s hired CRO editors whose objectives are to benefit the sponsor. Typical and ultimate cost of the final manuscript of the trial to the sponsor created by the hired CRO exceeds 1000 dollars per page, some have said. Merck engages in this behavior, which shocked many, as they were always viewed as an ethical pharmaceutical company that always placed patients over profits. Apparently not.
    Further disturbing is that once the creation of the trials is completed, the research paper is often composed with specific directions by the sponsor to writers known as ghostwriters. These people are not identified and acknowledged by the sponsor, and may not be trained in clinical research overall, as they are simply freelance writers, as one does not need research training or certification in order to perform this function. Rarely do trial ghostwriters question their instructions about their assignment, which is clearly deceptive and undocumented by the sponsor. Also, these hired mystery writers are known to make about 100 grand a year. This activity removes accountability and authenticity of the possibly fabricated clinical trial even further. The corruptive act is finally completed by the sponsor hiring an author to have their name be placed on the trial, while this hired author likely had absolutely no involvement with the trial, or even reviewing the trial is not asked by the hired author.
    To have the trial published, the sponsor has been known to pay a journal, and the sponsor bribes the journal in a few ways, such as the sponsor purchasing from a selected journal thousands of reprints of their study from the journal, for example. Again, how often this process is performed is unknown, yet frequent enough to create hundreds of such false writers mentioned earlier and progressively growing research sites to receive the support the pharmaceutical industry. So benefits of meds studied in such a malicious way potentially can harm patients and their treatment options along with clear safety risks. The purchased reprints bought by the sponsor of the study are distributed to the sponsor’s sales force to share the content with prescribers, with the sales force completely unaware about this manipulation. As a bonus, the sponsor may pay this journal to advertise their products to be placed in this journal as well.
    Such misconduct discussed so far impedes research and the scientific method with frightening ethical and harmful concerns, as stated previously. If so, our health care treatment options with meds are now undetermined in large part due to such corruptive situations, as well as the absence of objectivity that has been intentionally eliminated with trials produced in this way. Trust in the scientific method in this type of activity illustrated in this article is absent and replaced with what could be harmful to others.
    More now than ever, meds are removed from the market or are given black box warnings, which is basically eliminating future growth of the black box drug. Now I understand why this may be occurring.
    Transparency and disclosure needs to happen with the pharmaceutical industry for reasons such as this as well as many others, in order to correct what we have historically relied upon for conclusive proof, which is the scientific method. More importantly, research should not be conducted in a way that the sponsor cannot in any way interfere in such ways described in this article, which would require independent clinical trial sites with no involvement of the drug maker. And clearly, regulation has to be enforced not selectively, but in a complete fashion regarding such matters. Public awareness would be a catalyst for this to occur, after initially experiencing a state of total disbelief that such operations actually are conducted by such people, of course. We can no longer be dependent on others for our optimal health. Knowledge is power, and is also possibly a lifesaver.


    “Ethics and Science need to shake hands.” ……. Richard Cabot

    Dan Abshear

    Author’s note: What has been written was based upon information and belief.

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