Healthy Skepticism Library item: 13586

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Petersen M.
Drugs are hyped by ghostwriters, not sound science
Chicago Tribune 2008 Apr 21
http://www.chicagotribune.com/news/opinion/chi-oped0421ghostwritersapr21,0,2182667.story

Full text:

For years, doctors prescribed the pain reliever called Vioxx to millions of their patients. Why wouldn’t they? Articles by prominent academics in the medical journals described how the drug not only quickly eased pain but was safer than similar medicines. Based on what they read, doctors had no reason to doubt that solid science backed Vioxx’s use.

At least it seemed to. In fact, researchers reported last week that doctors reading those articles had been tragically misled. Many of the academics listed as authors appear to have done little, if any, of the work. Instead, dozens of articles had been secretly drafted by employees at Merck & Co., the manufacturer of Vioxx, or by marketing firms that Merck hired to promote the drug.

After more than 20 million Americans took Vioxx, we learned it was not a safe drug. In 2004, nearly five years after it was introduced, Merck pulled Vioxx off pharmacy shelves, acknowledging that it appeared to double the risk of heart attack for many patients. This was a danger that a handful of scientists had been pointing out for years, but Merck had denied. Researchers have estimated that Vioxx may have led to the deaths of thousands of Americans.

The evidence that many articles about Vioxx were apparently ghostwritten would never have been revealed if Merck had not been forced to turn over millions of internal documents as part of lawsuits filed by patients or their families. A group of researchers, led by Dr. Joseph S. Ross of New York’s Mt. Sinai School of Medicine, pored over those papers, discovering that dozens of articles appeared to have been falsely attributed to academics who had been paid for the use of their names and credentials.

This is hardly an isolated case.

The ghostwriting of scientific articles is not a fraud perpetrated by a rogue company. Instead, it has been one of the pharmaceutical industry’s standard marketing tactics for more than two decades. It is a form of the timeworn corporate public relations strategy known as “the third-party technique.” The marketers aim to put their words in someone else’s mouth to give the corporate message independent credibility.

Drug executives benignly call this process of ghostwriting and placing articles in influential journals “publication planning.” Marketers will spend millions in a coordinated campaign to publish as many favorable articles as they can about a medication in the world’s medical journals. Executives explain these articles are a key part of a drug’s “marketing mix.” Marketers often begin planning these manuscripts when the drug is still in the test tube, many years before its first sales.

The public rarely discovers how these articles have been created because secrecy is required for the highest impact. The ghostwriters work hard to stay in the shadows and not raise suspicions that the articles are anything other than the words and thoughts of academic physicians.

The doctors agreeing to lend their names to the articles can make $1,500 or more for each article, despite doing little work. The ghostwriters make far more.

In fact, the creation of journal articles has become a booming business for many Madison Avenue advertising agencies and smaller marketing firms. Thomson CenterWatch reports that revenues from medical writing have been growing recently by about 15 percent a year.

It is clear that some academics paid to be authors revise parts of the draft manuscripts given to them by executives to conform to their personal views. But the revised draft will then be reviewed and edited by the company’s marketers, allowing them to pick certain words or phrases to enhance the drug’s image. Benefits of a drug can be pumped up. A serious side effect may simply be called “an event.” A drug that works little better than a sugar pill might be described as having “proven efficacy.” Some might say it’s all a matter of semantics. But these semantics can mean life and death.

This kind of deceptive promotion is troublesome even if the company is selling a product like detergent. But the drug industry is using these tactics to mislead doctors and consumers by creating something that looks like objective science to sell risky-and sometimes deadly-medicines to patients desperate for cures.

Despite protests that ghostwriting is deceitful and dangerous, it has continued because it benefits all those involved. The academics enjoy a source of easy money to supplement their university salaries. The writers make a great living. The marketing firms rake in millions. And, the drug companies can sell billions worth of even a potentially deadly drug like Vioxx.

Everyone wins but those who matter most: patients.

Melody Petersen is the author of “Our Daily Meds” and a former reporter for The New York Times.