Ghostwritten

This New York Times article on the (apparently widespread) practice of drug companies drafting and ghostwriting scientific articles favorable to their products, and then arranging for academics to publish the articles under their own names, focuses, reasonably enough, on the potential for such practices to mislead doctors and other readers.

As an academic, though, I was particularly struck by the stress that the drug company Wyeth laid on the fact that the nominal authors of these articles were not being paid and endorsed the contents. In reality, having someone write articles for you amounts to not doing the job for which, as an academic, you are paid and, if the articles are sufficiently numerous and well-placed, promoted. It would be far more ethical (or less unethical) to pay academics for product endorsements, published as commercial advertisements.

Of course, in a world where a $50 billion (or maybe $17 billion, who can tell?) fraud barely makes the front page, and a $100 million rip-off is buried somewhere behind the shipping news, it seems a bit precious to worry about allegations of goldbricking academics passing off corporate propaganda as their own work. But at least I can understand how this scam works, as opposed to how a massive Ponzi scheme can be operated for decades under the noses of what are supposed to be the world’s most sophisticated fnancial markets and regulators.

36 thoughts on “Ghostwritten

  1. The problem with advertising is not that it exists, but that it is predominantly a mix of dishonesty and bullshit. Isn’t there a theory that capitalism only works in a scenario of complete information? Current advertising seems to me to be inconsistent with this theory. Perhaps advertising content needs to be regulated for honesty.

  2. Andrew R., Among the things that were achieved by the enlightenment was the separation of wealth accumulation from royal absolutism, i.e., the creation of individualism as the dominant strand in western philosophy. Without the Enlightenment, which is the same as saying ‘without the rise of philosophical individualism’, capitalism would not have been possible.

  3. In the biosciences, specifically in the bio-pharma arena, ghostwriting happens. However, a more subtle corruption of the academic peer review process that happens is the marketing campaign’s pre-launch phase (for want of a better way of putting it). For some new drugs that are very niche, and for drugs reaching end-of-patent, a pre-launch phase starts well before FDA final approval.

    The idea is to create an article blitz based around short trials, *and* to promote the efficacy of the drug for off-label applications. An off-label application is any medical condition other than the one for which the drug is designed. As an example, anti-depressants are FDA approved for the medical condition of depression; a stringent set of clinical trials are required to get that approval. Recently, various anti-depressants have been promoted in the academic literature for off-label use in treating chronic pain. Off-label use is usually a much easier goal for FDA endorsement.

    Once a drug has solid support in the academic literature, media pages are passed onto the various professional magazines; the off-label applications are promoted widely, and the academic literature is conveniently cited. That part of the medical community who read these mags (sometimes they receive the magazine gratis, if the drug is promoted in the magazine) then talk with colleagues in the tearoom about the drug. This builds credibility for the drug.

    In some cases, the off-label uses are what make a drug a block-buster (ie a billion dollar or more earner). The treatment of the original medical condition might be too small a market, hence the rationale behind this marketing strategy.

    As an example of how the pharma guys get the article count up, go to the Pubmed site – where all USA grantees must submit a copy of their articles – then search on any drug that is known for off-label use. Then check how many of the articles have a pharma guy or a pharma affiliation among the authors. Also count the number of articles with negative conclusions.

    A few months back, I did just that. I looked up one of the anti-convulsants (these are for the treatment of epilepsy), as they are being promoted by doctors for the treatment of chronic pain. After reading through a lot of articles in Pubmed I realised that I hadn’t seen a single article that only involved unencumbered researchers. Many of the trials were very short; many of the trials allowed the subjects to use up to 4 grams of paracetamol per day, if they needed additional pain relief. Does that not seem bizarre in a chronic pain relief trial?

    Pharmaceutical drugs have been life-savers for many; off-label applications have turned out to be very important for many. Nevertheless, something about the current practices of a number of bio-pharma companies leaves a sour taste.

  4. #30
    I think melanie was making the opposite point that you were making – the Enlightenment made capitalism possible, not vice versa.

    #31
    don’t assume everything you write is worthy of an answer.

  5. gerard,
    I have always thought that you should at least be polite and answer a question if asked. Perhaps standards of manners are different in your universe.
    .
    smiths point was (IMHO) that one polluted the other. Mine was that they enabled each other. While I disagree with melanie on the direction of causality, the difference is (IMHO) in the context of this discussion, irrelevant. One is (again, IMHO) freedom applied in the scientific and philosophicals areas, with capitalism being freedom applied in the economic context. Which caused the other is (in this context) irrelevant – one could hardly have polluted the other if they are the same thing applied in differing areas.

  6. Andrew R. One of the leading enlightenment figures is John Locke. I’m not sure if his brand of individualism counts as ‘capitalist’ since he came up with the notion that the product of one’s labour is one’s property. Capitalism on the other hand, says that one’s property can be the product of any number of people’s labour. Another aspect of enlightenment individualism was also, of course, that you shouldn’t own another person – though the treatment of humans as commodities to be traded seems perfectly compatible with “freedom applied to the economic context” or free trade.

  7. melanie,
    You always own your own labour. If you choose to sell it to another that is your decision on the use of your own (human) capital. Good capitalism. Government forces (or provides strong incentives for) you to work contrary to what you would choose to do – not capitalism.
    Which one would Locke recognise?

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

w

Connecting to %s