Following doctor’s orders has become synonymous with danger. Every year, FDA approved drugs kill twice as many people as the total number of U.S. deaths from the Vietnam War. Death by medicine flourishes because deceit, not science, governs a doctor’s prescribing habits. This deceit comes in many forms. Medical ghostwriting and checkbook science are the most prominent.
Doctors rely on peer-reviewed medical journals to learn about prescription drugs. These journals include the Lancet, British Medical Journal, New England Journal of Medicine and the Journal of the American Medical Association. It is assumed that these professional journals offer the hard science behind any given drug. This assumption is wrong. Medical journals can’t be trusted thanks to medical ghost writing. Medical ghostwriting is the practice of hiring PhD’s to crank out drug reports that hype benefits and hide negative side effects. Once complete, drug companies recruit doctor’s to put their name on the report as authors. These reports are then published in the above mentioned medical journals. The carrot for this deceitful practice is money and prestige. Ghostwriters can receive up to $20,000 per report. Doctors receive prestige from having been published. Ultimately, patients get bad drugs disguised as good medicine.
As deplorable as medical ghostwriting sounds, it is more common than you think. Dr. Jeffrey Drazen, editor for the New England Journal of Medicine, insists that he cannot find drug review authors who do not have financial ties to drug companies. As a result, the journal had to relax their conflict-of-interest rules for authors in 2000. Dr. David Healy, of the University of Whales predicts that 50% of the journals drug review articles are written by ghostwriters.
The editor of the British Journal of Medicine has acknowledged that medical ghostwriting has become a serious problem for his publication: “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.”
Consider the testimony from deputy editor of The Journal of the American Medical Association: “This [journal articles] is all about bypassing science. Medicine is becoming a sort of Cloud Cuckoo Land, where doctors don’t know what papers they can trust in the journals, and the public doesn’t want to believe.”
Other weapons of mass deception exist – checkbook science. As defined by Diana Zuckerman, PhD, checkbook science is research intended not to expand knowledge or to benefit humanity, but instead to sell drugs. It has stolen the very soul of University research, scientific method, and the patients who serve as human subjects.
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.