Medical Journals Are Haunted by Pharma’s Ghostwriters

Drugs

Readers are more likely to trust a paper written by a physician than one by a pharmaceutical company. Drug companies know this, which is why they engage in ghostwriting.

Universities kick students out for putting their names on papers they didn’t write. But, doctors are often financially rewarded for it.

Ghostwriting is when a writer writes a significant portion of a paper, or all of it, but isn’t credited. Instead, an academic or other notable figure’s name is recognized as the author. Sometimes the named author will edit the article before it’s published, but their contributions are often small.

Readers are more likely to trust a paper written by a well-respected physician than one by a pharmaceutical company. Drug companies know this, which is why they pay doctors for the right to list their names as authors on papers the company actually wrote.

Besides violating readers’ trust, swapping author names can have dangerous consequences in the medical field. Physicians rely on medical journals to help them make informed treatment decisions. Papers written by pharmaceutical companies are more likely to emphasize the benefits of their products, which may mislead doctors into thinking a drug or device is safer than it actually is.

Agencies Work ‘Hand-in-Glove’ With Drug Companies

Medical education and communication companies (MECCs) help drug companies write and publish content that shines a favorable light on their products. There are hundreds of these companies, which are mostly located near pharmaceutical companies in Pennsylvania, New Jersey, and the U.K.

“‘Key messages’ laid out by the drug companies are accommodated to the extent that they can be supported by available data.”

Pharmaceutical companies often hire MECCs to publish and place papers in peer-reviewed medical journals. Elliot Ross investigated the industry in an article for The Guardian.

“Having talked to over a dozen publication planners I found that the standard approach to article preparation is for planners to work hand-in-glove with drug companies to create a first draft,” he said. “‘Key messages’ laid out by the drug companies are accommodated to the extent that they can be supported by available data.”

Adelphi, a company that has promoted drugs like Neurontin, offers services like scientific narrative development, expert engagement, and scientific medical writing—services that sound an awful lot like ghostwriting.

Even Well-Respected Journals Have Ghostwriters

Publications like The Journal of the American Medical Association (JAMA), the Public Library of Science (PLoS), and The New England Journal of Medicine (NEJM) are respected for the quality of the research they print. Yet, even these publications are guilty of unknowingly publishing content written by ghostwriters.

In a survey of 622 medical research authors, nearly 8 percent said ghostwriters contributed to their articles. A separate study found that 8 percent of JAMA‘s articles had undisclosed ghostwriters, and 7.6 percent of PLoS content. More than one in 10 articles published in the NEJM were written with help from a ghostwriter.

When confronted with the high rates of ghostwriting in the NEJM, the highest among all of the journals, a spokesperson for the journal said she was “completely shocked.”

Half of Medical Literature Hides Dangerous Side Effects 

Nearly 75 percent of doctors change their treatment plans monthly or quarterly based on the medical literature they read. If this information isn’t accurate, it can have dangerous consequences. 

The reality though is that most published medical research has gaping holes. Even though adverse drug effects appear in 95% of medical research, only 46% of the literature discloses them. Physicians aren’t seeing the complete picture.  

In 2006, researcher Michael Steinman identified seven peer-reviewed articles for an anticonvulsant drug, Neurontin, that were written by MECCs: four of the articles had favorable conclusions, and the other three presented neutral conclusions. Parke Davis, a Pfizer-acquired company, reportedly paid academics $1,000 per paper for the right to use their names as the primary authors.

Internal documents released during litigation against drug companies shows similar practices across the industry. Ghostwritten articles about Prempro, a drug that treats menopause, downplayed its breast cancer risk, and articles about Paxil, an antidepressant, downplayed the increased risk of suicidal thoughts among children.

Merck Publishing Machine Spins Vioxx Safety Data

One of the most dangerous pharmaceutical ghostwriting strategies came from Merck, who tried to use content to boost sales of their arthritis drug Vioxx (rofecoxib).

Internal documents produced between 1996 and 2004 included contracts with medical publishing companies for ghostwritten articles, and exchanges with the academics who were listed as the authors of those articles.

Only 72 of the Vioxx articles ghostwritten by Merck disclosed Merck’s sponsorship or financial ties to the author.

One of the released internal documents was a flow-chart created by Eric Crown, Merck’s publications manager, that outlined each step of the editorial process. After Merck’s employees finished writing the articles, including discussing clinical study findings, and selecting where the article would be published, only then did they determine whose name would be used as the author. Academics received between $750 and $2500 to have their names listed as authors.

A JAMA study found that among 72 Vioxx articles ghostwritten by Merck, only half of them disclosed Merck’s sponsorship or financial ties to the author.

After just five years on the market, Merck voluntarily withdrew Vioxx in 2004. Research showed that Vioxx doubled the risk of heart attack and stroke in patients who took the medication for more than 18 months.

Not surprisingly, the peer-reviewed articles Merck wrote downplayed Vioxx’s risks. They only reported 17 of the 20 heart attacks experienced by their VIGOR trial participants in an article for the NEJM

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