Healthy Skepticism Library item: 16399

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

Pharma's clout weakens care
The Victoria Times Colonist 2009 Aug 30
http://www2.canada.com/victoriatimescolonist/news/comment/story.html?id=cfb9f1ee-d3a8-47e6-b5b9-44b3a6645f7f

Full text:

Another ghost-writing scandal has broken over the pharmaceutical industry. Last week, a senior professor at McGill University in Montreal admitted publishing a scholarly article that she did not entirely write. Part of the content was scripted by staffers at a firm called DesignWrite.

Why is that important? First, DesignWrite is paid by pharmaceutical giant Wyeth to promote its drugs. But there was no mention of those co-authors in the article. That could mislead readers into believing the report was independent, when it was not.

Second, the article concluded that estrogen therapy helps prevent memory loss. But Wyeth is a producer of estrogen-based medications. In the research field, such an obvious conflict of interest could invalidate the findings, if it were known.

In fairness, not all the facts are available. This might be an instance of carelessness rather than deception.

But it is, unfortunately, only the tip of an iceberg. There have been numerous cases of drug companies employing what some might consider fraudulent publications to boost sales.

According to the New York Times, Wyeth also used this strategy to promote hormone replacement therapy for women. The company arranged for the publication of 26 ghost-written articles, to help create the impression of a scientific consensus which may not have existed.

This allegedly enabled Wyeth to publicize the benefits of the treatment, while de-emphasizing its risks. Sales of the company’s therapy reached $2 billion, before independent research linked hormone treatments to breast cancer, heart disease and stroke in menopausal women.

And GlaxoSmithKline created a program called CASSPER to promote an antidepressant called Paxil. Sales staff enticed physicians to put their name on articles co-authored by company ghost writers (hence Cassper — the friendly ghost.)

And there are instances where it appears drug companies have gone beyond fraudulent authorship, to outright manipulation of facts. Merck and Co. are alleged to have arranged for dozens of ghost-written publications for the anti-inflammatory drug VIOXX.

An editorial in the Journal of the American Medical Association alleges Merck used this smokescreen to misrepresent the risks of VIOXX. Specifically, it claims the number of fatalities in Alzheimer patients was significantly understated. VIOXX was subsequently withdrawn in Canada and the U.S.

And a contraceptive device named the Dalkon Shield was marketed by the A.H. Robins pharmaceutical company, despite indications of unethical conduct in the research phase. The lead investigator appeared to have a major financial interest in the product, but this was not revealed. About $2 billion in damages were ultimately paid to women damaged by the device.

Most troubling of all, these various forms of misrepresentation and deceit appear to be widespread. One Canadian researcher reported that up to 40 per cent of clinical trial reports may be affected.

That elevates the practice from an occasional mis-step to more of a co-ordinated onslaught. It may explain, in part, why the pharmaceutical industry has a $20 billion marketing budget.

It’s difficult to exaggerate the seriousness of the problem. Later this year, 30 million Canadians will sign up for swine flu vaccine. The vaccine is brand new — it hasn’t even been developed yet. When it arrives, we will have to trust the pharmaceutical industry that it is safe.

In fact, there is enough government oversight in this instance to provide reassurance. But what about all the other new drugs and treatments that come onto the market? How are we supposed to have confidence, when the industry is manipulating the truth about them?

This isn’t about sales or profits or the corporate bottom line. It is a far bigger issue. Alan Cassels, a drug policy researcher at the University of Victoria, had this to say: “Ghostwriting, fundamentally, is about deception and fraud and is wreaking untold damage by gravely undermining our trust in medicine.”