- 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.
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- 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.
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- 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.
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- These papers endorsing certain drugs are paraded in front
of GPs as independent research to persuade them to prescribe the drugs.
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- 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.
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- 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.
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- 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.
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- 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.
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- '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.'
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- 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.
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- '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.
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- When contacted, Rees declined to give any details. 'I
signed a confidentiality agreement and am unable to comment,' she said.
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- 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.
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- '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.
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- '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.'
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- One field where ghostwriting is becoming an increasing
problem is psychiatry.
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- 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.
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- 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.'
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- 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.
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- The company replied, saying he had missed some 'commercially
important' points. In the end, the ghostwritten paper appeared at the conference
and in a psychiatric journal in its original form - under another doctor's
name.
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- Healy says such deception is becoming more frequent.
'I believe 50 per cent of articles on drugs in the major medical journals
are not written in a way that the average person would expect them to be...
the evidence I have seen would suggest there are grounds to think a significant
proportion of the articles in journals such as the New England Journal
of Medicine, the British Medical Journal and the Lancet may be written
with help from medical writing agencies,' he said. 'They are no more than
infomercials paid for by drug firms.'
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- In the United States a legal case brought against drug
firm Pfizer turned up internal company documents showing that it employed
a New York medical writing agency. One document analyses articles about
the anti-depressant Zoloft. Some of the articles lacked only one thing:
a doctor's name. In the margin the agency had put the initials TBD, which
Healy assumes means 'to be determined'.
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- Dr Richard Smith, editor of the British Journal of Medicine,
admitted ghostwriting was a 'very big problem' .
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- '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,' he said.
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- 'When we find out, we reject the paper, but it is very
difficult. In a sense, we have brought it on ourselves by insisting that
any involvement by a drug company should be made explicit. They have just
found ways to get round this and go undercover.'
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- Guardian Unlimited © Guardian Newspapers Limited
2003
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- http://www.guardian.co.uk/medicine/story/0,11381,1101706,00.html
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