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‘Ghosts’ still haunt the Medical Journals

"We are being hoodwinked by the drug companies"

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In February 2002 we posted an article commenting on the Ghost Writer problem in the medical press Flawed Evidence . However, a recent article in The Observer by Antony Barnett 1 suggests that the situation may have deteriorated in the last two years.

The medical journals, 'bibles of the profession', strongly influence doctors and hospitals both when prescribing drugs and providing treatment. Yet, in his Observer article, Barnett suggests that almost half of all articles which appear in medical journals are written by ghost writers. Whilst doctors are remunerated for putting their names to the papers, the ghostwriters and the pharmaceutical companies who commission the articles remain out of sight.

In his article Ghostwritten Research Papers www.talkaboutrecovery.com dated 4th December 2003, Jim Blair reported the experience of David Healy, a distinguished British psychiatrist. Healy was carrying out research on the possible dangers of anti-depressant drugs when he was approached by the representative of a drug company. He emailed a complete 12-page review paper, complete with graphs and footnotes, ready to present at a forthcoming medical conference. For convenience, Healy's name appeared as the sole author, even though the psychiatrist had never seen a single word of it before. The drug company wanted its advertising to look like an independent study - a "massive" scientific fakery top medical journals condemn because it prevents doctors from getting the straight facts on medicines they prescribe. Healy declined the offer, But the ghostwritten paper appeared verbatim at the conference and in a journal anyway-under another doctor's name. 2

Commenting on Healy’s experience, Dr. Ann Blake Tracy,3 Executive Director, International Coalition For Drug Awareness www.drugawareness.org confirms that current publications about serotonin promote exactly opposite conclusions to those of all the research during the last three decades. ‘Now, thanks to David Healy and a few others, who still know what the word “integrity” means, we have the documentation that this is indeed what is happening to a very great extent. With one half of journal articles being ghostwritten, where is the FDA? Why are we putting up with all this? These lies kill and they are killing more by the minute.’

The journals are themselves fully aware of the problem. Richard Smith, editor of British Medical Journal recalls being threatened with legal action by a drug company representative back in the early 1980s after the BMJ had published papers suggesting that a new non-steroidal anti-inflammatory drug, benoxaprofen, might have serious side effects.4

Commenting on the website of the American Academy of Allergy Asthma & Immunology www.aaaai.org the editor refers to a 1997 article in the newspaper USA Today 5 describing a reportedly increasing practice of medical/scientific articles written in the name of scientists by "script writing" companies. In some cases, the scientists are asked to be an author "after the fact," sometimes for a substantial fee.

Whilst accepting that medical journals depend upon pharmaceutical companies for substantial income for advertising, reprints and the sponsoring of supplements. It seems justified to wonder whether journals are resisting as vigorously as they might. Nathan Newman thinks not 6. In The Nation www.thenation.com he reported that the editors of New England Journal of Medicine, one of the most respected medical journals, had announced that they were dropping their policy stipulating that authors of review articles of medical studies could not have financial ties to drug companies whose medicines were being analyzed. The reason given was that the journal could no longer find enough independent experts who had not been paid off in some way by the industry. One result of this approach was that in February 2003, the journal was forced to retract an article published by doctors from Imperial College, London, and the National Heart Institute. It transpired that several of the listed authors had little or nothing to do with the research.

Reporting for the Marketplace feature of CBC News www.cbc.ca Erica Johnson describes how she was able to track down a live ghostwriter and learn some of the tricks of the trade. 7 ‘Medical ghostwriting can be as scary as it is spooky. People with scientific backgrounds - often, with PhDs - are paid to stay in the shadows and crank out favourable reports for drug companies. Then, drug companies get doctors to put their names on the studies - for money, prestige, or perks.’ The ghostwriter admitted that he is paid to write up positive reports. ‘So bad side effects that could affect patient safety, are sometimes completely ignored.’

Antony Barnett concludes his Observer article with the following quote from Dr Richard Smith, the editor of the British Medical Journal '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.' Not very comforting, is it?

1   Antony Barnett, Revealed: how drug firms ‘hoodwink’ medical Journals, The Observer 7 December 2003
2   Tom Spears, Canwest News Service
3   Dr. Ann Blake Tracy, Prozac: Panacea or Pandora? Cassia Publications 1994
4   Richard Smith, Medical journals and pharmaceutical companies: uneasy bedfellows BMJ 2003; 326: 1202-1205 (31 May)
5   Doug Levi, What Your Patients Are Reading, America Today 1996 6   Nathan Newman The Nation July 25 2002
7   Erica Johnson, Medical Ghostwriting, CBC News March 25th 2003

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