PHA-Exchange> [afro-nets] Drug makers deceive doctors

[Claudio Schuftan]

Drug makers deceive doctors
---------------------------

Pay "authors" of major studies for use of their name, credibil-
ity; ask minimal participation in research or writing.

By Gordon Guyatt

Peter (not his real name) is a physician-scientist who, a couple
of years ago, was finishing his research training in Canada.
Shortly before returning to his native Australia, Peter received
an interesting offer.

A pharmaceutical company was ready to pay Peter several thousand
dollars to write an opinion piece for a prominent medical jour-
nal. Peter is smart, and a good writer. Producing the article
would be a cinch. Attractive proposition, no?

Well, a couple of catches. First, Peter would have to follow the
company's direction about what to say. Second, when the article
was published, Peter's name would not appear.

Rather, a respected senior researcher who has conducted many
studies funded by the pharmaceutical industry would get the
credit.

Peter refused the offer. The company probably succeeded in find-
ing a different, willing ghost-writer.

Like all unethical practices, it is difficult to establish the
size of the medical ghost-writing problem. Senior authors will
never threaten their prestige by admitting someone else wrote
their article. Professional ghostwriters won't embarrass their
clients. People like Peter won't embarrass their colleagues.

Ghost writing is a big enough business, though, to sustain com-
panies focused on medical writing. Medical editors recognize
ghostwriting as a widespread practice and have tried to tighten
up their rules. Still, there is no protection against misleading
or dishonest representations, and authorities suggest that up to
50% of articles reporting results of pharmaceutical trials are
ghostwritten.

Lead authors of major drug studies may not only have done little
of the writing, but their participation in the research itself
may have been minimal. Company personnel may have developed the
research plan, supervised the collection of the data, conducted
the analyses, and written the first draft of the article.

The companies then go to prominent researchers, and ask: "Would
you like to be an author, or even the leading author, on the ar-
ticle?"

The higher the profile of the author, the better for the com-
pany. The author's prestige helps to establish the credibility
of the study, and contributes to the attention that the article
receives.

While these extreme situations are not the most common way drug
studies are reported, they merge into a grey area that is very
common. Academic researchers may participate in planning the
study and carrying it out, but they may never see the actual
data. The company conducts the analysis, and presents the aca-
demic authors with tables that summarize the results.

Biased presentations affect not only how individual doctors un-
derstand research results, but how experts who create guidelines
understand the results. Worse yet, the industry exerts direct
influence on those experts.

Drugs that are recently developed and released are far more ex-
pensive. About 25% of the time, these new drugs turn out to have
serious side effects that are not suspected at the time they
were released. On occasion, these side effects are fatal.

Doctors expect objectivity in the research reports and expert
recommendations that guide their practice. Too often, the drug
industry ensures that bias, rather than objectivity, is what
doctors receive.

--
Gordon Guyatt MD, FRCPC, lives in Dundas, Ontario. He is an aca-
demic physician at McMaster University's Department of Clinical
Epidemiology and Biostatistics and Department of Medicine. 
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