Two years ago, an investigation disclosed that Wyeth used a ghostwriting firm to generate material used to promote its hormone replacement therapies. By then, of course, the meds were linked to breast cancer in the 2002 Women’s Health Initative study. But the disclosure prompted a US Senate probe and has since been widely cited as an instance in which pharmaceutical marketing corrupted the process by which legitimate medical info is supposed to be disseminated (background).
But just how extensive was the Wyeth ghostwriting? Well, between 1997 and 2003, a firm hired by Wyeth called DesignWrite generated more than 50 peer-reviewed publications, more than 50 scientific abstracts and posters, journal supplements, internal white papers, slide kits, and symposia to promote its Premarin and Prempro meds. There were other firms, but DesignWrite was used most often and was paid between $20,000 and $25,000 for each of 20 review articles (you can read the publication plan for low-dose Prempro here, for instance).
“The beauty of this process is that we become your postdocs,” Karen Mittleman, a DesignWrite employee who supervised medical writers, wrote in a 2001 email to an academic author. “We provide you with an outline that you review and suggest changes to. We then develop a draft from the final outline. You have complete editorial control of the paper but we provide you with the materials to review/critique.” The author was puzzled over the concept of authoring, but not writing a paper.
All this and more is courtesy a paper published in PLoS Medicine, which reviewed approximately 1,500 documents - emails, contracts, internal memos, depositions - that were culled from litigation brought by some 14,000 women and their families against Wyeth - now owned by Pfizer - and obtained by PLoS and The New York Times last year. The paper was written by Adriane Fugh-Berman, a researcher at Georgetown University Medical Center in Washington DC, who has also been a paid expert witness for plaintiffs against Wyeth and Pfizer.
For the curious, the documents make interesting reading, so look here and search by using the name of a drug. Other drugmakers have also been cited for ghostwriting, most recently, GlaxoSmithKline in connection with its Avandia diabetes pill (see this) and Merck, which employed the practice to promote its Vioxx painkiller before it was yanked in 2004 over links to cardiovascular risks (see this). Although some industry defenders argue the recent disclosures refer to dated examples, industry critics say the practice may persist, but is not necessarily known because most instances do not involve high-profile litigation or government investigations.
“Medicine, as a profession, must take responsibility for this situation,” write Fugh-Berman. “Naivete is no longer an excuse. Perhaps physician-investigators should create and uphold a standard where relationships with industry are regarded as unsavory rather than sought after. Academic institutions and medical journals should take a hard line on ghostwriting. Patient care will benefit if physicians draw together as a profession to denormalize relationships with industry and avoid the role of corporate pawns in the future.”
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