I have every right to be cynical doc..
Ghost writing encourages deception and hidden agendas..

Ever hear of study 329? ..

http://www.healthyskepticism.org/documents/PaxilStudy329.php

Kids died because of the ghost writing in that piece of paxil propaganda..
To be cynical about the pharmaceutical industry is to be wise..
The whole industry and the way it does business is more cynical than I could ever be…

http://www.youtube.com/watch?v=kiBRbNNFzlA

Another interesting piece of info re ghostwriting:

http://hcrenewal.blogspot.com/2007/04/haunted-medical-literature-moffatt-and.html

‘The Haunted Medical Literature: Moffatt and Elliott on Ghost-Writing

We posted quite a bit back in 2005 about ghost-writing (see post here with links backward).

Back then it became evident that a particularly pernicious type of ghost-writing was much more prevalent than anyone seemed to realize.

This sort of ghost-writing has several important elements.

Commissioned by Those With Vested Interests - The writing is commissioned by an organization with a vested, usually commercial interest, e.g., a pharmaceutical company…’

I find it impressive that a member of Congress, who, I am sure, does not write his own speeches, triggered much of the angst here. Those who continue to pummel the issue and professional medical writers mindlessly need to keep in mind the source of the controversy.

Just as in the broader context, COI, it will be impossible to eradicate perceptions of a problem. Trying to do so will simply fail, but only after much angst. However, I continue to believe that as with all COI matters, transparency and basic disclosure are fundamental remedies. A well written scientific article should be presented in a way that allows the appropriately knowledgeable individual, the learned intermediary if you will, to be able upon careful review and consideration, to draw their own conclusions. Lazy-readers (scientist, clinician, reporter or politician) will go to the abstract, conclusions and summary comments and for them being misled is an unfortunate but real common event. As our future physicians, pharmacists and other health professionals come more and more from the ranks of the MTV – Instant Message – blogosphere generation Lazy-readers will proliferate.

Let’s be reasonable, medical writing will not – and should not – go away any more than should speech writing for politicians (who also engage in some mighty important dialog – at least at times) or opinion writing by law-clerks. Yes, commercial entities will always be positive advocates for their positions – but so will university based academicians, patient advocates and so many others. Maybe another, and ultimately more useful, tact should be taken; teaching learned-intermediaries how to read the scientific literature thoroughly, instilling in them the importance of doing so and maybe chastising Lazy-readers.

Publication plans are well-established. They make the best use of data and if a particular data set is published in more than one medium that’s ok - as you well know it is expensive to generate data and foolish to use it only once. Why would any industry do that? Failure to disclose poor data is not OK but the role of publication plan is to support the drug not destroy it, again provided the balance is fair.

In most companies - in my experience - there is extensive review of the plan, the supporting data, and the points that will be made. Research, regulatory and marketing review jointly. Any problems may be aired then; if not, well that’s up to the individual isn’t it. If the lead author (internal or external) has a problem they are at liberty to change something.

As far as your disclosure criteria, I was with you until half way but then it became silly and so I don’t think you really expect a serious answer to that.

The majority of commentators on this topic have been predominantly anti-pharma and especially anti Merck on this issue. With most things there are grey areas and this is no different but the JAMA article that precipitated this (authored by some of the most prolific academic writers in recent memory - presumably these wqrite every word themselves) was not wholly objective nor especially comprehensive. There was a rebuttal written and published soon afterwards in JAMA which presented another perspective but this has yet to appear here.

My point? Not particularly insightful and has been made here many times before: pharma is an industry - nothing else - that by and large employs decent people doing the right things. There are exceptions and these make the news but as always there is an inelegant and unseemly stampede to pillory it and its employees at the first whiff of impropriety. The ghostwriting issue is just one more example. And no, I do not work at an agency and I do not work in the industry (but if I did and was as down on it as some appear to be here, I’d be off like a shot).

I would agree with Chris on one point. Ghostwriting is not per se bad if there is disclosure. But how do you disclose the real truth. “This article was developed by agency writers who perform marketing services for ####. The writers and the agency received substantial fees for this work as well as for many other projects from the company that sells ####. Wherever possible emphasis has been given to efficacy benefits, although some safety may be added. The writers have found some interesting new ways to spin this data, but it’s old data that has been published in several other forms. The authors of the paper did not develop the content but they did review the paper before signing it.”

I guess if that’s what Chris means by sufficient disclosure then I change my mind, I agree with him that would be enough.

The other aspect of this is the extent to which the same leaders in academia actually write their own papers. Yes, even some of the same ones critical of the industry. Consider their workload against their prolific publishing: Think they have time to write all their own stuff? Might this ever be taken into account amidst the debate that’s going on now?

Let’s wait and see.