This is something that has bugged me for ages: when I joined the pharma industry something I called “institutional or organizational memory” existed. We could be internally consistent because of this memory and it served as an anchor for corporate policies and behavior. Even with people moving up and around the corporation there were resident “historians” who through their tenure, concern for the company or whatever, gave us context.

I’ve seen that disappear in the past decade, perhaps because of the therapeutic team or brand team decentralized operating model. One of the bad things is that you have a weak corporate structure that is basically a holding company for a bunch of independent pharma companies (fiefdoms) (oncology team, CNS team, Cardiovascular, etc.) The lack of communications across teams makes compliance difficult as well as internal consistency. We have, in effect, lost our identity.

It’s not nostalgia for the good old days; it’s the loss of identity and corporate “brand”.

And, indeed, I can easily imagine people with advanced degrees doing all kinds of things, for all kinds of reasons. Since I spend my days with them, I have seen a pretty wide range.

Also, the manipulation goes both ways. The guest signs off on the study, and gets moolah and more for doing so. As I’ve Paul Starr before here, “The dream of science did not take power into consideration.”

Re: pens, there are pretty good social psychological studies that show that it’s not the size of the gift that correlates with the size of the influence (change in rate of rx’ing something) shortly thereafter. Of course, all of this is in the context of a relationship, reciprocity, docs who are lonely, and maybe reps that are lonely too.

Anyway, anyone who has ever been to a relevant convention has seen otherwise very well-off people filling their plastic bags with free toys and trinkets. It’s obviously not just for their kids. It is a little poignant, a little addictive, and little ravenous.

Yes, folks in PhARMA and BIO have (LOL) created many of our own worst nightmears and 1000-pound-gorillas by doing things which make good sense but which then become unintended ego-inflators.

Dr. Sal, Yes,I am suggesting that there are occasions of which I do not quite understand and would make excellent research topic, as to why such astute people would fall under the charm and spell. However, there are times when I have thought that the clinicians themselves wanted to really believe the over stated outcome, that they themselves feel betrayed when they find that it wasn’t so.

Dr. Sal, as I mentioned there is at least one association of physicians that has recognized it and is implementing a guideline to stop it. So, that it happens is not debatable at all. The issue here is stopping it.

I wonder how you can ask the question in light of precisely Vioxx, Vytorin and anti depressants. Let’s pull out the “positive” papers on those products and track down the authors.

On the other hand, we are not saying it happens all the time. So, I am not arguing that you do not interact with incorruptible researchers. I agree, there are many fine honest and brilliant minds out there that have not taken the bait.

I like your second point. However, when a pharma marketing person provides the services of a medical writer, it does stoke the P.I.’s ego just a bit, some ego’s shouldn’t be stoked any further mind you.

Second quick point here, if MDs, PhD, PharmDs and others with advanced science training also spent time honing their writing skills and actually held to timetables (as those who are in the pharmaceutical or publishing business world must) then professional writing – while still useful – would not be as necessary.

Yes, I agree that there is/could be some fraud associated with it. I was at a conference last year were the decision was finally made that members should not allow their name to go on a publication unless they had reviewed all the raw data and completely concur with what was being written. That was a major step forward and something the AMA should adopt among its members.

Bob, I say it happens more than you think it does. Case in point is Vioxx, Vytorin, antidepressants.

However, I am more inclined to believe a study that was funded by the NCI or NIH. If I were a patient doing some research on a given disease and didn’t come across a couple of independent studies, I would be very nervous.

Oh yes, those lovely dinner circuits - speaker tours. It amounts to pharma paying a really nice meal for old buddies to connect up with one another and sample some really good wine. What muses we are to each other…

One area where professional writers are necessary occurs when a symposium is presented and the presenters speak from slides rather than prepared text. If the proceedings are to be published, usually in a journal supplement (another topic for discussion), the writer works with a recording and prepares manuscript drafts. They are sent to the speaker for editing and after internal vetting by regulatory affairs and legal, the set of manuscripts is published. Usually CME is given by an independent CME provider chosen by the journal.

I almost never read journal supplements. (Disclaimer, I have arranged for conference proceedings to be published in a supplement. They did not deal with products, only policy issues)

Justice, watch out too for manuscripts published in professional journals not referred ones. This is one outlet that the presence of brand team direction is likely strongest.

And then there is the slope - send the KOLs on the dinner circuit with their ghost-articles, etc., which continues the charade. Is “name-branding” a form of “mis-branding”?

Loose assocation … but was John Hancock a KOL?

Bob - you are right, I think there is nothing unethical about using ghost writers, but as you point out, when they are guided by the product team - that’s the problem.

Unfortunately, that is the big problem, usually it is marketings budget and contact that manages the ghost writers who are actually medical writers that are usually on contract with the particular company. These writers are part of the marketing team per se as they attend “pitches” and are made aware of the the quarterly/yearly marketing plans. So, they now what the marketing message is and they are told how that message is going to be conveyed. So, if they are smart and know what side their bread is buttered on….

So, very often, my marketing plan’s included getting a study published (favorable of course) CME events (lots of content to organize…) Speaker tours (to promote the study) etc, etc.

There is a recent trend to move some of these activities away from marketing and put this under the domain of medical affairs again. I can always be hopeful.

For the record, everywhere I worked, medical/regulatory ruled and I worked with them. I sleep well…