Medical Ghostwriting: California State University Professor Speaks Out on Big Pharma’s Manipulation of Scientific Journals

For years, I’ve been preaching about medical ghostwriting – where Big Pharma hooks people on dangerous drugs using false data and blatant lies.  Doctors are the targets and patients are the sufferers.  Our nation’s reliance on anti-depressants, blood pressure and ADHD meds, chemotherapy, and cholesterol lowering drugs is nothing more than a product of this craftiness, not one of science and necessity.  Sadly, ghostwriting is a bigger threat than any war, terrorist organization or disease, combined!  

Fortunately, a few brave people are speaking out against the atrocity.  “In my view, doctors who sign on these ghostwritten articles are guilty of fraud, of corrupting science and polluting the scientific record with misreporting of data,” says Dr. Leemon McHenry, a prominent Ph.D and professor of 30 years.

As someone who has read and admired Dr. McHenry’s work, I decided to interview him on his investigations into medical ethics and ghostwriting, which he defines as “the practice of disguising marketing as science.”  Here, he offers a refreshing perspective.  It proves that doctors can’t rely on scientific journals to guide prescribing habits and those that do risk the lives of their patients.  If you’ve ever choked down an aspirin or a prescription drug, this is a must-read interview! 

TPC #1: What prompted you to investigate medical ethics? 

Dr. McHenry: I began to develop an interest in medical ethics as a result of my research consulting work for the law firm of Baum, Hedlund, Aristei & Goldman in Los Angeles. The firm specializes in litigation against the pharmaceutical industry, particularly in the area of fraudulent reporting of the scientific testing of medicine.

TPC #2: In laymen’s terms, what is medical ghostwriting and why should it be a concern?

Dr. McHenry: Medical ghostwriting is a creation of the pharmaceutical industry and it has spawned another industry called “medical communication companies” that function as agents for ghostwriting. 

Medical ghostwriting is generally the practice of disguising marketing as science. A medical writer who acts as an agent for the marketing agenda of a pharmaceutical or medical device company writes a manuscript promoting the alleged safety and efficacy of a drug or device and then the company approaches a physician to sign on the published article as the “author.” The writer disappears as a “ghost” and the marketing agenda remains hidden to the readers of the article.

It is a concern or a problem because medical ghostwriting facilitates the misreporting of scientific testing of medicine and patients who are prescribed the medicine are potentially harmed as a result.

TPC #3: Why do drug companies use ghostwriting? What is the benefit to them?

Dr. McHenry: There are two reasons why the companies engage in this activity: (1) to maintain control over the content of the published article so that their marketing messages are conveyed to prescribing doctors and their patients, and (2) to conceal the true origin of the manuscript. As far as (2) is concerned, it appears that the article is written by a respected academic physician at a reputable medical school, but in fact it is written by a ghostwriter who is secretly manipulating the scientific data to advance the marketing of the drug or device.

TPC #4: Why do doctors/medical experts agree to put their name on articles they didn’t write?

Dr. McHenry: In my view, doctors who sign on these articles are guilty of fraud, of corrupting science and polluting the scientific record with misreporting of data.

First, they do it because they add another publication to their curriculum vitae, which enhances their academic reputation at their university. Second, they do it because they are already on the payroll of the company as consultants and signing on to the ghostwritten articles produced by the company enhances their financial relation with the company. Finally, it is easy money. The drug companies launder “honoraria” for signing on to these articles via the medical communication company.

TPC #5: How does ghostwriting impact the average American taking prescription drugs?

Dr. McHenry: Let’s take the case of a woman who is taking an antidepressant and then discovers she is pregnant. She wonders whether it is safe to continue taking the drug while she is pregnant and is told by her doctor that there is no evidence of harm to the fetus so she should continue to take the antidepressant. But then when the baby is born, there is a severe birth defect.

Now it turns out that the evidence that her doctor relied upon was the ghostwritten medical literature that promoted the drug as “safe and effective” even during pregnancy. The company in this case knew from its own clinical trials conducted on animals that there was evidence of birth defects and covered this up in the ghostwritten articles. Ghostwriting in this case contributed to the harm.

This affects every area of medicine such as diabetes medications, pain killers and medical devices such as the biological products used in spine surgeries.

TPC #6: Why does ghostwriting create a “crisis of credibility” in medical literature?

Dr. McHenry: The “crisis of credibility” is the problem that prescribing physicians or psychiatrists cannot determine which articles published in the medical journals are trustworthy. Since the average reader cannot discern which ones are genuine articles that honestly report on the scientific testing of a medicine and which are the fraudulent ghostwritten articles, the boundary between science and marketing is blurred.

TPC #7: I read your article “Of Sophists and Spin-Doctors: Industry-Sponsored Ghostwriting and the Crisis of Academic Medicine” and found it to be excellent. Too bad the average American would rather read People Magazine or Justin Bieber’s Twitter than face the truth that doctors and drug companies have been lying to them. What can be done to make the AVERAGE AMERICAN more aware of medical ghostwriting?

Dr. McHenry: Well, more than anything else, a segment devoted to medical ghostwriting on the television show, 60 Minutes.

TPC #8: Why do you think the phenomenon of ghostwriting has persisted? Is because of general complacency among the public? ghostwriters lured by high-paying salaries? doctors who are too busy to actually learn about the medicines they’re prescribing? drug company leaders who have no conscience? What is the ROOT CAUSE of the problem?

Dr. McHenry: The ROOT CAUSE, of course, is money. Medical ghostwriting is a lucrative business, but it is a scandal of science, and more importantly, a betrayal of physicians’ obligations to their patients.

TPC #9: What would be the CORRECT way for Big Pharma to use ghostwriting? – or should it be stopped altogether?

Dr. McHenry: My co-author, Dr. Jon Jureidini, and I have campaigned for the retraction of ghostwritten articles but our efforts have so far failed.

We have also advocated that the medical journals refuse to publish any industry-sponsored clinical research, since all of it is suspect. Pharmaceutical and medical device companies can simply post their research on their websites and it will be the job of the medical journals to critically evaluate the accuracy of the data and the conclusions. With the creation of the internet, there is no longer any scientific reason why medical journals should publish the commercially-oriented articles of industry.

This very sensible solution to the problem of medical ghostwriting has been ignored.

TPC #10: How does the FDA view ghostwriting? Are they doing anything to stop it?

Dr. McHenry: As far as I know the FDA has not even acknowledged the problem.

Senators Charles Grassley and Max Baucus of the United States Senate Committee on Finance have done more than anyone else in government to address the problem of medical ghostwriting, but even their efforts have not been sufficient to turn the tide against the fraudulent behavior of the pharmaceutical industry.

TPC #11: What are medical journals doing to stop ghostwriting?

Dr. McHenry: Some medical journals have policies against ghostwriting but the policies are “soft” or “passive” and there is no real oversight or any real effort to correct the problem. In other words, the stated policies are just “window dressing” to give the appearance of scientific and ethical integrity.

Medical journals, especially the leading high-impact journals, routinely reject submissions that attempt to expose the fraud of medical ghostwriting because they fear the loss of revenue from pharmaceutical advertising and reprint orders.

In my view medical ghostwriting continues to flourish because medical journals are part of the problem. They profit enormously from the reprints of ghostwritten articles and so they have very little incentive to police the ghostwritten articles that they publish.

When a medical journal article is published that claims some medicine or device is safe and effective this is worth millions of dollars, if not billions, to the manufacturer. The company will then purchase thousands of reprints of the article that are subsequently distributed to doctors at medical conferences and by pharmaceutical sales representatives who visit the doctors in their offices. The medical journal that publishes the article can profit over a million dollars from just one of these reprint orders.

TPC #12: Many readers who follow The People’s Chemist blog are either currently on medications, or looking to wean themselves off meds. How can the average person approach and/or confront his or her doctor about medical ghostwriting? Should this be a topic of discussion when someone visits their doctor?

Dr. McHenry: Practicing physicians and psychiatrists are generally unaware of the problem. We can always inquire about what evidence our doctors rely upon when they prescribe medications. If that source of evidence is an article distributed by a pharmaceutical sales representative or a medical journal article that is reporting on the results of an industry-supported clinical trial, there is reason for doubt.

TPC #13: What practical actions can the average American take, to make sure they don’t become a victim of ghostwriting?

Dr. McHenry: We are all patients and have to take medicine at some point in our lives. We can be better informed about the marketing practices of the pharmaceutical industry and insist on taking an active role in our treatment options. This requires that we reject the paternalistic model of the doctor-patient relationship. Our doctors must recognize that we collaborate in our health care decisions. What is required most is a healthy skepticism about the claims of safety and efficacy of medicine, even if the source is a reputable medical journal.