Former Ghostwriter Speaks Out about Fraud in Medical Journals

Today, pill hungry, social media-blanked out zombies can’t get their pills and vaccines fast enough.   Consuming 50% of the world’s total supply of prescription drugs, American’s form lines like red ants at a picnic table to “ask their doctor if the latest drug is right for them.”  Doctors are all too willing to capitulate, chirping, “yes, the benefits outweigh the risks.”

We’ve been hearing this warble as far back as the 1950’s, even as the “wonderdrug” thalidomide robbed children of their appendages.

Question your doctor about safety and efficacy of his prescriptions and he’ll cite any number of “medical journals” to substantiate his claims, just as they did with thalidomide when telling pregnant women it was the safest drug of all time.  And no doubt, that piece of “scientific writing” will be dripping with the drug’s “benefits” and bone dry of its reported side-effects.  That’s because it’s nothing more than expensive propaganda neatly crafted by a ghostwriter.

If you don’t already know, a ghostwriter is simply someone who gets paid to be a drug-industry cheerleader via well articulated, pseudoscientific writing.  Once the final is edited by Big Pharma, a top physician (opinion leader) is paid to sign as the author, even though they never researched the topic or placed a finger on the keyboard.  Polished and spit-shined, it’s published in prestigious medical journals like The New England Journal of Medicine or the Journal of the American Medical Society to sway doctors into prescribing the industry’s driblets of poison.

Ultimately, ghostwriting does more than sell drugs. It’s a tool used by scientists, doctors and politicians to sell the myth of Western Medicine.  It’s the supreme manipulator, always working to coax the American public into believing that prescription drugs descend from Heaven for the lucky few who can afford them courtesy of their insurance policy.  It’s the perfect crime.  

In addition to the Thalidomide Tragedy, ghostwriting has successfully: 

• Got doctors to hook children under 2 years of age on psych meds
• Made grown men fear cholesterol
• Addicted the injured and elderly to opiates
• Shoved blood pressure pills down the throats of anyone over 30 yo
• Swindled college kids into swallowing ADHD meds as a socially accepted study habit…and so much more

Linda Logdberg is a former ghostwriter. She has a bachelor’s degree from the University of Michigan, an MA in psychology from UCLA, and an MSW from the U of Michigan in Ann Arbor. She also has a PhD in neuroanatomy from UCLA.  She’s been a writer for more than 22 years (formerly publishing research reports under the name “Linda A. Paul”).

High salary, interesting work, convenience and flexibility, and a belief that she was helping sick people — were all compelling reasons for Dr. Logdberg to be a ghostwriter.  Plus, she had three children to take care of.

Eventually though, she began noticing the industry was involved with a slew of dirty deals.  After realizing that her ghostwriting was nothing more than “marketing masquerading as science,” she quit. “Pharma is unworthy of trust: evidence from many sources reveals these companies to be focused on the bottom line only,” she says.  It was “fraud in authorship,” explaining that medical researchers rarely informed the public on the pitfalls of drugs.  Instead, ghostwriters were crafting sales pitches for scientific publication and hired doctors moonlighting as the authors.  I had to learn more so I asked her if she’d share her insights with my readers…Her bravery and willingness to share her story here with me and admirable and surely more will follow her lead!

TPC #1: How is this fraud is able to take place?

Linda: It’s the result of a multifactorial collaboration among researchers, universities, pharmaceutical companies, device manufacturers, medical education accreditors, and patients.

Busy clinicians are glad for any help “writing up” clinical trials results — and when the assistance is paid for by a pharmaceutical company, all the better.  Plus, universities like their academic doctors to have ever-longer publication lists. They promote publication while giving token acknowledgement of competing interests by “full disclosure” statements. Pharmaceutical companies have an obvious stake in publishing research that’s positive to their product. The sponsors of medical education programs want to exhibit their “cutting edge” profile by publicizing the latest data. Patients contribute by demanding remedies they have read about in mass media, thus putting more pressure on doctors who are already in a time crunch.

TPC #2: Is anyone held accountable for the fraud?

Linda: The short answer is no. The longer answer is, “Accountable for what?” Ideally, inaccuracies in the research itself should be detected either by those who did the work or by others when replication fails to duplicate the results.

Hence, the ideal of the scientific method — hypothesis testing followed by replication — is rarely achieved. As a medical writer, I never felt “accountable” for what appeared in print, partly because my name wasn’t on the piece and because it was thoroughly vetted by both the pharmaceutical company and the physician author.

TPC #3: What consequences does this fraud have for the average American who is prescribed a drug by their doctor?

Linda: I’m not sure how to estimate the impact. I think the greatest risk is at the lowest levels of the medical decision-making tree — where doctors attend an evening event that includes wine and a great meal, then listen to Key Opinion Leaders (KOLs) tell their experience with Drug X.

Pharma strives for local influence, because as in any community, prescribing physicians like to fit in and do what the rest of the guys are doing. If a likable, popular Key Opinion Leader (KOL) supports Drug X over Drug Y for treating depression, there is potential for influencing others in the local community to switch to X. So this is one way in which the field of drug selection can be narrowed. I saw this effect in the case of an ovarian cancer drug where the KOL is a nationally recognized, charismatic individual who really, really loved the newer drug and enthusiastically promoted it in dinner meetings.

Increasingly, clinical trials are huge, multi-center affairs that require years to complete and that have author lists a mile long. There are many reviewers of the final published manuscript and I doubt that ghostwriting plays a role here.

TPC #4: In your experience, did doctors ever have a problem with being authors of articles they didn’t write?

Linda: Yes, I did encounter a few who refused to let even a word pass by them that they hadn’t approved. They did not, however, even consider that I — a researcher with my own history of publication — might receive credit for my work. I had no ethical concerns over helping someone write a paper, as I would not have had concerns over being a technician or even a director in someone’s lab. Medical writers are good at writing; physicians are good at being physicians. Let them work together. However, the writer should receive credit along with the other collaborators.

TPC #5: During your 11 years as a ghostwriter, what’s one example of an unethical project you were asked to do?

Linda: The most memorable example was probably a contraceptive product that caused severe, unpredictable vaginal bleeding in some women. My job was to write a monograph that would highlight the product’s benefits, one of which — according to the client [drug company] — was that although the bleeding could be severe, it was at least something that women could anticipate.

In other words…the bad news is that a meteorite will strike you…but the good news is, a meteorite will strike you!  This kind of doublespeak became more and more troubling.

TPC #6: What led you to believe that ghostwriting is “marketing masquerading as science?”

Linda: This differed according to the settings in which I worked. I worked in two main types: one where I reported to an in-house physician, the other where I reported to an in-house marketing person whose title was variably “Product Director” or “Product Manager.” In the first, much-rarer case, I felt that honest attempts were made to present information fairly and in a scientific manner. I met with the in-house physician regularly and had access to the “author” as needed. Because my boss was a physician, I could discuss other questions with him. Data on competing products was provided.

The second setting WAS marketing masquerading as science. I was pressured by the Product Manager to limit my questions so as to “not bother Dr. X” and was (often sarcastically) essentially told how to write the manuscript. A memorable example of this was the rather nasty direction by the PM to “eliminate all discussion of competing products from the Discussion section” of a manuscript. I protested that the format of a Discussion section is to sum up the results and put them in the context of other findings — that’s how scientific pubs work. She was adamant and told me to edit the piece to include only findings about Drug X.

A few days later, we had a conference call with Dr. Y, the “author” of the piece. He was enraged at the manuscript, particularly the Discussion section, and told the PM that (paraphrasing, not a direct quote) “If I ever see anything like this again, I will sever all ties with your company.”

Although some medical writers with less academic backgrounds than mine may need direction from a person whose education is in business, not science, this was of no value at all to me. Of note, both these examples occurred at the same large med-ed (medical education) company.

TPC #7: Did Big Pharma or your employer try to silence you on speaking out against ghostwriting?

Linda: After the piece appeared in the NY Times in 2002 (Madison Ave. Has Growing Role In the Business of Drug Research), I received a phone call from the med-ed company threatening legal prosecution.

TPC #8: Given your past experience as a ghostwriter, do you trust ANY medical journals, doctors, or drug companies?

Linda: Of course I do. I think that the majority of physicians are both ethical and responsible. It’s not their fault that most drugs are “me-too” drugs with slightly different formulations. This is the nature of Pharma research — many basic disease mechanisms are now known, and there is a finite number of ways to affect these mechanisms.

Pharma is unworthy of trust: evidence from many sources reveals these companies to be focused on the bottom line only. However, in this they are no different from car manufacturers, who kept seat belts from becoming standard equipment for decades and who still refuse to implement many lifesaving modifications.

I don’t trust non-FDA-approved vitamin and mineral supplement manufacturers who don’t subject their products for testing and reject attempts to introduce standardization and quality control. Into this non-trust category, I put chiropractic, personal training, healing with pendulums, acupuncture, and the benefits of facing North. Although these things have their place, it isn’t to cure or treat disease, as the required disclaimers on their products and services attest.

Regarding medical journals: I trust them while understanding the obstacles they face. Physicians don’t make decisions based on articles they read in journals, when they even have time for journals. No one has come up with a better paradigm than the randomized clinical trial, but its limitations in the days of modern medicine are apparent.

TPC #9: What is your own personal process for determining whether or not you’ll use a medication for yourself or your family?

Linda: I first determine what class the drug belongs to (statin, loop diuretic, etc). I read online and in medical texts about the class. I then read up on the product, beginning with the Product Insert, which will be online. I ask friends and family (my husband and son are both physicians). Then I email my personal physician to ask him what he thinks about the drug.

I believe that patients must take responsibility for coordinating their own care. This means more than just complaining that you can’t get an appointment with your doctor — it means gaining health literacy. I believe that you shouldn’t blame the doctor for your high blood pressure unless you’ve tried exercising, eating well, stopping alcohol and drug abuse (including OTC meds) and losing weight.

TPC #10: If you had a chance to go back in time, would you do it all over again (knowing what you know now about ghostwriting)? Why or why not?

Linda: I don’t look at choices people make in this way. The medical writing career gave me a lot of flexibility and a good income. I was able to limit the ghostwriting part, which was the part that made me most uncomfortable. I didn’t like having to “pitch” jobs when I worked freelance, and so teaching was a better career for me.

TPC #11: What do you believe needs to change in order for drug companies to start putting science ahead of marketing? (e.g., stricter laws? Better regulation of those laws? Harsher penalties for non-compliance with those laws?)

Linda: Pharma won’t put science ahead of marketing because Pharma is, well, a company that markets what it produces. Better enforcement of existing laws could certainly help. Publishing results from all trials, not just those with positive findings; requiring more head-to-head drug comparison trials; and requiring replication trials, would all help, too. However, I believe that physicians need the expertise that Pharma provides: no one knows the strengths and weaknesses of their products better than they do. A partnership between clinicians and drug developers seems necessary.

And then there’s the patient. I think, as stated above, that patients need to take responsibility for managing their own care to the greatest extent possible. That means asking smart questions and not making the physician or pharmaceutical companies into all-knowing entities who can then be disdained when things don’t go well.

Take a complete list of all medications with you when you visit the doctor. Know when you take these meds and why you take them. Don’t decide to take half-doses to “save money.” Follow the doctor’s advice, which will generally be to lose weight, exercise, etc. The majority of adults in the US lack the necessary skills to interpret medical advice (What is health literacy?). Although this stems in part from the demotion of biology education in recent decades (a major current concern of mine and the topic of a book I’m working on), it can be combatted with deliberate efforts.

That’s where Pharma could really help out — to educate people about mechanisms of disease so that they understand how carrying around giant cups of Coke might contribute to their Type 2 diabetes. I’d force Pharma to divert some fixed share of their profits to patient education, perhaps including a boost to biology instruction in K-12.