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Tech Central Journal of Medicine

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There was a terrific article by Anna Wilde Mathews in Monday’s Wall Street Journal about how an increasing number of medical journal articles are ghostwritten by drug company PR flacks. Of course, the article wasn’t online, and WSJ isn’t even on the academic L/N we get here, but thanks to an insanely overworked but generous lawyer, I can give you a taste of what the article found:

In 2001, the American Journal of Kidney Diseases published an article that touted the use of synthetic vitamin D. Its author was listed as Alex J. Brown, an associate professor at Washington University in St. Louis.

But recently, that same article was featured as a work sample by a different person: Michael Anello, a free-lance medical writer, who posted a summary of it on his Web site. Mr. Anello says he was hired to write the article by a communications firm working for Abbott Laboratories, which makes a version of the vitamin D product. Dr. Brown agrees he got help in writing but says he redid part of the draft.
It’s an example of an open secret in medicine: Many of the articles that appear in scientific journals under the by-lines of prominent academics are actually written by ghostwriters in the pay of drug companies. These seemingly objec-tive articles, which doctors around the world use to guide their care of patients, are often part of a marketing campaign by companies to promote a product or play up the condition it treats.

Now questions about the practice are mounting as medical journals face unprecedented scrutiny of their role as gatekeeper for scientific information. Last week, the New England Journal of Medicine admitted that a 2000 article it published highlighting the advantages of Merck & Co.’s Vioxx painkiller omitted information about heart attacks among patients taking the drug. The journal has said the deletions were made by someone working from a Merck computer. Merck says the heart attacks happened after the study’s cutoff date and it did nothing wrong.

[…]

When articles are ghostwritten by someone paid by a company, the big question is whether the article gets slanted. That’s what one former free-lance medical writer alleges she was told to do by a company hired by Johnson & Johnson.

Susanna Dodgson, who holds a doctorate in physiology, says she was hired in 2002 by Excerpta Medica, the El-sevier medical-communications firm, to write an article about J&J’s anemia drug Eprex. A J&J unit had sponsored a study measuring whether Eprex patients could do well taking the drug only once a week. The company was facing competition from a rival drug sold by Amgen Inc. that could be given once a week or less.

Dr. Dodgson says she was given an instruction sheet directing her to emphasize the “main message of the study” — that 79.3% of people with anemia had done well on a once-a-week Eprex dose. In fact, only 63.2% of patients re-sponded well as defined by the original study protocol, according to a report she was provided. That report said the study’s goal “could not be reached.” Both the instruction sheet and the report were viewed by The Wall Street Journal. The higher figure Dr. Dodgson was asked to highlight used a broader definition of success and excluded patients who dropped out of the trial or didn’t adhere to all its rules.

The instructions noted that some patients on large doses didn’t seem to do well with the once-weekly administration but warned that this point “has not been discussed with marketing and is not definitive!”

The Eprex study appeared last year in the journal Clinical Nephrology, highlighting the 79.3% figure without men-tioning the lower one. The article didn’t acknowledge Dr. Dodgson or Excerpta Medica. Dr. Dodgson, who now teaches medical writing at the University of the Sciences in Philadelphia, says she didn’t like the Eprex assignment “but I had to earn a living.”

Defenitely read the whole thing if you have access. Obviously, since scientists have to sign off, the articles may be titled toward drug companies but are less likely to contain actual errors (at least of commission.) On the other hand, the fact that scientists maintain their bylines (often, if I understand correctly, without crediting the ghostwriters) makes it harder to trust any of a journal’s articles; at least you know when you see that James Glassman has written something and know how much stock to put in it. I hope the article will help bring some serious scrutiny to the practice…

…UPDATE: more shilling at the Cato Institute (although, to their credit, they at least fired the party involved, while John Lott is still an AEI fellow the last time I checked.) And, surprisingly enough, at Tech Central Station.

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