Puff Pieces and Ghostwriting

The journal European Neuropsychopharmacology ran a supplement issue in Sepotember 2006 titled:

September 2006, Pages S149-S155
From the Clinic to the Community: Treating the Whole Schizophrenic Patient and Innovation in Psychiatric Therapy: The Promise of the New Antipsychotics

What is a supplement issue? It is a journal issue paid for by drug companies (GlaxoSmithKline, in the case of this particular supplement) which control the content contained in this issue. Isn't that just an advertisement, you ask? I'm not sure what else you could call it, but the words independent and scholarly certainly do not apply.

Siegfried Kasper has an advertisement, er, article in which he says (with my emphasis): "The use of atypical agents to address the full range of psychotic symptoms with minimal adverse effects should ensure improved functionality and an improved patient quality of life in patients with schizophrenia: both can be regarded as positive reinforcers for long-term compliance."

Who is Siegfried Kasper? Let's find out. David Healy was given a ghostwritten article a few years ago to which he was expected to attach his name. However, he made several changes to the paper. In fact, it was altered to the extent that it no longer served its originally intended purpose as an advertisement for milnacipran. So, the paper that was originally ghostwritten and sent to Healy was forwarded to an Austrian psychiatrist. The psychiatrist was Siegfried Kasper and he attached his name to the paper, making not a single change. In other words, someone wrote an article intended to serve as an advertisement for milnacipran, and Kasper affixed his name to it as if it were his own work. In fact, to quote from the Guardian...

… the original, ghostwritten article which contained what they described as "the main commercially important points" was to be there too. "Siegfried Kasper has kindly agreed to author this one," they said. The name of Professor Kasper of the University of Vienna, editor of the journal, duly appeared on the unaltered, published article, complete with the original references to Dr Healy's work. Professor Kasper told the Guardian that he was happy with the content of the article.

According to one source, Kasper has “authored over 800 research reports and reviews.” One is left to wonder how many of those were actually written by him versus written by ghostwriters and rubber stamped under his name.

When academics are willing to sell their names and reputations, how can the university system function as an independent check on the claims made by drug manufacturers?

Listen to David Healy

David Healy made some insightful comments in the Daily Mail the other day. Everyone should be listening carefully. An excerpt follows, in which all emphasis is added…

Documents prised out of companies by American court cases have become the main way we have of discovering the truth about some of our best-selling drugs.

As well as Prozac, there have been another four or five other drugs exposed in this way.

Two years ago, the painkiller Vioxx was found to double the risk of heart problems; company documents revealed that the drugs sales team were instructed to keep this information from doctors.

Just before Christmas, internal documents suggested attempts were made to play down the serious health risks associated with the top-selling anti-psychotic drug Zyprexa.

Last week similar boxes formed the background to a Panorama programme showing how the company making Seroxat distorted evidence that the drug raised the risk of suicide in children.

The effect of these scandals is to show that something has gone badly wrong with the way our medicines are researched and sold.

--SNIP--

Now company employees analyse the data and medical journalists are hired to write them up for publication. Then Oxbridge and Ivy League professors are paid several thousand pounds to be credited as the authors of these articles.

This is something I've come across personally. Articles have been "ghostwritten" for me by drug companies, and then - when I refused to put my name to them - the same articles have appeared under someone else's name.

I have also seen company memos asking who would be the most "useful" academics to have as the authors of articles already written.

Once published in top medical journals, these confections will deliver more sales than any number of drug representatives, but all too often they are not accurate reports of the trial results.

In other organisations when evidence of disregard for public safety emerges, heads roll. But there have been no resignations following these drug disasters - barely a flicker of embarrassment.

--SNIP--

There's no point appealing to the government drugs watchdog - the MHRA. It is a small outfit entirely funded by the drug industry.

It has never taken any action against the academics who make fraudulent claims in ghostwritten articles, nor doctors working for the companies who repeat such claims, even when they have been shown to be untrue.

So the only other body to turn to is the General Medical Council, whose job it is to investigate the conduct of doctors - but it has shown no inclination to act.

But there is one simple thing we could all do to reclaim the clinical trials. People who participate as guinea pigs should insist the consent form states that the data will be available to all, and without this any drug tester should refuse to sign.

Think Healy has gone mad? Check out some background stories related to his concerns. Try Seroxat/Paxil and the academics who seem to have played the role of company hucksters (here and here). The Zyprexa coverup – too many links to list, but you can start here and here. How about allegedly independent academic physicians making misleadingly positive statements about Seroquel, a drug they “independently” investigated? Ghostwriting? Plenty of evidence available on that – you can start here and here. Cherry picking data to focus on the (minimal) positive results? Try here and here.

Suffice to say that Healy is spot on. When he speaks, I advise paying close attention.