David Healy describes
… the astonishing marketing power of pharmaceutical companies, which can now effect huge changes in medical culture within months. [To take one] case, a great part of the scientific literature (the primary marketing tool of companies) on the use of antidepressants in pregnancy and on dependence on antidepressants is ghostwritten – just as virtually all literature on giving antidepressants to children was, at one point, company-written. Firms of medical writers are contracted to pharmaceutical companies to place in academic journals articles attributed to, but not actually authored by, university researchers.
Because of this, guideline makers like Nice, which can only go by the published literature, are trapped. Regulators, like the FDA and MHRA, which reflect a professional consensus rather than lead on issues like this, are likewise stuck. Doctors who believe their role is to follow Nice, the MHRA and the scientific evidence are in the same bind.
The process of manufacturing clinical consensus has become so slick that it is now almost impossible to find independent articles from academic physicians with no links to industry that will sound a note of caution about prescribing antidepressants to women of child-bearing years. This is a problem that increasingly applies across all of medicine – from the use of HRT, to drugs for osteoporosis, respiratory or gut problems, pain-relief, as well as all psychotropic drugs.
Where once drugs were seen as poisons to be used judiciously and with caution, they are now treated as fertilisers whose more or less indiscriminate use can only do good. Where once farmers knew to keep their cattle out of fields growing the serotonin reuptake inhibiting weed, St John’s Wort, as it caused miscarriages, under industry influence women have been herded by doctors in exactly the opposite direction.
August 9th, 2009 at 12:37PM
I’ve been around the business long enough to know that this is a real problem, but not because of medical "ghost writers." The writers are hired by drug companies, doctors, hospitals, clinical research groups, etc. in order to help busy, often writing-challenged researchers get their articles together. Nothing goes out without the researchers’ OK. The influential data appears in peer-reviewed journals, which have their own responsibilities to deny publication if it’s not warranted. Many medical writers belong to professional groups like the AMWA that discuss and advise on ethics and conflicts of interest in this kind of arrangement.
It’s not a perfect system, but it’s not necessarily shady, either. The core problem is the structure of pharmaceutical research, the majority of which is done by private mega-corporations with profit goals. Of course they’re trying to shift the discussion to favor their products. Any corporation would. The real issue is the influence of corporate money on academia — not medical writing.
August 9th, 2009 at 3:05PM
Thomas Hager said, The core problem is the structure of pharmaceutical research, the majority of which is done by private mega-corporations with profit goals.”
It gets worse. Corporate marketing memes have infected NIH, so we now see this agency funding academic investigators to conduct projects that are disguised experimercials. The STAR*D “effectiveness” study of antidepressants is a good example. It cost the taxpayer $32 million, and it did little more than showcase the drugs already in use. It was an exercise in numbing empiricism, defective in research design, lacking real hypotheses, and bereft of a conceptual framework. Naturally, the director of NIMH issued a series of self congratulatory press releases when the unsurprising results were in. Pharma had to be pleased – all drugs were equal and all must have prizes.
For someone like myself who has been in the field of antidepressant drugs since close to the beginning, what passes for sophisticated clinical psychopharmacology nowadays looks like pretend science.