Once upon a time, the drug giant Wyeth Pharmaceuticals wanted to get some medical journal articles published that would emphasize the positives and de-emphasize the negatives about their hormone replacement drugs, Premarin and Prempro. For the sake of clarity, let’s call this “lying”.

What’s a poor drug giant to do? How about getting well-known medical school professors and researchers to submit HRT-flattering articles to medical journals, pretending that they are the sole authors instead of the  medical ghostwriters you hired who actually wrote them?

And thus a brilliant marketing scam is hatched.  

And it’s working – 26 of these bought-and-paid-for articles are accepted and published in prestigious medical journals. Doctors reading the journals believe the articles (unaware that they were commissioned by a drug company) and start prescribing your HRT drugs like crazy.

Sales of Premarin and Prempro explode to $2 billion (by far the best-selling HRT on the market). The fraudulent physician ‘authors’ take credit for one more title on the all-important lists of academic publications on their CVs.

Everything is swell, until one horrible day when that pesky Women’s Health Initiative, an independent federally-funded research project that’s the largest randomized controlled clinical trial on HRT ever undertaken, halts a major study.  It reveals that, unlike what your hired flacks have been paid to say in all those tainted medical journals, women taking HRT actually suffer significantly higher rates of heart disease and breast cancer than those who did not take HRT.

Sales of HRT drugs fall off a cliff, and you find yourself the target of over 8,400 lawsuits from patients claiming that Wyeth drugs have harmed them. It is the worst possible outcome for a drug giant.

This is the kind of juicy issues management case that takes me back to my old corporate PR days.

I would dearly love to be a fly on the wall over at Wyeth, or at the medical ghostwriting company DesignWrite, or at one of the growing list of universities now being slammed for having lying cheats on their payroll, but especially in the flopsweat-soaked offices of the exposed med school profs who, like Dr. Barbara Sherwin at Montreal’s McGill University, are now offering a version of this preposterous defense to the media:

“Who knew that a drug company was paying my ghostwriters?”

You can bet that all parties are at this very moment shrieking in unison at their high-priced PR consultants: “DO SOMETHING!” to help stop the big bad media onslaught. I must say that, from a public relations perspective, it looks bad.

In the Reputation Management workshops I used to teach to corporate audiences, I liked to tell two real-life PR stories that illustrate the best and the worst in crisis communications and issues management: the Johnson & Johnson Tylenol Murders story, and Union Carbide’s Bhopal poison gas leak story respectively. I’d recommend a careful review of these two cases to all parties involved here, now trying desperately to scrape the medical ghostwriting poop off their fine Italian shoes as if it were merely an accident that they had stepped in it in the first place.

So let’s take a wee break from all this lying, and just tell the truth for a change. My recommendations:

Design Write (the medical communications firm who wrote the 26+ published scientific papers on Wyeth’s dime).  Try saying something like: “We are a team of professional writers  with advanced degrees who have an excellent reputation for producing a broad range of medical-journal-ready articles. And they don’t stop with rave reviews of only hormone replacement therapy drugs!  Oh, no! We’ll write really convincing articles for false sole authorship claims by any academic professional of your choosing , on any topic as advertised on our website:

• allergies
• cardiology
• endocrinology
• gastroenterology
• hematology
• immunology
• infectious  diseases
• oncology
• orthopedics
• pain management
• rheumatology
• urology
• virology
• women’s health
• wound care

And besides, every other medical ghostwriting firm is doing this, too. Just check your favourite medical journal for (uncredited) examples of our work.”

Wyeth Pharmaceuticals (the drug giant who hired Design Write ghostwriters to produce 26+ scientific papers for submission to medical journals).  “We are a compassionate and caring company. We especially care about our beloved shareholders. Women who are hurt by our drugs?  Not so much.

“We like to keep well known doctors in our pockets because you just never know when we might need to hire them as Speakers Bureau ‘thought leaders’ to convince other docs to prescribe more of our drugs, or pretend to be ‘authors’ to help our drug marketing pitch to medical journals someday. We are very savvy marketers. In fact, like most players in the $235 billion pharmaceutical industry, we spend on average 24% of every sales dollar to market our drugs compared to just 13% on research and development. And, although we have suddenly smartened up in the face of those 8,400 lawsuits* by now insisting that our ‘authors’ must actually participate in the ‘research’ we pay for, every other pharmaceutical company out there is doing the same thing, so it’s not fair that we are being singled out for shame.”

University academics (who submitted the Wyeth-commissioned articles to medical journals and fraudulently passed off these papers as their own).  “We are very busy physicians and teachers who must ‘publish or perish’ if we want to make tenure, get promoted, receive more grants, or get the new Beamer and the Benz. Everybody knows that. We realize that we’re lying when we attach our names to these articles as authors, but, really, who has the time to do all this research and writing anyway? And since getting one more article published is always what matters, the ends do justify the means.

“The fact that our secret relationships with Big Pharma taint all of our published articles, past and future, is a consequence that will affect our reputations and those of our university employers, big time. It’s so unfair. Maybe we should have seen this scandal coming earlier. In the meantime, we know that lots of journal articles (nobody can be really sure how many)  are supplied by paid industry ghostwriters and not the physician ‘authors’ listed, so what’s the big deal?  Everybody else is doing it.”

Universities (who employ the academics in their medical schools). “We are outraged and very concerned. We will immediately launch the most aggressive investigation possible of our professors. We will distance ourselves lickety-split from them and all of this nasty and unwanted attention that is now spotlighting our elitist ivory towers. The integrity of our hallowed institutions is at stake, blah blah blah. We get that now.

“We really had no idea that this appalling practice was going on, honest we didn’t, cross our hearts and hope to die.We will not tolerate our professors engaging in fraudulent and potentially dangerous medical ghostwriting any longer, although it’s worked pretty well for us so far, garnering respect, international exposure and big investors for our institutions, not to mention spinoff citations in hundreds of other (real) medical journal articles. And anyway every other university is doing this, too!

“Did we mention that we are outraged and very concerned?”?”

Medical journal editors: (who accepted for publication papers that were signed by medical professionals but written as drug promotional pieces by industry funded medical ghostwriters). “Ghostwriting? What’s that? Hahahaha. Jeez, can’t you take a joke? We are not idiots, no matter what the public may now believe.

“Of course we’ve known the score for some time. Everybody here knows that this is just how it’s done: Big Pharma buys its way to increased sales by getting into bed with the docs who agree to be the pretend ‘authors’ of what boils down to be product marketing campaign material. We run these as peer-reviewed scientific papers, even though our reviewers don’t like to pry into the reasons that the ‘authors’ decline to reveal that drug companies pay for the actual writing of these papers. Perhaps because our reviewers themselves are also on the take. Who knows?

“Everybody is doing this, really. And those unsuspecting MDs out there blindly trust what they read in our journals are none the wiser.

“Besides, the truth is that these scientific papers can mean big money for our journals down the road. The New England Journal of Medicine, for example, sold 929,400 reprints of a single research article about the now-discredited painkiller Vioxx (mostly sold to the drug’s manufacturer Merck to distribute to physicians as part of the Vioxx sales pitch) bringing in more than $697,000 in revenue for the journal.”

Well, here’s another truth, from the perspective of a heart attack survivor who takes a fistful of cardiac meds every morning:

Medical ghostwriting isn’t only unethical. It’s irresponsibly dangerous to the health of millions of trusting patients worldwide.

I may very well be putting powerful drugs into my body each day that were prescribed precisely because pharmaceutical companies and their partners in slime convinced my physicians that these drugs are safe and effective. But how do I know now which ones I can trust — and which ones I can’t?

Not even my doctors can know this.

Willing participants in medical ghostwriting, what the Public Library of Science Medicine calls “scientific misconduct”, should be exposed and, even better, face criminal charges of fraud.

I for one am grateful to the New York Times, to the Public Library of Science Medicine, to medical ethics reporter Stuart Laidlaw at the Toronto Star, and to other science journalists for first uncovering and, more importantly, continuing to harp on the practice of medical ghostwriting. I’d love to believe that this exposure might mean the end of medical ghostwriting and the swift punishment of the guilty.

But sadly, I recall this axiom from my corporate PR days:

“Today’s news is tomorrow’s fish wrapping.”

Let’s hope that’s not true here.

Originally published in Heart Sisters, my blog about women and heart disease.

© 2009  Carolyn Thomas   www.myheartsisters.org

* NEWS UPDATE: November 5, 2009 – A Philadelphia jury has ordered Wyeth to pay a $75 million bad-conduct award (about 20 times larger than the $3.7 million in actual damages the panel awarded to Connie Barton, an Illinois woman who developed cancer after taking Wyeth’s Prempro menopause drug).  Barton, a retired records clerk, took Prempro for five years before developing breast cancer in 2002. Jurors in Philadelphia concluded Prempro helped cause the illness, and the manufacturer had failed to warn Barton and her doctors adequately about the drug’s risks. Wyeth has now lost five of eight trials, including the last three in a row, since HRT cases began reaching juries in 2006. New York-based Pfizer, the world’s biggest drug company, completed its $68 billion purchase of Wyeth on October 15th.  Watch this five-minute video called “Prempro: The Plaintiff’s Perspective”.

* NEWS UPDATE: June 19, 2012

Pfizer Paid $896 Million in Prempro Settlements

Pfizer, the world’s largest drugmaker, has now settled about 6,000 lawsuits alleging Prempro and other hormone-replacement drugs caused breast cancer, and has set aside an additional $330 million to resolve the remaining 4,000 suits, according to a May 10, 2012 filing with the U.S. Securities and Exchange Commission. The reserve means New York-based Pfizer has now committed more than $1.2 billion to resolving claims that it failed to properly warn women about the menopause drugs’ health risk.

More than 6 million women took Prempro and related menopause drugs to treat symptoms including hot flashes and mood swings before a 2002 study highlighted their links to cancer. These hormone medications are still on the market.

Read more about the subject of medical ghostwriting (written by the actual people whose real names appear next to the content.)

See also:

• Why Are Gynecologists Still Prescribing HRT Despite Known Risks?
• Medical Ghostwriting: If You’re Not Alarmed, Perhaps You’re Not Paying Attention
• Doctors on the Take: How to Read the Fine Print in Medical Research Reports
• Partners In Slime: Why You Should Be Alarmed About Medical Ghostwriting
• Medical Ghostwriting and Guest Authorship: Twins Separated At Birth?
• How Are Hockey-Playing Goons the Same as ‘Puzzled’ Medical Journal Editors?
• Why Doctors Who Pretend To Write Journal Articles Should Be Punished