I’ve often said to my hockey-mad son Ben that we could end on-ice fighting in hockey (not, incidentally, our national sport, but arguably our Canadian obsession) if only the National Hockey League would put me in charge for just one week. But the folks who do run the NHL clearly have no appetite for banning hockey fighting, or they would have acted to end it by now.

Despite their feeble protests about the unacceptability of fighting and the known dangers of career-ending concussions, team owners tolerate cheap shots by beefy goons who spear, hit, and drop their gloves to fight. The League accepts it, the owners accept it, the players accept it, and the fans apparently love it.

There is, alas, no organizational will to ban violence on the ice.

And much like hockey goons, medical journal editors could end the appallingly unethical and dangerous practice of medical ghostwriting in one week, but these editors clearly have no appetite for banning ghostwriting in their journals, or they would have acted to end it by now.

There is, alas, no organizational will to ban medical ghostwriting.

Instead, medical journals are to a large extent financially dependent on Big Pharma, just as those hockey teams are dependent on fighting because they believe on-ice brawling helps them sell tickets.

Medical journals accept up to $500 million worth of full-page drug ads placed by Big Pharma every year. According to a study published last April in the Journal of the American Medical Association, the drug giant Merck hired medical ghostwriters who drafted dozens of flattering ‘research’ studies for their now-discredited pain drug Vioxx. They then lined up well-known doctors who agreed to fraudulently claim to be the actual authors for submission to journals.

Then, the prestigious New England Journal of Medicine sold 929,400 reprints of a single Vioxx-friendly ‘research’ article they’d published  – mostly sold directly to the drug’s own manufacturer Merck.  Merck’s sales reps then distributed these reprints to physicians on their daily call routes as part of the aggressive Vioxx sales pitch.  Reprint orders from this one ghostwritten Vioxx article brought in more than $697,000 in revenue for the NEJM.  Medical journal editors who don’t want to bite the Big Pharma hand that feeds them must learn to hold their noses and accept this.

Coincidentally, when a recent report revealed that at least 11% of the articles published in the same New England Journal of Medicine last year were actually written by medical ghostwriters instead of the physicians claiming to be the article authors, journal editors responded by claiming that they were “puzzled” and “completely shocked” by the report’s data. Spokeswoman Karen Buckley told The New York Times that her journal was “continually strengthening safeguards” against ghostwriting.

Oh, really, Karen? That would be like a gutless NHL telling the New York Times that they are “continually strengthening safeguards” against fighting in hockey – but without actually ever doing much to stop it.

How on earth could the NEJM editors be either puzzled or completely shocked by ghostwriting accusations?  It is beyond the limits of comprehension that they were not perfectly well aware, as all medical journal editors must surely be by now, of the widespread practice of medical ghostwriting in their publications.

In fact, Big Pharma-paid ghostwriters played a role in more than 40 medical journal articles published last year in six major medical journals, according to a study made public last week. Basically, this means that the published conclusions of any medical journal article bought and paid for by the manufacturers of the drug or medical device being ‘studied’ are highly suspect.

A 2003 study in The British Journal of Psychiatry revealing that over half of all published medical journal articles about the Pfizer anti-depressant drug Zoloft over a three-year period were actually written by Pfizer’s hired New York ghostwriting firm – and not the academics who claimed to be the articles’ real authors. The rest were written by independent medical researchers who actually did the work.

Guess whose articles were more positive about Zoloft?

An earlier independent 1996 study found that 98% of scientific papers based on research funded by drug companies promoted the effectiveness of that company’s drug. When the Canadian Medical Association Journal reviewed 19 previously published cardiac studies on the safety of drug eluting coronary stents, all seven of the studies that were sponsored by the stent manufacturers recommended continued widespread use of this device, compared to just three of the 12 unsponsored independent studies.

And it means that treatment is impacted by what our physicians read in respected medical journals. “These articles are likely to influence the direction of new investigations as well as the practice of oncology,” said Dr. Bruce Chabner, Clinical Director at Massachusetts General Hospital Cancer Center, and the editor-in-chief of the medical journal, The Oncologist, adding:

“It is critical that such articles represent the unbiased views of the authors, and not those of a ghostwriter or a drug’s sponsor.”

Ironically, Dr. Chabner admitted:

“The Oncologist plans to continue publishing clinical trials sponsored by drug companies.”

Perhaps Dr. Chabner is also puzzled, because a growing body of evidence has suggested that drug company-funded trials are five times more likely to come out with a positive result for the drug than independent trials are.

Dr. Tim Kendall, of the UK-based National Collaborating Centre for Mental Health, believes the problem to be the close relationship between doctors and the drug industry:

“Some doctors don’t seem to see the relationship as problematic.”

He cites a British study of 4,000 physicians that found 96% of them received money from drug companies, and yet “the majority did not see this as a conflict of interest.”

Ghostwriting is just one manifestation of a bigger problem which Dr. Kendall claims is the institutional bias of doctors who work closely with and for drug companies. He says:

“In mental health, 85% of all published trials are funded by the drug industry.  Allowing for the unsuccessful trials that the industry does not publish, the figure is probably nearer 95%.”

Welcome, doctors, to the rock ’em, sock ’em world of hockey goons.

See also: more medical ghostwriting articles.

© 2009 Carolyn Thomas The Ethical Nag http://www.ethicalnag.org