How are hockey-playing goons the same as “puzzled” medical journal editors?

hockey calgary fightI’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

14 thoughts on “How are hockey-playing goons the same as “puzzled” medical journal editors?

  1. Excellent comparison – hockey brawls and ghostwriting. Many parallels here.

    The bottom line is quite clear: medical journal editors are too enmeshed with their pals in Big Pharma to do more than toothless threats to clean up this mess. Just like the NHL, team owners and ticket buyers.

    Very distressing, really. Thanks for keeping on top of this ghostwriting scandal and spreading the word. I’ve just subscribed to your blog posts here and am forwarding them to my colleagues too.

  2. As a former goon myself, I take exception to being compared with unethical medical journal editors. I never PRETENDED to be anything other than a hockey ‘enforcer’ in my day, whereas these editors are acting like they’ve never even heard of medical ghostwriting.

    This comparison is offensive to all hockey brawlers! 😉

  3. Ha! I agree – let’s protect the reputation of noble hockey goons by not comparing us to those gutless medical journal editors….

  4. Puzzled? The only ones who are “puzzled” here are the patients whose doctors read these ghostwritten journal articles and prescribe drugs they read about in these industry-commissioned articles!

    The journal editors are not “puzzled” at all, unless they are truly stupid, which I’m assuming they are not. What they are is in collusion with the drugmakers whose financial support they rely on to continue publishing. What a sick relationship this must be.

    Love your website.

  5. Unlikely analogy between hockey brawls and medical ghostwriting, but oddly enough, it fits brilliantly.

    The bottom line: if something is important, it will get done. If it isn’t, for whatever reason, it won’t.


  6. Hi Carolyn

    “…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….”

    And those research results illustrate exactly the issue here – that doctors have become so numb to this kind of conflict of interest reality that they no longer seem able to discern what is right and what is wrong about it.

    I enjoy your interesting articles here. Keep up the good work! 🙂

  7. I’m not a hockey fan so I was unaware of these brawling goons you have in canada. But I’ve become very aware of medical journal editors who for some reason are too spineless to get tough with drug companies and their hired help who submit these tainted journal articles.

    Maybe you have it backwards – let’s hire some of your big, scary hockey brawlers to deal with Big Pharma !

    Love your Ethical Nag blog. regards, K.

  8. I think it’s a bit of a stretch with this NHL hockey goon analogy. Playing hockey is nothing like editing a medical journal. Hockey players are regular common-sense guys who know the difference between a good call and a bad one. Apparently journal editors do not.

  9. Hey, very cool topic on the integrity of medical journal editors. I’m an instant fan, I have bookmarked your website. Thanks so much,

  10. It’s one thing for medical journal editors to be aware of the conflict of interest reports of study authors – but it’s not enough merely to list all the financial conflicts of interest at the end of a journal article. The obvious solution: DO NOT ACCEPT ANY TAINTED STUDIES FOR PUBLICATION. You’re right – editors obviously lack the will to tackle the problem.

  11. I play hockey 2xwk in a night league. I have discussed your comparison at practise with the guys. We all agree that we don’t deserve to be compared to these medical journal editors, who are faking being impartial ethical academics with integrity. We are not faking anything. We ARE goons. At least by night on the ice. 🙂

  12. Could it possibly be that the NHL is finally getting serious about goons, given the concussion scandal going on now? On second thought….. maybe they’re just waiting for this to all blow over. They’re about as serious as those journal editors are, I guess.

  13. “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…”

    BINGO. That’s the key. You CAN’T bite the hand that feeds you, especially if it means asking hard questions that might alienate Big Pharma. Thx for this, keep on raising the hard questions, maybe one of these gutless editors might develop a backbone one day.

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