Ghostbusting: Exposing Drug Company-Hired Ghostwriters in Medical Journals

Julie Bromberg

October 2009

Doctors rely on scientific papers for accurate information on which drugs and treatments are best for their patients, but are all these papers trustworthy?

In July 2009, a court case uncovered thousands of documents detailing how a major drug company, Wyeth, paid professional writers to draft scientific papers that emphasized the benefits and de-emphasized the harms of Wyeth’s hormone therapy drug, Prempro. These industry-paid “ghostwriters” were not listed as authors of the papers-instead, independent, top scientists who did little (if any) research or writing for the papers were recruited to be “authors.” 1 Ghostwriting can lead to biased articles that mislead doctors into prescribing medication that may not work or can be harmful to their patients.

Between 1998-2005, Wyeth helped produce 26 papers that promoted the use of Prempro to prevent aging skin, heart disease, dementia, and other health problems associated with aging. Sales of Wyeth’s drug soared, until 2002 when a federal study on hormone therapy was stopped early because hormone therapy had increased the risk of invasive breast cancer, heart disease, and stroke (see Hormone Therapy and Menopause for more information). Despite the mounting evidence of harmful side effects, Wyeth continued to pay ghostwriters to draft favorable articles about Prempro through 2005.2

This is not the first time drug companies have been caught hiring ghostwriters to draft scientific articles. Several drug companies, such as Merck3 and Pfizer,4 were caught using ghostwriters to promote their drugs and hide their negative side effects. Despite many medical journals’ attempts to stop publishing ghostwritten articles, recent evidence suggests that ghostwriting is still a fairly common occurrence. A study conducted by editors of the Journal of the American Medical Association, released in September 2009, tried to determine just how many articles involve ghostwriters. The researchers looked at 630 articles published in six top medical journals and found that authors of 8% of these articles admitted to using ghostwriters. Of the six medical journals, the New England Journal of Medicine had the highest ghostwriting rate (11% of articles), while The Annals of Internal Medicine and Nature Medicine had the lowest rates (5% and 2% of articles, respectively). Although the researchers did not study the financial ties of the ghostwriters, they expressed their concerns about the regular presence of industry-sponsored work and its potential to bias published results.5

Ghostwriting is not the only way drug companies can influence scientific papers. Drug companies often pay for research on their own drugs, allowing them to shape the design, statistical analysis, writing, and publishing of the studies. Although the research methods of industry-sponsored studies appear similar to independent studies, it is well documented that industry-sponsored studies are far more likely to publish favorable results than research that is not financed by drug companies (see Industry Ties Report “Rosier” Results for more information).6, 7 Because published scientific articles have a huge effect on doctors’ treatment decisions, and ultimately, their patients’ health, medical journals are getting stricter about requiring authors to disclose their ties to drug companies. Getting authors to disclose all contributors is likely to be the next challenge for medical journals.8

References:

1. Barbour V, Clark J, Jones S, Peiperl L, Veitch E, and Yamey G, PLoS Medicine Editors. Ghostwriting: The Dirty Little Secret of Medical Publishing That Just Got Bigger. PLoS Medicine, September 2009; 6(9): e1000156. doi:10.1371/journal.pmed.1000156

2. Singer N. Medical Paper by Ghostwriters Pushed Therapy. New York Times, A1; August 5, 2009.

3. Ross JS, Hill KP, Egilman DS, and Krumholz HM. Guest Authorship and Ghostwriting in Publications Related to Rofecoxib: A Case Study of Industry Documents From Rofecoxib Litigation. JAMA, April 2009; 299(15):1800-1812.

4. Sismondo S. Ghost Management: How Much of the Medical Literature Is Shaped Behind the Scenes by the Pharmaceutical Industry? PLoS Medicine, September 2007; 4(9): e286, 1429-1433 doi:10.1371/journal.pmed.0040286

5. Wislar J, Flanagin A, Fontanarosa PB, and DeAngelis CD. Prevalence of Honorary and Ghost Authorship in 6 General Medical Journals, 2009. JAMA, in press.

6. Lexchin J, Bero LA, Djulbegovic B, and Clark O. Pharmaceutical Industry Sponsorship and Research Outcome and Quality: Systematic Review. British Medical Journal, May 2003; 326:1167-1170. doi:10.1136/bmj.326.7400.1167

7. Jagsi R, Sheets N, Jankovic A, Motomura AR, Amarnath S, Ubel PA. Frequency, nature, effects, and correlates of conflict of interest in published clinical cancer research.  Cancer. 2009;115: 2783-2791.

8. Sismondo S. Ghost Management: How Much of the Medical Literature Is Shaped Behind the Scenes by the Pharmaceutical Industry? PLoS Medicine, September 2007; 4(9): e286, 1429-1433 doi:10.1371/journal.pmed.0040286