Medical Ghostwriting

Lawrence R. Velvel

This commentary is approximately the final third of an extensive article Dean Velvel sent to his e-mail recipients on January 25, 2006. If you wish to read the entire article, you can find it on Dean Velvel's own web site:

It is a dreadful fact that the picture of the medical profession that we are getting from leading books and articles today is of a profession that is heavily on the take from major drug companies that are pushing their products. To give one example among many, leading doctors and researchers are paid large sums to go around the country making speeches about companies’ products before medical meetings. The speeches made by these highly paid medical shills, naturally, laud the products of the drug companies that hired them. As Gomer Pyle used to say, "Surprise, surprise, surprise." Another major example of doctors being on the take, is that the drug companies pay doctors and researchers significant sums to write laudatory articles that appear in major medical journals. And -- the focus here - - drug companies, their marketing departments, their hired consultants and communications companies, their Washington lobbyists, are paying doctors and researchers to put their names as authors to articles that appear in medical journals but that the purported authors did not write, and that were written instead by ghostwriters hired by the companies or their various hirelings and that are slanted in favor of the companies’ marketing-driven desires for profit. Important information contrary to the companies’ views -- information that could create doubts about or even discredit the product - - is left out (just as important information was left out of the 2000 article on Vioxx). Favorable information is cherry picked (the same process the Bush Administration used to get us into the war in Iraq, incidentally). The emphasis in a ghostwritten article can be very different from what it would have been had the listed author written it himself or herself. Moreover, sometimes the listed author is not even the researcher or one of them, but is instead just some shill who is putting his or her name to the article for money -- sometimes, indeed, articles are drafted by company shills and then listed in company records with authors "TBD" -- to be determined. (Can you believe it?) Companies influence the shills to write an article in a certain way, or to structure it in a certain way.

As is always the case with anything that is dishonest, fraudulent, or immoral, those who engage in this process come up with reasons, e.g., researchers don’t have time to write, or they write poorly, or the true researchers look over and approve the manuscripts. No matter. The entire business is a species of fraud, fraud that puts lives and health at risk.

It is hilarious that an association called the American Medical Writers Association is pressing for medical ghostwriters to receive credit for their work. Under the banner of disclosure, it seems, the AMWA wants ghostwriters to receive recognition for their participation in the fraud. Or perhaps the idea is that doctors who read the ghostwritten articles will be more skeptical about them if they know the articles are ghostwritten. Still, the readers won't know what was left out, how emphases may have been changed, what was cherry picked at the behest of the drug companies or their hirelings. I think that all one really needs to say about this is that some of the ghostwriters themselves do not want full disclosure of their roles because they fear -- they know perfectly well? -- that ghostwritten articles will not be accepted for publication by journals that have integrity. This was put very nicely in the Wall Street Journal by a guy who heads the medical ghostwriters of one consulting group:

But some medical writers say they fear articles with full disclosure are likely to get bounced. Editors "say they want disclosure, but if you do it, they scream, Oh ghostwriter’!" says Art Gertel, who oversees medical writing at Beardsworth Consulting Group in Flemington, N.J. "Despite the cries for transparency, the journal editors still feel that there’s an element of corruption if a medical writer is paid by a drug company."

Being one who despises the dishonesty and fraud of ghostwriting (I -- like Richard Posner too -- write my own stuff, as bad as it may be), I, like Jonathan Swift, would like to make a modest proposal. The proposal is designed to put an end to the medical ghostwriting, which involves matters of health, life and death. The proposal is that anyone who participates in any way in the process of allowing or creating medical ghostwriting -- drug companies, their executives, consultants and communication groups, ghostwriters, Washington lobbyists, the putative but false authors -- be subject to serious criminal penalties if a ghostwritten piece or pieces contribute to medical mistakes that harm people. If, for example, ghostwritten pieces contribute to deaths, then any and all of these people could be subject to imprisonment for many years, even for life.

I know, I know. There are lots of objections to this modest proposal, ranging from what would be the exact definition of a ghostwritten piece, to you don't want to jail doctors and researchers who can contribute heavily to future research, to this might be thought inconsistent with our capitalist system. The big objection, however, the real objection, is that criminal punishment for these people is a new and novel idea that nobody has gotten used to yet. That has always been the real, underlying objection to new ideas, from abolition to civil rights. But if you really want to stop the dishonesty that pervades this society, sometimes with consequences disastrous to life, there is really no substitute for criminally punishing people, ranging from the top officials of the federal government to the medical ghostwriters. The fear of serious criminal punishment for misconduct will go a lot farther towards stopping it than all the (easily avoided) regulation in the world.

Let me close with one other point on a different but related subject. To a considerable extent, the information in this posting was disclosed by The Wall Street Journal (as well as in some books), especially by a Journal article of December 13, 2005. The Journal’s news pages are, as said here before, first rate. They often contain major pieces, major exposes, about serous subjects, including exposes of wrongdoing in the capitalist system that the Journal’s editorial pages defend so stridently. This writer, like many other people, finds it remarkable that such constantly excellent news pages exist in the same newspaper that puts out absolute crap in its editorial pages. One concludes that The Wall Street Journal is the only newspaper in the world that has schizophrenia.

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