Time to deal with medicine’s dirty little secrets?

As health care eats up more of US GDP year after year, it is being held increasingly accountable. Today the Wall St. Journal’s has another front page article (At Medical Journals, Writers Paid by Industry Play Big Role) revealing something not so nice about the field:

It’s an example of an open secret in medicine: Many of the articles that appear in scientific journals under the bylines of prominent academics are actually written by ghostwriters in the pay of drug companies. These seemingly objective articles, which doctors around the world use to guide their care of patients, are often part of a marketing campaign by companies to promote a product or play up the condition it treats…

The practice of letting ghostwriters hired by communications firms draft journal articles — sometimes with acknowledgment, often without — has served many parties well. Academic scientists can more easily pile up high-profile publications, the main currency of advancement. Journal editors get clearly written articles that look authoritative because of their well-credentialed authors.

There are other “open secrets” as well. A few examples:

  • Academic medical centers and individual physicians sometimes have an ownership stake in companies whose devices they are using and doing research on. These stakes are rarely disclosed. (See How a Famed Hospital Invests in Device It Uses and Promotes.)
  • Orthopedic device sales reps are often in the operating room to assist or guide orthopedic surgeons in performing procedures
  • Physicians who are on the influential committees that set guidelines (e.g., for cholesterol and blood pressure levels) often have consulting relationships with companies that benefit from how those guidelines are set

It’s time to bring these and other secrets out in the open, to debate them and to change the practices that aren’t right. The fact that conflicts of interest are rarely disclosed and are sometimes intentionally hidden shows that the people involve realize something’s not quite ok. Disclosure is a first step, but as we’ve seen in the financial services business, disclosure of conflicts isn’t enough to ensure objectivity.

An idea I’ve suggested before –to avoid conflicts of interest in drug trials– is to outsource evaluation to India.

December 13, 2005

6 thoughts on “Time to deal with medicine’s dirty little secrets?”

  1. And an illuminating example of this from Pond.

    In the Blumson case from England, Blumsohn, a scientist researching osteoporosis was refused access to randomization codes from Procter and Gamble in his own study, created a fuss and was fired from his institution for his trouble.

    More than just ghostwriting – its ghost everyting. I would commend this story. It is so hilariously funny that I almost had a fit on reading it. It really is the season for pharmaceutical companies to be doing a bit more foot shooting.

    http://www.thes.co.uk/current_edition/story.aspx?story_id=2026780
    http://observer.guardian.co.uk/uk_news/story/0,6903,1657302,00.html
    http://www.ahrp.org/infomail/05/12/11.php
    http://www.thes.co.uk/search/story.aspx?story_id=2026632
    http://www.thes.co.uk/search/story.aspx?story_id=2026307

  2. I’m wondering what technology could be put into place to help extract conflicts of interest. Here some thoughts (perhaps I can blog about more at Healthcare IT Guy if there’s further interest):

    * Using natural language parsing techniques to “read” articles by authors and compare them against others they may have purportedly written to see if they are ghostwritten. Techniques like this are already used to help ferret out plagiarism.

    * Using publicly available and private government databases (SEC, FDA) to “discover” linkages between individuals and companies that may not already be known. We use this in CIA, FBI, and other systems to discover terrorist and mafia links so I’m sure it could work here, too.

    I’m sure there are dozen other, quite easy, things we could to create systems that will help perform “automated disclosure”. The question would undoubtedly be — who benefits most from the technology and who would pay for it? I can’t imagine the industry will police itself so we will require some external force to do so and that force may be some smart pieces of software.

    Thoughts?

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