Ghost Writing and the “peer-review” process

Dr. Weeks’ Comment:    Shame!   Shame!!    Shame!!!

It turns out that the authors of important articles in the august peer-reviewed medical journals are often really NOT the authors...

Ghostwriting: Why No Outrage Among Our Nation’s Most Prestigious Peer-Reviewed Medical Journals?

The bedrock of healthcare reform has been that our nation’s medical care will improve, and money will be saved by implementing a government plan utilizing prescription drugs and procedures shown to be the most effective – but now we learn that the medical research is rigged.

The research on which healthcare reform relies has been shown to be authored by ghostwriters: that is, bought and paid for by the very prescription drug companies and manufacturers of medical devices that stand to gain by the use of their products.

Imagine your company makes a drug named ABC. You hire a PR firm to draft an article lauding ABC as very effective in fighting disease CDE. You then pay a renowned doctor, who may be on the staff of one of the nation’s leading medical schools, for the use of his or her name as the article’s ostensible author. This is a hoax.

Medical journals rely on the integrity of doctors to divulge any conflicts of interest. However, doctors often fail to do so (after all, everyone else is doing it, right?).  When other doctors read ”” and believe ”” these shoddy articles, they may change their treatment of disease CDE accordingly. Ghostwritten articles even enter the curriculum for continuing medical education. As a result, the standard of medical care declines, with consumers and their physicians never knowing the truth.

According to the New York Times, Sen. Charles Grassley, R-Iowa, asked eight leading medical journals to describe their policies regarding ghostwriting. Grassley also asked if, since 2004, any action had been taken against an author who failed to report the involvement of a third party in producing a manuscript. No journal reported punishing an author for ghostwriting. While some journals stressed their insistence on honesty, others implied a “Don’t ask, don’t tell” policy. A new JAMA study found the rate of ghostwriting to be more than 7 percent at the Journal of the American Medical Association and nearly 11 percent at The New England Journal of Medicine.

The medical profession’s lack of outrage is sobering. Save for a few courageous authors ”” including Jerome Kassirer, M.D. (former editor of the New England Journal of Medicine and author of On the Take) and John Abramson, M.D., of Harvard, who wrote Overdosed America ””  ghostwriting seems to be yet another example of “the way we have always done it.” Dr. Bruce Chabner, the editor-in-chief of The Oncologist, says it well: “These articles are likely to influence the direction of new investigation as well as the practice of oncology [cancer medicine]. It is critical that such articles represent the unbiased views of the authors, and not those of a ghostwriter or a drug’s sponsor.”

Profit appears to triumph over stringent research, good medicine and what our doctors feel is best for their patients. The stakes are higher as the healthcare-reform debate, which every day gains momentum, relies on the Comparative Effectiveness Research plank of the economic stimulus bill, now the law of the land.

The United States has the dubious distinction of spending about $7,400 per person per year on healthcare, twice what Canada, the next highest spender, spends on healthcare. And yet, in Canada you can expect to live 2 ½ years longer on average than in the United States (80.4 years in Canada vs. 77.8 years in the United States). And in Canada 5.4 out of every 1,000 infants die while in the United States, 6.37 infants die out of every 1,000.

Harvard’s Michael Chernew and his colleagues have calculated the long-term impact of not changing the crippling costs of the current U.S. system. Their published study (Health Affairs DOI:10.1377/hlthaff.28.5.1253) indicates that healthcare costs will consume 150 percent of the wealth Americans would expect to gain as the economy grows between now and 2050.

It’s time to express your anger and tell elected officials to support the efforts of Sen. Grassley to rein in ghostwriting in our nation’s most prestigious medical journals. After all, $1.1 billion of our money will be spent on comparative effectiveness research to determine the best way to treat diseases such as high blood pressure. But we now know the research is tainted.

We deserve to have our money better spent. We deserve what Sen. Thomas Harkin, D-Iowa (the new chairman of the Senate Committee on Health, succeeding the late Sen. Edward Kennedy), and his co-sponsor, Sen. John Cornyn, R-Texas, have proposed for Medicare recipients, the Take Back Your Health Act, S. 1640.

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