CBC MARKETPLACE: HEALTH » MEDICAL
GHOSTWRITING Inside the business of medical ghostwriting Broadcast: March 25, 2003 | Reporter:
Erica Johnson; Producer: Michael Gruzuk; Researcher: Colman
A medical ghostwriter can make $100,000 a year writing
favourable drug reports
Medical ghostwriting: you may not have heard of it, but you'll
probably want to know about it. It's a world that could make
your doctor prescribe the wrong drug.
For trusted guidance, articles rigorously reviewed in medical
journals are the gold standard when it comes to scrutinized,
scientific reports. They're what our doctors rely on to make
decisions affecting our health. But more and more we can’t
be sure who’s serving up that medical advice.
Medical ghostwriting can be as scary as it is spooky. People
with scientific backgrounds —often with PhDs—
are paid to stay in the shadows and crank out favourable reports
for drug companies. Then, drug companies get doctors to put
their names on the studies — for money, prestige, or
Marketplace tracked down ghostwriters in Vancouver,
Montreal and Ottawa. One agreed to talk with us, but only
if we protected their identity. Their job could vanish if
their identity is revealed. We'll call our busy ghostwriter
Blair Snitch: I’m given an outline
about what to talk about, what studies to site. They want
us to be talking about the stuff that makes the drug look
Marketplace: They don’t give you
the negative studies?
Blair Snitch: There’s no discussion
of certain adverse events. That’s just not brought
Blair Snitch is paid to write up positive reports. Bad side-effects
that could affect patient safety, are sometimes completely
Snitch makes over $100,000 a year as a medical ghostwriter.
An article that makes its way into a prestigious medical journal
— like the Lancet, British Medical Journal,
New England Journal of Medicine — will earn
up to $20,000.
Snitch’s work is brisk and busy, but not problem free.
Marketplace: How much pressure is there
from the drug company to write something favourable?
Blair Snitch: You’re being told
what to do. And if you don’t do it, you’ve lost
A matter of efficiency
Snitch works for what’s called a 'medical writing'
company. There’s a whole industry churning out drug
company bumph. It’s partly a matter of efficiency, says
'What appear to be scientific articles are really
infomercials," says Dr. David Healy, University of Wales
“Doctors don’t have time to write those articles.
The people who have their names on those articles are very
They're busy and usually high-profile: the higher the profile,
the greater the credibility for the article.
“What appear to be scientific articles are really infomercials
of some sort,” says Dr. David Healy of the University
Healy’s no stranger to controversy. His job at the
University of Toronto was suspended after he criticized the
pharmaceutical industry, but he still gets invited to lecture
and remembers one in particular:
“I said 'yes' to the meeting. To my big surprise I
had an e-mail shortly afterwards. 'In order to reduce your
workload, we have had our ghostwriters produce a first draft
based on your published work. I attach it here.'"
Healy wasn’t comfortable with the glowing review of
the drug, so he crafted his own article. The drug company
wrote back and said he’d missed something key. In the
end, the drug company put someone else's name on the article.
Healy is spooked by the deception. He says it goes beyond
being misleading — it can be dangerous. He’s seen
a lot of articles on drugs, like anti-depressants, that don’t
mention serious problems:
“[They don't talk about] people and children, for
instance, that have been put on these drugs, actually committing
suicide or becoming suicidal. The finished articles actually
don’t reflect this at all.”
Reason for concern
Blair Snitch says the public should be concerned: "Are
they being prescribed a drug because it’s the best drug
- or because it’s the drug most favourably positioned?"
Marketplace: Do you have any concerns
about what you’re doing?
Blair Snitch: I don’t feel ownership
of the product.
Marketplace: But you are taking the research
and delivering to the drug company something that’s
Blair Snitch: I expect that all the drug
companies are doing it with all the drugs. So I figure in
the end, it’ll be balancing itself out.
'We have no way of checking,"
says John Hoey, editor of the Canadian Medical Association
Healy’s not so sure. He’s seen internal drug
company documents. They had lists of scientific papers written
up, ready to go. All that was missing was the name of a high
profile doctor to be listed as author. Healy estimates as
much as 50 per cent of the literature on drugs is ghostwritten.
Ghostwriters we talked to said they do a good job of taking
complicated science and turning it into something understandable.
We wanted to ask a doctor why they’d agree to sticking
their name on a paper, but it’s tricky getting people
to fess up. Some doctors didn’t call back. One we reached
said he “couldn’t remember who wrote the paper”
his name was on - then said the drug company “might
have” written the first draft. By the end of our conversation,
he remembered — he’d written every word.
The world’s leading medical journals say they're trying
to ferret out who lurks behind the pen. When a study is submitted
to top journals like the Canadian Medical Association
Journal, The Lancet, New England Journal
of Medicine, everyone whose had anything to do with the
article is listed — like a film credit.
John Hoey, the editor of the CMAJ, admits it's a
tough rule to enforce: "We have no way of checking. We
barely have the resources to do what we’re doing, let
alone whether so-and-so is telling us honestly what they did."
Hoey says drug companies don't just want positive articles,
but positive research results. Some critics say all this industry
influence is a problem because ghostwriters rely on research
material that's given to them by drug companies — so
it may be biased to begin with. That means even ghostwriters
might not know about negative side effects and safety problems.
'It's clearly unethical,"
says Dr. Mohit Bhindari, McMaster University
“I think it is clearly unethical," said Dr. Mohit
Bhindari, an orthopaedic surgeon at McMaster University. He’s
just penned a report on drug company studies — a report
he wrote himself.
“If you have funding from an industry sponsor, you
are four times more likely to include a positive, pro-industry
result which favours that particular industry’s product,"
says Bhindari. He adds that researchers have told him there's
pressure to come up with "good results."
Dr. David Healy says that’s dangerous and has to change:
“The only way to know whether the articles really are
honest is for people, if need be, to be able to get access
to the raw data.”
Blair Snitch is in a rush to go. There’s another big
drug company contract to work on, with no regrets.
Blair Snitch: As long as I do my job well,
it’s not up to me to decide how the drug is positioned.
I’m just following the information I’m being
Marketplace: Even though you know that
information is often biased?
Blair Snitch: The way I look at it, if
doctors that have their name on it, that’s their responsibility,
So for now, keep in mind that medical information you read
may be other-worldly - since people paid big bucks to spin
research show no sign of giving up the ghost.