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CBC MARKETPLACE: HEALTH » MEDICAL GHOSTWRITING
Inside the business of medical ghostwriting
Broadcast: March 25, 2003 | Reporter: Erica Johnson; Producer: Michael Gruzuk; Researcher: Colman Jones

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 perks.

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.

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 good.

Marketplace: They don’t give you the negative studies?

Blair Snitch: There’s no discussion of certain adverse events. That’s just not brought up.

Blair Snitch is paid to write up positive reports. Bad side-effects that could affect patient safety, are sometimes completely ignored.

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 the job.

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 Snitch:


'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 busy professionals.”

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 of Wales.

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 favourable.

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.

John Hoey
'We have no way of checking," says John Hoey, editor of the Canadian Medical Association Journal

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.

'Clearly unethical'


'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 given.

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, not mine.

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.



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RELATED:

Statistical flaws found in top journal studies (May 28, 2004)

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Medical journals agree to new publication rules (November 30, 2001)

Medical journals call for research integrity (September 10, 2001)

Medical journal apologizes for conflicts of interest (November 11, 2000)

EXTERNAL LINKS:

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Documents and Articles:

Uniform Requirements for Manuscripts Submitted to Biomedical Journals Updated October 2001

The CONSORT statement a research tool that comprises a checklist and flow diagram to help improve the quality of reports of randomized controlled trials

"Spin doctors soft pedal data on antihypertensives" Jeanne Lenzer, British Medical Journal, January 18, 2003

"Medical newsletters: Can they be trusted?" by Jay Brophy, Canadian Medical Association Journal, October 29, 2002

"Hype in Health Reporting: "Checkbook science" buys distortion of medical news" Diana Zuckerman, Extra!, September/October 2002

"Relaxing The Rules" Tufts E-News, June 19, 2002

"Prevalence of Honorary and Ghost Authorship in Cochrane Reviews", by Graham Mowatt et al., Journal of the American Medical Association, June 5, 2002

Jobs on this list: Ethical issues a May 17, 2002 post on a mailing list run by New York freelance journalist Norman Bauman

UW's Friendly Corporate Ghostwriter Rick Giombetti, Eat the State, May 8, 2002

"Drug industry writers propose code of ethical conduct", by Gavin Yamey, British Medical Journal, April 6, 2002

"Covering Medical Technology", by Trudy Lieberman, Columbia Journalism Review, March/April 2002

"Selling Drugs - with a little help from a journalist", by Rob Burton, British Medical Journal, Nov 24, 2001

Sponsorship, authorship and accountability Frank Davidoff et al., Canadian Medical Association Journal, September 18, 2001

Maintaining the integrity of the scientific record British Medical Journal, September 15, 2001

"Beware a conflict of interest" David Nicholson, The Scientist, August 23, 2001

"Reporting of conflicts of interest in guidelines of preventive and therapeutic interventions", by George N. Papanikolaou et al., BMC Medical Research Methodology, June 4, 2001

"Uneasy Alliance - Clinical Investigators and the Pharmaceutical Industry" Thomas Bodenheimer (originally published in New England Journal of Medicine, May 18, 2000)

"Is Academic Medicine for Sale?" Patricia Nell Warren, A&U Magazine, October 27, 2000

"Who wrote this paper anyway?: The new Vancouver Group statement refines the definition of authorship" John Hoey, Canadian Medical Association Journal, September 19, 2000

"Where To Draw The Bottom Line: Financial Conflict Of Interest In Clinical Research" by Fran Pollner, NIH Catalyst, September, October 2000

"Medicine, the media and monetary interests: the need for transparency and professionalism" by Ray Moynihan and Melissa Sweet, The Medical Journal of Australia 2000; 173: 631-634

"The Invisible Hand of Peer Review" by Stevan Harnad, Exploit Interactive, April 2000

"Applying Criteria for Authorship and Acknowledgement to Ghostwriters in Scientific Publications" [PDF] by Keith Lantz, Student Poster Presentation at 35th Annual Drug Information Association (DIA) Meeting, June 1999

"Prevalence of Articles With Honorary Authors and Ghost Authors in Peer-Reviewed Medical Journals" by Annette Flanagin, Journal of the American Medical Association, July 15, 1998

"Editorials and Conflicts of Interest", by Marcia Angell & Jerome P. Kassirer, New England Journal of Medicine, October 3, 1996

"The Bitterest Pill: the unhealthy dominance of the pharmaceutical industry" by Steven Ransom

Organizations:

GhostWriters International

American Medical Writers association (AMWA)

Canadian chapter

Editors Association of Canada

Board of Editors in the Life Sciences

Council of Science Editors

Drug Information Association

Society for Technical Communication

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