By Kate Johnson – October 12, 2009
Commenting on my recent blog about medical ghostwriting, Adam Jacobs, Ph.D., emphasized his position that “most medical writing funded by the pharmaceutical industry is perfectly ethical, with no attempts made to ‘spin’ the science.”
Adam Jacobs is well-versed on the subject of ethical medical writing. He is former president of the European Medical Writers Association, set up the group’s ghostwriting taskforce in 2003, and co-authored the EMWA guidelines on the role of medical writers in peer-reviewed publications.
He may be right that medical writers do not spin the science themselves, but sometimes the science is already spun by the time it gets to them – and it’s not just pharmaceutical companies that do the spinning. As a medical journalist, I’ve seen independent researchers perform some clever manoeuvers with their data when presenting their yet-to-be published studies at scientific conferences.
The bottom line is, writers who assist researchers in preparing papers can only work with the material they’re given, so even if they present that material fairly, it may only tell part of the story.
As a society we accept bias when it comes to advertising, and we take it into consideration when we make our decisions. But bias in medicine has crept up on us like subliminal advertising, unfairly influencing patients and their doctors.
A recent analysis in the Journal of the American Medical Association uncovered the potential for various degrees of bias in almost 70% of more than 300 published drug or device trials. Most of the bias came from selective reporting of outcomes, in other words, telling only part of the story.
“Drug companies hiding negative test results,” was the headline on a newspaper article about the study. Inaccurate registration of trials when they begin “allows scientists, or the drug companies who pay for the work, to release good results but quietly cancel anything that looks bad for their product,” it said.
In an interview one of the co-authors of the JAMA study, Dr. Moher told me “ this particular paper is not a smoking gun for the pharmaceutical industry”. Product promotion by the pharmaceutical industry is just one of many possible motives, he says. Independent researchers may also be tempted to spin their data in an attempt to produce more publishable results.
Either way, whether it’s pharmaceutical companies promoting their products, or researchers promoting their careers, promotion should not be displacing science in medical reporting .
Bias is ethically unacceptable in medicine (and biased independent researchers are the subject of my other blog) . In contrast, we expect and accept bias in marketing. Marketing is the main focus of the pharmaceutical industry. So, as research ethics blogger Nancy Walton asks, can we trust the pharmaceutical industry to play fair in science?
Big Pharma blogger Rich Meyer is honest about his industry’s agenda when he says: “Medical journal articles sponsored by drug companies are part of marketing”. This is view that was shared by 42% of respondents to an online survey by Pharma Marketing News.
Meyer goes on to say (rather clumsily, so I paraphrase) that he sees nothing wrong with this mixing of medicine and marketing “as long as it is made clear at the beginning of the article who wrote it and who endorses the content.”
But, as we’ve seen, that kind of transparency is often lacking. The pharmaceutical industry has infiltrated medical publications using ghostwriters. And, as Nancy Walton wrote in another blog, once transparency is lost, even sound science is questioned. “The problem is not whether the paper that resulted from the ghost-writing process was sound… The point is: how can we be sure?… the process used to generate the paper …was one highly likely to cast doubt upon the process of scientific publication.”
Adam Jacobs appeals: “Just because there have been a few well-publicised instances of pharma companies behaving extremely badly, let’s not tar everyone with the same brush.” But I wonder, by expecting Big Pharma to play fair in the world of science, are we trying to fit a square peg into a round hole?
Big Pharma’s priorities are plain to see. It’s research spending is dwarfed by its marketing budget. In this context, where medical publishing is viewed as a form of marketing, spinning the science may be considered an acceptable promotional strategy. Perhaps we should just expect and accept this bias, encourage pharmaceutical companies to publish their own medical journals – and weigh “the evidence” as we would any other form of advertising.
At least this would be transparent bias, a visible entity whose influence could be understood. This influence would be far safer, less insidious than pharma’s invisible influence recently described by investigative journalist and blogger Alex Roslin. Roslin shows how Big Pharma’s subtle influence on doctors starts early, with free lunches for medical residents.
Free lunches seem harmless, but actually come at a steeper price than most doctors may appreciate. One study found that doctors who “occasionally” ate pharma-sponsored meals were 2.7 times more likely to request that the sponsor’s drug be added to a hospital formulary. Doctors who “often” ate the meals were 14 times more likely to do so. And doctors who accepted funding for a trip to a company-sponsored conference prescribed that company’s drugs 80- to 190-percent more often than those who hadn’t, says Roslin.
As a medical journalist I attend scientific conferences where lunchtime lectures are often sponsored by Big Pharma. I used to eat the lunches, knowing I’d find no other food between presentations, interviews and deadlines. I don’t eat them anymore, but I do report anything newsworthy that is said at them – making sure I clearly state Big Pharma’s role in the event.
I enjoy attending Big Pharma lectures, even if I leave hungry, because they are often the most relevant, focused and well-prepared presentations at the conference. The pharmaceutical industry’s money makes an invaluable contribution to education and scientific advancement in medicine. There are many brilliant, articulate and ethical researchers who work for the pharmaceutical industry, but when they speak to us we just have to remember who they work for.