Just the Facts
In 2008, research showed that pharmaceutical companies had systematically failed to publish negative studies on their SSRIs, the Prozac generation of antidepressants. Of 74 clinical trials, 38 produced positive results and 36 did not: 94% of the positive studies were published, but only 23% of the negative ones were, and two-thirds of those were spun to make them look more positive.
Physicans reading the scientific literature got a biased view of the benefits of SSRIs. This helps to explain the huge number of antidepressant prescriptions, in spite of the fact that, according to a meta-analysis in JAMA in January 2010, for 70% of people taking SSRI antidepressants, the drug did not bring more benefits than a placebo. Compared to placebo, however, SSRI antidepressants can result in serious adverse drug reactions.
Therein, we see one of the problems with the ghost management of medical research and publication. Pharmaceutical companies want upbeat reports on their drugs. They design, write, and publish studies that are likely to show their drugs in positive lights—and there are myriad ways to do so. Ghosts sometimes bend the truth, and sometimes even commit fraud, with grave results.
But if the industry is selling its products by writing thousands of scientific articles per year, the public should be concerned about more than fraud. These studies produce biases that covertly advertise particular drugs, support them scientifically, and set agendas for diagnosis and treatment. Academics are performing a disservice to medical research and to the public as a whole if they sign off on pharmaceutical company articles—even if they firmly believe the claims of those articles.
Why do academics serve as authors on articles they did not write, using research they did not perform? They are rewarded, both by their universities and by their colleagues, for how much they publish and for the prominence of what they publish. Pharmaceutical companies and their agents are very good at placing articles in good journals, and then making them even more prominent by having their armies of sales reps circulate them and talk them up.
Researchers who serve as authors on studies and analyses (perhaps scientifically correct) that are favorable to the industry can expect to see these articles increase their prestige and influence, and possibly even funding.
What happens, however, when a researcher produces studies and analyses (also scientifically correct) showing that some products are dangerous or inefficient, as some did about Vioxx before the scandal broke? Reading Merck’s internal e-mails, revealed during the class lawsuit, it was exposed that the company drew up a hit list of “rogue” researchers who needed to be “discredited” or “neutralized”—“seek them out and destroy them where they live,” reads one e-mail. Eight Stanford researchers say they received threats from Merck after publishing unfavorable results.
In a report published in February, the U.S. Senate Committee of Finance relays a similar story about how GlaxoSmithKline downplayed the risks in the case of Avandia, a diabetes drug. GSK was reportedly aware, for years, that Avandia posed possible cardiac risks. Instead of warning patients and the FDA, “GSK executives intimidated independent physicians [and] focused on strategies to minimize findings that Avandia may increase cardiovascular risk.”