"Scandal
of scientists who take money for papers ghostwritten by
drug companies:Doctors named as authors may not have seen
raw data" by Sarah Boseley, health editor.
The
Guardian Thursday February 7, 2002
[http://www.guardian.co.uk/medicine/story/0%2C11381%2C646078%2C00.html]
Scientists
are accepting large sums of money from drug companies to
put their names to articles endorsing new medicines that
they have not written - a growing practice that some fear
is putting scientific
integrity in jeopardy.
Ghostwriting
has become widespread in such areas of medicine as cardiology
and psychiatry, where drugs play a major role in treatment.
Senior doctors, inevitably very busy, have become willing
to "author" papers written for them by ghostwriters
paid by drug companies.
Originally,
ghostwriting was confined to medical journal supplements
sponsored by the industry, but it can now be found in all
the major journals in relevant fields. In some cases, it
is alleged, the scientists
named as authors will not have seen the raw data they are
writing about - just tables compiled by company employees.
The
doctors, who may also give a talk based on the paper to
an audience of other doctors at a drug company-sponsored
symposium, receive substantial sums of money. Fuller Torrey,
executive director of the Stanley Foundation Research Programmes
in Bethesda, Maryland, found in a survey that British
psychiatrists were being paid around $2,000 (£1,400)
a time for symposium talks, plus airfares and hotel accommodation,
while Americans got about $3,000. Some payments ran as high
as $5,000 or $10,000.
"Some of us believe that the present system is approaching
a high-class form of professional prostitution," he
said.
Robin
Murray, head of the division of psychological medicine at
the Institute of Psychiatry in London, is one of those who
has become increasingly concerned. "It is clear that
we have a situation where, when
an audience is listening to a well-known British psychiatrist,
you recognise the stage where the audience is uncertain
as to whether the psychiatrist really believes this or is
saying it because they them selves
or their department is getting some financial reward,"
he said.
"I
can think of a well-known British psychiatrist I met and
I said, 'How are you?' He said, 'What day is it? I'm just
working out what drug I'm supporting today.'" Marcia
Angell, former editor of the New England Journal of Medicine,
wrote a year ago that when she ran a paper on antidepressant
drug treatment, the
authors' financial ties to the manufacturers - which the
journal requires all contributors to declare - were so extensive
that she had to run them on the website. She decided to
commission an editorial about it
and spoke to research psychiatrists, but "we found
very few who did not have financial ties to drug companies
that make antidepressants." She wrote: "Researchers
serve as consultants to companies
whose products they are studying, join advisory boards and
speakers' bureaus, enter into patent and royalty arrangements,
agree to be the listed authors of articles ghostwritten
by interested companies, promote drugs and devices at company-sponsored
symposiums, and allow themselves to be plied with
expensive gifts and trips to luxurious settings. Many also
have equity interest in the companies."
In September her journal joined the Lancet and 11 others
in denouncing the drug companies for imposing restrictions
on the data to which scientists are given access in the
clinical trials they fund. Some of
the journals propose to demand a signed declaration that
the papers scientists submit
are their own.
The
success of Prozac, the antidepressant which became a cult
"happy" drug in the 1990s, substantially raised
the stakes in psychiatry. Its promotion coincided with the
decline of state funding for research,
leaving scientists in all areas of medicine dependent on
pharmaceutical companies to fund or commission their work.
That in turn gave the industry unprecedented control over
data and ended with research
papers increasingly being drafted by company employees or
commercial agencies. The responsibility of scientists for
the content of their papers takes on serious significance
in the context of court cases in the
US, where relatives of people who killed themselves and
murdered others while on SSRIs (selective serotonin reuptake
inhibitors) - the class of drug to which Prozac belongs
- claimed the drugs were responsible.
According
to David Healy, a north Wales-based psychopharmacologist
who has given evidence for the families, the companies have
relied on articles apparently authored by scientists who
may in fact have not seen the raw data.
Dr Healy,
who had unprecedented access to the data that the companies
keep in their archives, said: "It may well be that
50% of the articles on drugs in the major journals across
all areas of medicine are not
written in a way that the average person in the street expects
them to be authored."
He cites
the case brought last year against the former SmithKline
Beecham (now GlaxoSmithKline) by relatives of Donald Schell.
The court found that the company's best-selling antidepressant,
an SSRI called
Seroxat, had caused Schell to murder his wife, daughter
and granddaughter and commit suicide.
The
company's defence was based on scientific papers which analysed
the results of trials comparing Seroxat with a placebo and
found there was no increased risk of suicide for depressed
people on Seroxat.
But the raw data probably does not support that, argues
Dr Healy. Some of the placebo suicides took place while
patients were withdrawing from an older drug. When the figures
are readjusted without these, he says, they show there is
substantially increased risk of suicide on Seroxat. This
raises the question of whether the eminent scientists whose
names were on the papers ever saw the raw data from the
trials - or saw only tables compiled by company employees,
he says. David Dunner, a professor at the University of
Washington, who co-authored one of the papers in 1995, admits
he did not see the raw data. "I don't know who saw
it. I didnot," he said.
"My
role in the paper was that the data were presented to us
and we analysed it and wrote it up and wrote references."
His co-author Stuart Montgomery, then of St Mary's hospital
medical school in London, declined to answer calls and emails
from the Guardian. The third name on the paper is that of
Geoff Dunbar, a company employee.
The
World Health Organisation has expressed concern about the
ties between industry and researchers. Jonathan Quick, director
of essential drugs and medicines policy, wrote in the latest
WHO Bulletin: "If
clinical trials become a commercial venture in which self-interest
overrules public interest and desire overrules science,
then the social contract which allows research on human
subjects in return for medical
advances is broken."