Sam Uretsky

Ghost Writers in the Medical Spin Cycle

If anybody is serious about cutting healthcare costs, a good place to start would be by making intelligent purchase decisions, which should begin with providing decision makers — physicians and surgeons, dentists and nurse practitioners — with accurate product comparisons.

This has been a stated goal for a long time, but it hasn’t happened, because any attempt to impose rational decision making on the practice of medicine is tarred and feathered with the stigma of “socialized medicine” and “decisions made by bureaucrats.”

Over time we’ve made small steps towards improving the practices of drug and device manufacturers, and in June there were two more baby steps. On June 24, Sen. Charles Grassley (R-Iowa) released a report titled “Ghostwriting in Medical Literature.” The day before, the University of Michigan announced that it would no longer accept financing from drug or device manufacturers for continuing medical education programs.

As sciences go, medical science falls somewhere between physics and economics. Physics can find real laws that are totally reproducible as long as a few variables are held constant. Economics can occasionally reveal patterns that may or may not be reproducible, but get credibility as long as they can be reduced to a graph or a mathematical formula.

Medicine, with proper studies, at best can come up with a consensus, but there are so many variables that even after all the studies are done, there’s still room for dispute. The next published study may have completely different results. As long as there’s room for disagreement, there’s room to improve market share.

Start with the ghost writers. A physician conducts a study — assume for a minute that it’s a well-designed study with an appropriate sample size and controls. Most often the results are equivocal, or equal but less expensive. Ideally, the researchers write their results for publication. Sometimes, though, the raw data is then handed to a professional medical writer who is paid by either the product’s manufacturer or a contractor being paid by the manufacturer. In either event, the writer knows where the money is coming from, and functions as a spin doctor.

A great deal of talent is devoted to making sure that the results prove what they were paid to prove. The ghost writer, if credited at all, will be mentioned in a footnote as having provided “editorial assistance.”

Medical journals also publish review articles — where the presumptive authors compare the results of previously published studies and draw conclusions. This type of paper allows for more subjectivity, and while you can’t make a silk purse out of a sow’s ear, given enough ears to work with, you can not only make the purse, but fill it with profits.

Drug and device makers have been known to commission a review article, then shop around for a suitable expert willing to claim authorship and give the work a gloss of legitimacy. The technique here is to cherry-pick favorable studies and ignore design deficiencies. As long as there’s any material to work with, a skilled writer can show that studies favor the sponsor’s product. After that, the sponsor can usually find qualified experts who will sign off on the paper as their own work, and submit it to a journal that won’t ask too many questions.

Medical writers — those who prepare papers for publication is professional journals — have a function. The job often calls for an advanced degree and requires both an understanding of the topic and facility in presenting the facts — but the way the game plays out, the paper claims to have been written by a practitioner affiliated with a reputable medical school, when it was really prepared by an employee of a drug or device manufacturer. A report that’s supposed to be objective is slanted towards the newer, higher priced product.

Finally, practitioners are required to take continuing education courses, and these too may be financed by drug and device manufacturers. The programs are presented by speakers who are paid an honorarium, and are allowed to focus on their own results and subjective impressions. The more favorably a speaker finds the sponsors product, the more often he’ll be invited to speak. Usually the amount paid is trivial, but one or two speakers have been paid six and even seven figures for their efforts. That’s enough to impair objectivity.

Studies should reveal the author, the author’s affiliation, and education, which should be objective. Neither of these changes will resolve the problem of biased information, but they’re still moving in the direction of giving physicians accurate information.

Sam Uretsky is a pharmacist living on Long Island, N.Y. He has done some ghost writing, speaking for drug manufacturers and freelance work for a medical ad agency, but generally he is not paid enough to impair his objectivity. Email sdu01@mail.com.

From The Progressive Populist, August 15, 2010