Friday, July 08, 2005

"Pharma Goes to the Laundry"

And nobody is left feeling clean....
Thanks for Sue Pelletier's blog Capsules for discovering an article written in 2004 entitled "Pharma Goes to the Laundry." (Full citation: Elliott C. Pharma goes to the laundry: public relations and the business of medical education. Hastings Center Rep 2004; 34: 18-23.) The article suggested that pharmaceutical companies "launder" their marketing message through medical education and/or communication companies to produce medical education or scholarly articles that appear to be independent and unbiased, and that these practices are much more frequent than even I previously thought.
In particular, Elliott, in turn, pointed out a 2003 article by David Healy (Healy D, Cattell D. Interface between authorship, industry and science in the domain of therapeutics. Br J Psych 2003; 183: 22-27) which took advantage of documents released during litigation from a medical communications company (Current Medical Directions) used by Pfizer to market sertaline (Zoloft). Healy and Cattell compared Current Medical Directions' log of the "scholarly" articles it wrote and PubMed searches. The results suggested that the majority of articles on sertaline from 1998-2000 were ghost-written by Current Medical Directions. If this data is generalizable, then the majority of apparently independent, scholarly articles in the medical literature related to the use of pharmaceuticals may have been ghost-written. Yikes!
Elliott also summarized how Wyeth allegedly marketed Fen-Phen via a "medical education" campaign designed to convince physicians that obesity was causing a "public health crisis," a few strategically placed articles ghost-written by Excerpta Medica, and an additional $100 million campaign to minimize the adverse effects of the drug (all derived from the book Dispensing with the Truth, by Alicia Mundy).
Finally, Elliott suggested that bioethicists have not helped, because "we forfeited any credibility we may have had when we started taking pharma money ourselves." As examples, he juxtaposed Healy's data about how Pfizer supported ghost-written articles about sertaline with the company's support for the Pfizer Hall for Medical Humanities at New York University Medical School, the Pfizer Lectureship in Medical Humanities at Royal Free and University College Medical School (in the UK), and the Center for Bioethics at the University of Pennsylvania. (And he noted that Hasting Center Reports are funded by Merck.)
More yikes! Read it, and read Sue Pelletier's post here.


Anonymous said...

Your reference to the obesity "educational" effort reminds me of the spotlight focused on bipolar disorder now.Apparently we should believe that this disorder is much more common that we realize.A group of internists were at a table at a lecture on that topic recently and the 6 of us could only think of perhaps 6-7 patients we have seen with bipolar over our roughly 200 years of combined experience.I guess we all just miss it.

Egan Allen said...

One wonders about many "fad" diagnoses: ADHD, PTSD, Hypercholesterolemia, Hypoglycemia, Bipolar Illness, etc. Roy's post certainly has scary implications!


Anonymous said...

Here's the part about the rise in bipolar diagnoses that I like best (or really, least): bipolar is on the rise, according to several accounts I've seen, because it is being "unmasked" by the use of SSRIs. What does unmasking mean? The implication is that the bipolar is there, lurking just under the surface, and the SSRI triggers a manic episode, which presumably would have emerged at some later date, had the patient been left unmedicated.

Here's what's really bizarre about this interpretation of events. There's no evidence that the patient has some underlying bipolar tendencies. This interpretation is merely a conceptual link between the rise in bipolar diagnoses, and the coincidental use of SSRIs. What if the SSRIs actually cause bipolar, the way at least one drug can cause Parkinson's? Maybe the patient would never have exhibited bipolar symptoms if not for taking the SSRI. Or maybe bipolar symptoms would have emerged much, much later. I could find only a couple of papers suggesting that handing out SSRIs with abandon might not be such a great idea if they can trigger a much more serious disease.