Is Drug Research Turning Into a Scam?

Big Pharma has developed new forms of 'research' to serve its own interests.

The medical research world has been concerned about the problem of ghost writing for more than a decade. Over the past few years, the issue has been repeatedly raised in the mainstream media. Most of the commentary has focused on the ethics of academics signing their name on papers they did not write and on some of the most egregious actions by pharmaceutical companies.

But these efforts miss the ways in which Big Pharma has developed new forms of medical research to serve its own interests.

How Ghost Writing Feeds Big Pharma Profits

According to a study by Marc-André Gagnon and Joel Lexchin in PLoS Medicine, Big Pharma firms spend twice as much on promotion as on research and development. But it is worse than that: More and more medical R&D is organized as promotional campaigns to make physicians aware of products. The bulk of the industry’s external funding for research now goes to contract with research organizations to produce studies that feed large numbers of articles to medical journals.

Internal documents from Pfizer, made public in litigation, showed that 85 scientific articles on its antidepressant Zoloft were produced and co-ordinated by a public relations company. Pfizer itself thus produced a critical mass of the favourable articles placed among the 211 scientific papers on Zoloft in the same period. Internal documents tell similar stories for Merck’s Vioxx, GlaxoSmithKline’s Paxil, Astra-Zeneca’s Seroquel, and Wyeth’s hormone-replacement drugs.

To promote the now-notorious Vioxx, Merck organized a ghost-writing campaign that involved 96 scientific articles. Key ones did not mention the death of some patients during clinical trials. Through a class-action lawsuit against Vioxx in Australia, it was discovered that Elsevier had created a fake medical journal for Merck – the Australasian Journal of Joint and Bone Medicine – and perhaps 10 other fake journals for Merck and other Big Pharma companies.

In another example, GlaxoSmithKline organized a ghost-writing program to promote its antidepressant Paxil. According to internal documents made public in 2009, the program was called “Case Study Publication for Peer-Review,” or CASPPER, a playful reference to the “friendly ghost.” Such strategies are not exceptions; they are now the norm in the industry.

Most new drugs with blockbuster potential are introduced accompanied by 50, 60, or even 100 medical journal articles. Any firm that refused to play this game in the name of ethics would likely lose market share. Profits in the pharmaceutical industry depend on companies’ capacity to influence medical knowledge, and create market share and market niches for their products.

A Call for Evidence-Based Medicine

In 2008, research showed that pharmaceutical companies systematically failed to publish negative studies on their SSRIs – formally called selective serotonin reuptake inhibitors, the Prozac generation of antidepressants. Of 74 clinical trials, 38 produced positive results and 36 did not; 94 per cent of the positive studies were published, compared to only 23 per cent of those that were negative, and two-thirds of those were spun to make them look more positive.