Monday, July 13, 2015

Decontaminating the medical literature

To ensure that its clinical review articles reflect current medical literature, the American Family Physician journal (of which I am an associate deputy editor) requires prospective authors to consult evidence-based resources that synthesize the best available evidence from clinical trials and other high-quality studies. The goal of this process is to produce unbiased recommendations for primary care physicians. But what if the authors of clinical reviews are actually professional scientific writers paid by pharmaceutical companies, rather than the physicians who are named as authors?

In fact, drug-company funded "ghostwriters" have been publishing articles in the medical literature for years. A 2011 study found that from 2 to 11 percent of articles published in 2008 in six major journals were actually written by people who were not named as authors. Although the study could not establish that these ghostwriters had been directly financed by industry, the practice of writing up a scientific study and then recruiting a lead author (usually an academic physician under pressure to "publish or perish") has been well-documented in the case of previous "blockbuster" drugs that were taken by millions of patients for common conditions but later turned out to have dangerous or fatal side effects, including Prempro and Vioxx.

Ghostwriting is not the only way that the pharmaceutical industry is able to influence the interpretation of evidence in its favor. As a Letter to the Editor pointed out, a 2005 Cochrane Review on medications for diabetic neuropathic pain unintentionally exaggerated the effectiveness of gabapentin in treating this condition due to the manufacturer's selective publication of favorable trials and suppression of unfavorable ones. (Antivirals for influenza present a similar problem.) In an accompanying editorial, Drs. Adriane Fugh-Berman and Jay Siwek reviewed these and other "stealth marketing" tactics that contaminate the medical literature, along with ways that readers can help identify and correct these biases:

Distorted information, once ensconced in the medical literature, is propagated by industry and by well-intentioned authors who unwittingly cite these studies. The medical literature is a permanent record that scientists and physicians rely on for decisions that ultimately affect patient care. Although the scientific process is never linear, the self-correcting process by which evidence is continually refined can be corrupted by the infiltration of medical journals with research studies and review articles distorted by a hidden marketing agenda.

Although there is no foolproof way for readers to detect undue industry influence, readers should be alert for marketing messages that disparage older, generically available drugs or that position newer branded (or upcoming) drugs as more effective, more convenient, safer, or filling an unmet need. The last sentence of the abstract is typically where the marketing spin is inserted. Readers should alert medical journals to suspicious articles by writing letters to the editor.


This post originally appeared on Common Sense Family Doctor under the title "Compromising the medical literature" on September 8, 2011.