Research Article: Ghost Management: How Much of the Medical Literature Is Shaped Behind the Scenes by the Pharmaceutical Industry?

Date Published: September 25, 2007

Publisher: Public Library of Science

Author(s): Sergio Sismondo

Abstract: Sismondo discusses how pharmaceutical companies and their agents shape multiple steps in the research, analysis, writing, and publication of articles.

Partial Text: There are many reports of medical journal articles being researched and written by or on behalf of pharmaceutical companies, and then published under the name of academics who had played little role earlier in the research and writing process [2–14]. In extreme cases, drug companies pay for trials by contract research organizations (CROs), analyze the data in-house, have professionals write manuscripts, ask academics to serve as authors of those manuscripts, and pay communication companies to shepherd them through publication in the best journals. The resulting articles affect the conclusions found in the medical literature, and are used in promoting drugs to doctors.

Because ghost management is hidden, we cannot tell how common it is from published exposés. Current practices in the medical sciences legitimately allow people to serve as authors on the basis of narrow contributions. Therefore many near-honorary authors find little reason to feel uncomfortable with their roles. Fully honorary authors may not see enough of the process of the production of their articles to know that they are ghost managed. Finally, it is not in the interests of writers, authors, or sponsors and their agents to reveal ghost management processes; hence a number of the published accounts of ghost management have stemmed from legal proceedings and investigative journalism. So how common is ghost management?

The most solid information available on ghost management comes from the work of David Healy and Dinah Cattell. A lawsuit in which Healy was involved allowed access to a document listing 85 manuscripts on sertraline that were being coordinated for Pfizer by the medical education and communication company (MECC) Current Medical Directions (CMD) [9,23]. The document lists other agencies as the vendors of some of the documents, and some authors “TBD” (to be determined), so it is almost certain that a number of these 85 manuscripts were written by professional writers acting for Pfizer, possibly via CMD.

A survey in 2001 identified 182 MECCs in the United States, up from 153 in 1998 [25]. A number specialize in producing, placing, and tracking journal articles, known in the trade as “publication planning” or “strategic communication planning.” While these firms hide details of their work—from potential critics and competitors—they also energetically promote themselves and their services. Many have flashy Web sites highlighting their ability to prepare meeting presentations and publish articles.

Merck’s ghost management of the Advantage trial paper was described as “an unusual practice” when it was reported in The New York Times [4]. Given the amount of data that pharmaceutical companies control, the number of publication planning agencies that openly advertise on the Internet, the number of medical writers, the existence of two associations for publication planners, and meetings organized and reports written for them, we can conclude that ghost management is common. The CMD document obtained by Healy suggests that during key marketing periods as many as 40% of published articles focusing on specific drugs are ghost managed [24]. Even if the more typical figure is half that, ghost management exerts a huge force on the shape of scientific opinion on new drugs, and does so in the service of marketing.



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