A friend of mine who’s a doctor says that he doesn’t trust what he reads in his medical journals any more. He believes that they’ve been too corrupted by the drug companies. I also know of a psychiatrist who considers medical journals and professional education seminars so compromised by Big Pharma that he relies chiefly on the anecdotal accounts of his peers in prescribing drugs.
Paranoid doctors? Hardly. In today’s Wall Street Journal, we learn that such skepticism about the reliability of medical journals is entirely warranted. Reporter Anna Wilde Mathews writes:
Many of the articles that appear in scientific journals under the bylines of prominent academics are actually written by ghostwriters in the pay of drug companies. These seemingly objective articles, which doctors around the world use to guide their care of patients, are often part of a marketing campaign by companies to promote a product or play up the condition it treats.
The article goes on to describe how ghostwriters are frequently hired to write articles that academics are invited to publish under their own names. It’s a sweet scam. Academics get to pad their publishing resumes. Medical journals get well-written articles by big-name scientists. And the drug companies get to exploit the credibility and independence of academic science for a relative pittance.
We get the predictable PR defenses by drug companies — that they don’t intend for their ghostwriters to affect the tone of articles, that scientists do get to review and approve the articles before publication, and so on. But the violation of trust is obvious. The market is corrupting some core ethical principles of the scientific commons, such as independence and integrity of judgment. It is little reassurance to be told that such deceptions are infrequent. Trust is not fungible, but organic: once a capacity for deception is shown, the entire edifice of credibility is properly called into question.
One of the key reasons that scientific knowledge is trustworthy is because it is the product of a commons. Medical results are trusted only because they emerge from a community of peer-researchers committed to an open process of rigorous inquiry. Their judgment is not “for sale.” Science is not a market, in which money can buy whatever it wants. It is a commons, a gift economy in which the primary currency is reputation and trust. In a scientific commons, people have a keen interest in upholding community norms because their own identities and reputations are implicated in those norms. And no one wants to belong to a community that allows free riders to trade on the credibility of the community.
The seduction and betrayal of medical journals became newsworthy when the New England Journal of Medicine recently revealed that it had published a misleading article about the Merck painkiller Vioxx. The article touted the advantages of Vioxx and failed to mention that some patients had experienced heart attacks — precisely the issue now being litigated in hundreds of lawsuits against Merck. (For more on the lessons of Vioxx, see an article by Representative Henry Waxman in The New England Journal of Medicine — June 23, 2005, page 2576).
Now other stories of “gaming the journals” are emerging. There’s the University of Arizona professor who revealed that he had little to do with an article that identified him as the lead author. There is the Georgetown professor who was asked to publish a ghostwritten article under her name — she refused — and then was later asked to peer-review the same article for publication, now submitted under another researcher’s name.
The corrupting influences of Big Pharma on the commons of scientific research is a much larger story, of course. The drug industry is using its ample profits to corrupt the integrity of the federal advisory committee process, the medical education of doctors, and even peer interactions among doctors. In each case, truth is deliberately warped to serve drug marketing goals. Just as the Soviet people once had to read between the lines of Pravda to construct an accurate approximation of the truth, so conscientious doctors need to “read through” articles in medical journals to develop a simulation of the truth. An unchecked market has contaminated the scientific commons, an open secret that is finally being told.
As an antidote, I have two prescriptions of my own: Marcia Angell’s excellent book, The Truth About Drug Companies: How They Deceive Us and What to Do About It (Random House, 2004) and Merrill Goozner’s equally revealing book, The $800 Billion Pill: The Truth Behind the Cost of New Drugs (University of California Press, 2004).
Update: My friend Peter Suber at Open Access News suggests another excellent “antidote” — an article by Richard Smith, “ Medical Journals Are an Extension of the Marketing Arm of Pharmaceutical Companies,” which appeared in PLoS Medicine, May 17, 2005. Smith was editor of the British Medical Journal for 25 years. Thanks, Peter.