Friday, August 07, 2009

Ghostwritten medical literature

How does one believe that a doctor's prescriptions are in your best interests? In India, the really good doctors are going by long experience with patients. The bad ones go by the marketing materials of pharmaceutical companies. Very few doctors read the medical literature actively. Yet, as a scientist, I would like to believe that the peer-reviewed medical literature should be the first resource for a good doctor in trying out new treatments.

And then one comes across stories like this New York Times article:

Newly unveiled court documents show that ghostwriters paid by a pharmaceutical company played a major role in producing 26 scientific papers backing the use of hormone replacement therapy in women, suggesting that the level of hidden industry influence on medical literature is broader than previously known.

The articles, published in medical journals between 1998 and 2005, emphasized the benefits and de-emphasized the risks of taking hormones to protect against maladies like aging skin, heart disease and dementia. That supposed medical consensus benefited Wyeth, the pharmaceutical company that paid a medical communications firm to draft the papers, as sales of its hormone drugs, called Premarin and Prempro, soared to nearly $2 billion in 2001.....

The court documents were unveiled after a request from the NYT and the journal PLoS Medicine, which has a blog post on the topic.

This is probably the tip of the iceberg. It is not the first time I have worried about the reliability of medical advice. But I don't think the utter corruption and depravity -- I wish I could think of stronger words -- of medical research has been so clearly exposed before.

When Jan-Hendrik Schön falsifies his research, other researchers end up wasting their time and money and the field is set back by a few years. When doctors lend their names to the publicity material of pharmaceutical companies, ordinary people suffer and possibly die. Wyeth now faces about 8400 lawsuits about the consequences of their "hormone replacement therapy", but no amount of money can compensate the victims. And what of the doctors who agreed, and continue to agree, to be a part of this sordid game? We can boycott individuals like Dr Gloria Bachmann, named in the article (I wonder how many will do so, though), but how do we find a doctor we can trust? Luckily we do have a very sound paediatrician, of whom I may write more later. But we have also had bad experiences with other doctors (I gave one example here, but it was not the only one).

The medical industry is constantly worried, with good reason, that people are going for "alternative" treatments that may range from good-but-of-limited-scope (ayurveda, naturopathy) to ineffective but probably harmless (homeopathy, the genuine kind) to possibly dangerous (additives in many so-called "herbal" or "homeopathic" medicines) to totally crackpot (chiropractic). It is indeed very worrying. But the people who go for these therapies have decided that the medical community is in the pockets of the pharmaceutical industry, and are looking out only for the industry's interests and not the patient's. This is unfair to the majority of medical practitioners, but I increasingly feel, accurate about the most high-profile and headline-hogging doctors, in this country and elsewhere. The medical profession has to find a way to tackle this, if patients aren't to be driven to cranks and quackery.


Rahul Basu said...

Be careful what you say about chiropractors - or you might suffer the fate of Simon Singh. And they have tons of money which is another reason many people don't want to make explicit statements about either pharmaceutical companies or dubious medical practices.

Rahul Siddharthan said...

Yes, I was thinking of Simon Singh's case. Thanks for the link. UK libel laws are in need of rethinking (here's Monbiot on the subject); I'm not sure where Indian law stands on this.

km said...

I could share more anecdotes from my interactions with the pharma business, but I would have to kill you all first.

I'm sorry if there are any professionals from the pharmaceutical industry reading this, but *nothing* about that industry is what it seems to be.

Vikas said...

but that's not all, what about unauthorized clinical trials on unsuspecting patients and that too in government hospitals!!

The practice is rampant and there are no checks, laws yes but no checks.