Flacking for Big Pharma

Editor's note: The following article was adapted from "Flacking for Big Pharma," published in the summer 2011 issue of The American Scholar.

When John Abramson, M.D., author of Overdosed America: The Broken Promise of American Medicine, lectured at Harvard's 2008 Ethical Issues in Global Health Research course, he dismissed much of the content of contemporary U.S. medical journals — widely embraced as irreproachable bastions of disinterested scientific evaluation — as "little better than infomercials."

See also: Doctors push drugs for dollars.

It is true that Big Pharma, as the top tier of the $310 billion pharmaceutical industry is known, advertises copiously and often inaccurately in peer-reviewed medical journals, impinging heavily on editorial content, sometimes with surprising brazenness. It's also true that medical journals are utterly dependent on pharmaceutical advertising, which can provide 97 percent to 99 percent of their advertising revenue. But what prompted Abramson's especially harsh assessment?

A medical reviewer is supposed to be an expert in the field who evaluates medications, devices and practices, distilling expertise and informed, disinterested opinion for a journal's readership. Journals do not pay the authors of such articles. But the manufacturers of the drugs and products in question often do.

Standard Operating Procedure

Today, an estimated 95 percent of the academic-medicine specialists who assess patented treatments have financial relationships with pharmaceutical companies. Drs. Paul M. Ridker and Jose Torres at Harvard Medical School found that 67 percent of the results of industry-sponsored trials published from 2000 to 2005 in the three most influential medical publications favored the sponsoring company's experimental heart drugs and often its devices. Trials funded by nonprofits, however, were as likely to support the drugs or devices as to oppose them.

Moreover, many biased medical-journal articles are not even the work of physicians or scientists, but of ghostwriters who script them in accordance with the drugmakers' marketing messages. A medical expert is found who, for a few thousand dollars, is willing to append his or her signature, and then the piece is published without any disclosure of the ghostwriter's role.

Case Study

In September 2010, Adriane Fugh-Berman, M.D., of the Georgetown University Medical Center, drew back the veil on a ghostwriting campaign undertaken by Wyeth, a drugmaker now a part of Pfizer. At the time, Wyeth had been promoting Premarin and Prempro, its brands of hormone replacement therapy (HRT). By shoring up hormone levels, HRT promised to preserve health and femininity indefinitely by treating the biological torments triggered by menopause, such as heart disorders, troubled skin, hot flashes, vaginal dryness and insomnia.

Next: How to check for bias in peer-reviewed articles.