Air Date: CBC News - Mar 25, 2003
Reporter: Erica Johnson
Producer: Michael Gruzuk
Researcher: Colman Jones
You may not have heard of it, but you'll probably want to know
about it. It's a world that could make your doctor prescribe the
For trusted guidance — articles rigorously reviewed in medical
journals are the gold standard when it comes to scrutinized, scientific
reports. They're what our doctors rely on to make decisions affecting
our health. But more and more — we can’t be sure who’s
serving up that medical advice.
Medical ghostwriting can be as scary as it is spooky. People with
scientific backgrounds — often, with PhDs — are paid
to stay in the shadows and crank out favourable reports for drug
companies. Then, drug companies get doctors to put their names
on the studies — for money, prestige, or perks.
Marketplace tracked down ghostwriters in Vancouver, Montreal
and Ottawa — one agreed to talk with us, but only if we
protected their identity. Their job could vanish if their identity
is revealed. We'll call our busy ghostwriter, Blair Snitch.
Blair Snitch: I’m given an outline about what to talk
about, what studies to site. They want us to be talking about
the stuff that makes the drug look good.
Erica Johnson : They don’t give you the negative studies?
Blair Snitch: There’s no discussion of certain adverse
events. That’s just not brought up.
Blair Snitch is paid to write up positive reports. So bad side
effects that could affect patient safety, are sometimes completely
Snitch makes over $100,000 a year as a medical ghostwriter. An
article that makes its way into a prestigious medical journal
— like the Lancet, British Medical Journal, New England
Journal of Medicine — will earn up to $20,000.
Snitch’s work is brisk and busy, but not problem free.
Erica Johnson: How much pressure is there from the drug company
to write something favourable?
Blair Snitch: You’re being told what to do. And if you
don’t do it, you’ve lost the job.
'A matter of efficiency'
Snitch works for what’s called a “medical writing”
company. There’s a whole industry churning out drug company
bumph. It’s partly a matter of efficiency, says Snitch.
“Doctors don’t have time to write those articles.
The people who have their names on those articles are very busy
Busy — and usually high-profile. The higher the profile,
the greater the credibility for the article.
“What appear to be scientific articles are really infomercials
of some sort,” says Dr. David Healy of the University of
Healy’s no stranger to controversy: his job at the University
of Toronto was suspended after he criticized the pharmaceutical
industry. But he still gets invited to lecture and remembers one
“I said 'yes' to the meeting. To my big surprise I had
an e-mail shortly afterwards. 'In order to reduce your workload,
we have had our ghostwriters produce a first draft based on your
published work. I attach it here.'"
Healy wasn’t comfortable with the glowing review of the
drug, so he crafted his own article. The drug company wrote back
and said he’d missed something key. In the end, the drug
company put someone else's name on the article.
Healy is spooked by the deception. He says it goes beyond being
misleading — it can be dangerous. He’s seen a lot
of articles on drugs — like anti-depressants — that
don’t mention serious problems.
“People and children, for instance, that have been put
on these drugs, actually committing suicide. Or becoming suicidal.
But the finished articles actually don’t reflect this at
Reason for concern
Blair Snitch says the public should be concerned.
"Are they being prescribed a drug because it’s the
best drug or because it’s the drug most favourably positioned?"
Erica Johnson: Do you have any concerns about what you’re
Blair Snitch: I don’t feel ownership of the product.
Erica Johnson: But you are taking the research and delivering
to the drug company something that’s favourable.
Blair Snitch: I expect that all the drug companies are doing
it with all the drugs. So I figure in the end, it’ll be
balancing itself out.
Healy’s not so sure. He’s seen internal drug company
documents. They had lists of scientific papers written up, ready
to go. All that was missing, was the name of a high profile doctor
to be listed as author.
Healy estimates as much as 50 per cent of the literature on drugs
Ghostwriters we talked to said they do a good job of taking complicated
science and turning it into something understandable.
We wanted to ask a doctor why they’d agree to sticking
their name on a paper. But it’s tricky getting people to
fess up. Some doctors didn’t call back. One we reached said
he “couldn’t remember who wrote the paper” his
name was on. Then said the drug company “might have”
written the first draft. But by the end of our conversation, he’d
remembered — he’d written every word.
The world’s leading medical journals – say they're
trying to ferret out who lurks behind the pen. When a study is
submitted to top journals like the Canadian Medical Association
Journal, The Lancet, New England Journal of Medicine, everyone
whose had anything to do with the article is listed — like
a film credit.
John Hoey, the editor of the CMAJ, admits it's a tough rule to
"We have no way of checking. We barely have the resources
to do what we’re doing, let alone whether so-and-so is telling
us honestly what they did."
Hoey says drug companies don't just want positive articles, but
positive research results.
But some critics say all this industry influence is a problem
because ghostwriters rely on research material that's given to
them by drug companies — so it may be biased to begin with.
That means even ghostwriters might not know about negative side
effects and safety problems.
“I think it is clearly unethical," said Dr. Mohit
Bhindari, an orthopaedic surgeon at McMaster University. He’s
just penned a report on drug company studies — one that
he wrote himself.
“If you have funding from an industry sponsor, you are
four times more likely to include a positive, pro-industry result
which favours that particular industry’s product.”
Bhindari says researchers have told him there's pressure to come
up with "good results."
Dr. David Healy says that’s dangerous and has to change.
“The only way to know whether the articles really are honest
is for people, if need be, to be able to get access to the raw
Blair Snitch is in a rush to go. There’s another big drug
company contract to work on, with no regrets.
Blair Snitch: As long as I do my job well, it’s not up
to me to decide how the drug is positioned. I’m just following
the information I’m being given.
Erica Johnson: Even though you know that information is often
Blair Snitch: The way I look at it, if doctors that have their
name on it, that’s their responsibility, not mine.
So for now, keep in mind that medical information you read may
be other-worldly. Since people paid big bucks to spin research
show no sign of giving up the ghost.