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Scandal of Scientists 

Thursday February 7, 2002

Sarah Boseley, health editor of The Guardian

Scandal of scientists who take money for papers ghostwritten
by drug companies. Although this article focuses on psychotropic
drugs and psychiatry, the article states that these scandals occur
with approximately 50% of all drugs.

Doctors named as authors may not have seen raw data.

Scientists are accepting large sums of money from drug
companies to put their names to articles endorsing new medicines
that they have not written - a growing practice that some fear is
putting scientific integrity in jeopardy.

Ghostwriting has become widespread in such areas of medicine
as cardiology and psychiatry, where drugs play a major role in
treatment. Senior doctors, inevitably very busy, have become
willing to "author" papers written for them by ghostwriters paid by
drug companies.

Originally, ghostwriting was confined to medical journal
supplements sponsored by the industry, but it can now be found in
all the major journals in relevant fields. In some cases, it is alleged,

the scientists named as authors will not have seen the raw data
they are writing about - just tables compiled by company
employees.

The doctors, who may also give a talk based on the paper to an
audience of other doctors at a drug company-sponsored
symposium, receive substantial sums of money. Fuller Torrey,
executive director of the Stanley Foundation Research
Programs in Bethesda, Maryland, found in a survey that British
psychiatrists were being paid around $2,000 (1,400) a time for
symposium talks, plus airfares and hotel accommodation, while
Americans got about $3,000. Some payments ran as high as
$5,000 or $10,000.

"Some of us believe that the present system is approaching a high-
class form of professional prostitution," he said.

Robin Murray, head of the division of psychological medicine at the
Institute of Psychiatry in London, is one of those who has become
increasingly concerned. "It is clear that we have a situation where,
when an audience is listening to a well-known British psychiatrist,
you recognise the stage where the audience is uncertain as to
whether the psychiatrist really believes this or is saying it because
they themselves or their department is getting some financial
reward," he said.

"I can think of a well-known British psychiatrist I met and I said,
'How are you?' He said, 'What day is it? I'm just working out what
drug I'm supporting today.'"

Marcia Angell, former editor of the New England Journal of
Medicine, wrote a year ago that when she ran a paper on
antidepressant drug treatment, the authors' financial ties to the
manufacturers - which the journal requires all contributors to
declare - were so extensive that she had to run them on the
website. She decided to commission an editorial about it and
spoke to research psychiatrists, but "we found very few who did not
have financial ties to drug companies that make antidepressants."

She wrote: "Researchers serve as consultants to companies
whose products they are studying, join advisory boards and
speakers' bureaus, enter into patent and royalty arrangements,
agree to be the listed authors of articles ghostwritten by interested
companies, promote drugs and devices at company-sponsored
symposiums, and allow themselves to be plied with expensive
gifts and trips to luxurious settings. Many also have equity interest
in the companies."

In September her journal joined the Lancet and 11 others in
denouncing the drug companies for imposing restrictions on the
data to which scientists are given access in the clinical trials they
fund. Some of the journals propose to demand a signed declaration
that the papers scientists submit are their own.

The success of Prozac, the antidepressant which became a cult
"happy" drug in the 1990s, substantially raised the stakes in
psychiatry. Its promotion coincided with the decline of state funding
for research, leaving scientists in all areas of medicine dependent
on pharmaceutical companies to fund or commission their work.
That in turn gave the industry unprecedented control over
data and ended with research papers increasingly being drafted
by company employees or commercial agencies.

The responsibility of scientists for the content of their papers takes
on serious significance in the context of court cases in the US,
where relatives of people who killed themselves and murdered
others while on SSRIs (selective serotonin reuptake inhibitors) - the
class of drug to which Prozac belongs - claimed the drugs were
responsible. According to David Healy, a north Wales-based
psychopharmacologist who has given evidence for the families, the
companies have relied on articles apparently authored by scientists
who may in fact have not seen the raw data.

Dr Healy, who had unprecedented access to the data that the
companies keep in their archives, said: "It may well be that 50% of
the articles on drugs in the major journals across all areas of
medicine are not written in a way that the average person in the
street expects them to be authored."

He cites the case brought last year against the former SmithKline
Beecham (now GlaxoSmithKline) by relatives of Donald Schell.
The court found that the company's best-selling antidepressant, an
SSRI called Seroxat, had caused Schell to murder his wife,
daughter and granddaughter and commit suicide.

The company's defence was based on scientific papers which
analysed the results of trials comparing Seroxat with a placebo and
found there was no increased risk of suicide for depressed people
on Seroxat. But the raw data probably does not support that,
argues Dr Healy. Some of the placebo suicides took place while
patients were withdrawing from an older drug. When the figures
are readjusted without these, he says, they show there is
substantially increased risk of suicide on Seroxat.

This raises the question of whether the eminent scientists whose
names were on the papers ever saw the raw data from the trials - or
saw only tables compiled by company employees, he says. David
Dunner, a professor at the University of Washington, who co-
authored one of the papers in 1995, admits he did not see the
raw data. "I don't know who saw it. I did not," he said. "My role in
the paper was that the data were presented to us and we analysed
it and wrote it up and wrote references."

His co-author Stuart Montgomery, then of St Mary's hospital
medical school in London, declined to answer calls and emails
from the Guardian. The third name on the paper is that of Geoff
Dunbar, a company employee.

The World Health Organization has expressed concern about the
ties between industry and researchers. Jonathan Quick, director of
essential drugs and medicines policy, wrote in the latest WHO
Bulletin: "If clinical trials become a commercial venture in which
self-interest overrules public interest and desire overrules science,
then the social contract which allows research on human
subjects in return for medical advances is broken."

Guardian Unlimited Guardian Newspapers Limited 2002

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