orgtheory.net

power is knowledge in medical research

First off, thanks to the orgtheory crew for inviting me on as a guest blogger.  I am clearly the oldest one in the room by a couple of decades, which reminds me of that Mos Def concert I attended a couple of years ago. I can only hope that blogging does not lead to Twitter and piercings.

It has recently come to light that major drug companies routinely contract with ghostwriters to draft journal submissions favorable to the drug companies’ products and then shop them around to high-status researchers to serve as their “authors.”  The most recent example is Wyeth, which evidently paid for over two dozen published papers (at $25K a pop) supporting the use of hormone replacement therapy for menopausal women.  Wyeth sold $2 billion per year of such drugs in 2001.  The following year, Wyeth’s sales plummeted when a large Federal study found that hormone replacement drugs increased the risk of cancer, heart disease, and stroke.

Wyeth was far from alone, as apparently ghost-written journal articles are an open secret in the industry, widely used as a marketing device by big pharma companies for drugs ranging from fen-phen (which causes heart damage) to Vioxx (which increases the risk of heart attack and stroke).  In fact, Merck funded the creation of a faux-journal in Australia, the “Australasian Journal of Bone and Joint Medicine,” which ran for 3 years to push its pain reliever Vioxx until the drug was removed from the market.

Top medical schools are rife with researchers who have attached their names to articles that, in some cases, they have barely read.  Some journals have adopted policies requiring the disclosure of financial relationships, and Sen. Grassley is attempting to use NIH funding as a lever to stop the practice.  But the prior scientific record, going back at least a dozen years, evidently contains hundreds of articles that are effectively marketing propaganda for drug companies.

I had two divergent reactions to this revelation.

(1) Organizational researchers, particularly in business schools, are constantly hounded about the importance of making their research “relevant” and applicable, with medical research held up as the positive exemplar.  Can we call a moratorium on such demands for relevance, now that so much “relevant” medical research published under the names of high-status scientists turns out to be just marketing, often in the service of dangerously faulty products?

(2) Maybe Foucault was right, and I’m stuck in some outdated Enlightenment-era view of “science.”  For a decade I’ve required students in my research methods course to read Deirdre McCloskey’s excellent Rhetoric of Economics, which gives a neo-pragmatist account of science as a form of rhetoric (persuasive speech).  Many students are uncomfortable with the idea that “scientific truth” is just a provisional judgment by a community of skilled interlocutors.  It’s particularly discomforting when this is operationalized in terms of what ends up in the journals (that is, publication = truth).  Now it turns out that the scientific record is littered with hundreds and perhaps thousands of published articles in reputable journals “written” by well-regarded scientists that are basically advertising gambits by giant drug companies.  Correcting the record is out of the question, as the articles in print rarely note who really wrote or funded the reported research, and the implicated researchers have little incentive to fess up. I doubt that this phenomenon is limited to medical research, but I hesitate to inquire about its application in the social sciences.  Was Weber being funded by the Lutherans?

Written by Jerry Davis

August 21, 2009 at 3:35 am

Posted in uncategorized

14 Responses

Subscribe to comments with RSS.

  1. I had not heard anything about this practice. Although I’m not really in this field, I know people who are and this is really distressing. Perhaps within the field it’s an open secret as to who is willing to pimp themselves out and who is not? I’m curious to know more about the social dynamics among the researchers active in these fields.

    Longer term, government regulatory agencies (and not just the NIH) are going to put a stop to this kind of practice. It’s only a matter of time. The smart drug companies will stop now and try to mitigate whatever damage has already been done to their reputations.

    Practices like this actually make it much harder to get good deals done between universities and industry.

    Like

    Michael F. Martin

    August 21, 2009 at 5:20 am

  2. Its quite a story Jerry. But are you making a bit of a leap from what seems like a blatantly unethical practice of “buying” research and what happens in business schools? How rude to the poor medical hacks. The pressure on us b-school types is faaar more insidious isn’t it? One doesn’t need to be corrupted. Its more in whether our students and colleagues light up or shut down when, say, the future of unions or obama’s vision for manufacturing is discussed vs., oh say, how best to segment a market and exploit short term hedging opportunities. Its not whether we should be relevant, but what is considered worthy of relevance.

    Like

    seansafford

    August 21, 2009 at 6:01 am

  3. I wonder if it is possible to find articles supporting particular financial instruments written by bankers and then sold to finance scholars to publish.

    Most of the influence that business has on business schools is probably of a much more general (though, yes, perhaps also more insidious, as Sean points out), ideological nature. So, as I understand it, public health care, which has long had popular support in the US, has become a viable political project because US industry has begun to warm to it. It would be interesting to see if there has been a shift in the b-school literature that is favourable to health care (perhaps merely an increased interest in it). If so, it is more likely a reflection of the pursuit of “relevance” than the sort of thing that goes on in medical journals.

    Then again: could we not imagine a corporate policy-maker in the auto-industry (which wants health care reform, as I understand it) penning an article and giving it to a like-minded scholar at a major b-school along with a cash incentive to publish it in his own name? Could we not imagine insurance companies doing the same thing for the opposite cause?

    Like

    Thomas

    August 21, 2009 at 8:43 am

  4. As the publisher of a scientific journal on geriatric pharmacy, this is of course a special concern to me. We all have policies in place around this stuff, but funding from pharmaceutical companies is pervasive in every aspect of health care and always has been. Some of the most egregious abuses have been rooted out (“educational” trips to the Caribbean for the top prescribing doc in the region, etc.) but they are businesses with products to sell. We are working hard (as are all health care associations) to make it clear to our members who supports what activities. If it is a commercial (sales) message and it is clearly identified as such, that’s OK. What is disturbing everyone is the under-the-table aspect here. That said, for non-business school types like me, the most striking thing about visiting one of your fine institutions is that every room, toilet, and door knob is sponsored by some company or another. Is it realistic to think they are just writing a check and walking away?

    And of course, Weber was funded by the Calvinists, not the Lutherans.

    Like

    John Feather

    August 21, 2009 at 11:55 am

  5. This is a great example of the risk of being in an industry with competitors taking very short-sighted (and in this case ethically wrong) actions. I’m concerned that actions like these may ruin collaborative research between industry and academia. At a point in time when more data sharing, not less, is needed, policy responses barring all industrial-academic intellectual collaboration may stifle a lot of really good work.

    That being said, with so much on the line in terms of revenue, lapses like these happen. Some companies get caught exaggerating efficacy claims, others end up having salespeople engage in under the table deals to meet quotas, and more benignly(?) companies sponsor pens, door knobs and toilets.

    The best way out may be national data sharing, increased public funding of research into marketed drugs, and broad discussion of data. Ideally these discussions should occur in open forums where the voices of industry, patients, critics, and practitioners can be clearly heard. The points of both consensus and disagreement need to then be transformed into views interpretable by both the medical and general public. Point (2) above concerning scientific literature as persuasive speech is an excellent one and it’s time we stop using what can be a very useful status-conferring and discussion generating mechanism instead of a system that only concerns itself with establishing best medical practice.

    Unfortunately the provisions of HIPAA (sponsored by the left), the resistance to having single payer systems or national review structures (sponsored by the right), and the need to make tenure and win grants (core to academia) make tackling these issues difficult at best.

    Like

    Blaze Stancampiano

    August 21, 2009 at 1:34 pm

  6. That said, for non-business school types like me, the most striking thing about visiting one of your fine institutions is that every room, toilet, and door knob is sponsored by some company or another.

    Tis true…our department has social psych labs sponsored by AT&T and last year I taught a class, a segment of which was about ethics, in the Arthur Andersen classroom.

    Like

    brayden

    August 21, 2009 at 2:13 pm

  7. […] journals have adopted policies requiring the disclosure of financial relationships, and Sen. …Read Full about this medical News / resources Related Medical informationsMedical Depression – A Basic KnowledgePharmaGossip: "Medical […]

    Like

  8. I’m in complete agreement with Blaze Stancampiano.

    A core question for us as a society right now is how can we adapt our institutions to scale globally? The flow of information and people is much faster and much wider, and that expansion will not be reversed over time (barring catastrophe).

    In the past, delegating authority to experts was a reasonable solution since there was time for deliberation, and even reprisals where experts failed at their task. Today we need experts to be working in parallel with the people who are gathering data and the people who are impacted by the experts’ decisions. More centralized institutional structures simply do not scale, or cannot withstand rapid changes. For example, few businesses can afford to make deals and then let the lawyers paper them; lawyers now have to be involved from the begining, and have to understand the business issues just as the business people have to understand the legal issuse — and everybody has to understand the impact on other stakeholders as well as the parties to the agreement. What form will institutions take on to achieve this kind of collaboration? I have no idea. But the old batch-process approach to tech transfer, for example, is not cutting the butter anymore. That much is for sure.

    Like

    Michael F. Martin

    August 22, 2009 at 12:15 am

  9. Great first post, Jerry!

    One quick thought: Do any of us think that truth is operationalized as publication? Much of graduate school coursework seems to be taking published, high-profile, agenda and theory-setting pieces and trying to destroy them. So, my question is, for who and what purposes does publication=truth? Health regulatory agencies? Consumers? Doctors? Who have we failed to train to be sufficiently critical?

    Also, I’d almost go more Baudrillard than Foucault here – this isn’t about the subtle interactions of power and knowledge but about the simulacra of a journal serving the same purpose as the real one.

    Like

    Dan Hirschman

    August 24, 2009 at 5:25 pm

  10. This has been an informative set of posts that raised several issues worth more discussion, about academic-industry collaboration, definitions of expertise and whose opinion counts, and plausible methods of addressing science-for-profit.
    One thing it has emphasized for me, and that Dan’s post highlights, is that the standards that we imagine apply in sociological and medical research are perhaps different. Michael’s response to the initial post was distress, as was my own. The idea tht the medical literature is larded with drug company propaganda, and that there is no easy way to figure out which research is “pure” and which is tainted, is really troubling. As a thought experiment, I pondered how I would react upon discovering that the sociological literature was full of articles secretly funded by Planned Parenthood, the NAACP, and the Canadian government. (Hint: it was not a welling horror that social policies had been informed by biased regressions.)
    Why Foucault rather than Baudrillard? Because for Federal agencies that approve (FDA) and fund (Medicare) drugs, doctors that prescribe treatment, and courts that adjudicate claims, publication in a reputable journals (JAMA, not the Merck simulacrum) are scientific truth. Francisco Polidoro’s (UT Austin) excellent dissertation showed that the FDA approves drugs faster, and thus pharm companies milk rents for longer, to the extent that there are supportive publications. Doctors prescibe more Vioxx and hormone replacement therapy when scientific publications show that it’s a good idea. (They don’t have time to run double-blind studies, and unlike grad students, they don’t spend their productive hours doubting published research!) And courts and juries defer to expert witnesses, who are more experty when they have long CVs with relevant pubs (even if they have not read their own articles).
    So: for pragmatic purposes, in medical research publication==truth. In sociology, publication==open season!

    Like

    jerrydavisumich

    August 24, 2009 at 6:00 pm

  11. As an aside, I’d like to make a small plug for lawyers here. We take a beating (and usually justly), but note that for once it was lawyers that helped uncover this abuse.

    “The documents on ghostwriting were uncovered by lawyers suing Wyeth and were made public after a request in court from PLoS Medicine, a medical journal from the Public Library of Science, and The New York Times.”

    http://www.nytimes.com/2009/08/05/health/research/05ghost.html?_r=1

    Like

    Michael F. Martin

    August 24, 2009 at 6:05 pm

  12. Agreed, Michael, and thanks for the deserved plug. This is far from the first time that the plaintiff’s bar has been a vital force for uncovering corporate nonsense.

    That being said…we want to be fair and balanced, and point out the role that litigation consultants play in tainting science. Here’s an article from the Wall Street Journal a few years back on a Chinese researcher who uncovered a link between chromium in water and cancer, then seemingly published a “clarification” retracting his prior life’s work.
    “Yet Dr. Zhang didn’t write the clarification, judging by voluminous testimony and exhibits in a lawsuit in a California state court. The court papers indicate that the second study was conceived, drafted, edited and submitted to medical journals by science consultants working for the lawsuit’s defendant, a utility company being sued for alleged chromium pollution. The consultants paid Dr. Zhang about $2,000 for research assistance on the second study.”

    http://online.wsj.com/article/SB113530126572230084.html

    Like

    jerrydavisumich

    August 24, 2009 at 6:16 pm

  13. My sense of the sponsored research is, it’s part and parcel of a philosophy of finance and game theory that underlies the bubble. However, it goes far back in US history, see Walter McDougall’s writings on the US as a nation of hustlers in his book “Freedom Just Around The Corner”.

    I still hope that the new US society that will grow as the US recovers from the bubble will make real a distinction between Gesellschaft and Gemeinschaft, i.e., between game-playing (which, to a real game-player, includes designing biased games) and working together. The notion that one can just fold Gemeinschaft into Gesellschaft is, frankly, a crock.

    Still, it will ba a slow climb. The new generation is getting drenched in stories about double-dealing, shady sales tactics, and using wealth unfairly, but I don’t see many stories about how to defeat the nasty system. Obama’s election campaign was an excellent example of how to win by Gemeinschaft. But it hasn’t carried through to government yet, except in the new public data web sites.

    Google, with its auction culture and its stress on computational thinking, and Toyota, that old example of scientific method, show working together can lead to great success. In addition, the web makes it a real possibility that robust trust networks can form which could be large. We have more power than ever to decide what new mores to diffuse, to market them, and to find ways to make livelihoods from them.

    I’ll step off my soapbox now.

    Like

    Tony

    August 24, 2009 at 8:04 pm

  14. […] a comment » The revelation that hundreds of articles published in medical research journals were actually written by contractors in the employ of pharmaceutial companies, and fronted by […]

    Like


Comments are closed.

%d bloggers like this: