All of us at WDDTY are shaken to the core by the recent disclosures that most studies in the medical literature are marketing dressed up as research. For as many as 90,000 published drug trials, a drug company hired a PR firm-a 'medical education and communication company' (MECC)-to carry out its clinical trials, engaged a 'ghost' to write an article with a positive spin, enlisted a prominent academic to put his name to the paper he's had nothing to do with-and then succeeded in getting it published in a peer-reviewed journal.
This widespread practice came to light a few months ago during the discovery process of a class-action lawsuit against drug manufacturer Wyeth by 14,000 women who developed breast cancer after taking HRT.
The 1500 documents afford an unprecedented glimpse into the underworld of pharmaceutical marketing. The paper trail reveals how an MECC called DesignWrite, hired by Wyeth, launched a major damage-limitation exercise after a major study demonstrated an unequivocal link between HRT and life-threatening illness.
Wyeth's HRT products had reached annual revenues of $2 billion, but nose-dived by 65 per cent in 2002, when the Women's Health Initiative (WHI) study found that hormone replacement therapy-specifically Wyeth's version-increased the risk of breast cancer, ovarian cancer, stroke and heart disease.
DesignWrite proceeded to flood the professional press with positive reports of Premarin, cast doubt on the WHI, downplayed the cancer-causing potential of HRT and claimed cardiovascular benefits, while promoting unproven uses of HRT such as for preventing dementia.
A few months later, the German Institute for Quality and Efficiency in Health Care, which produces evidence-based consumer-health information, encountered "serious obstacles" in trying to wrest all sponsored published and unpublished studies from Pfizer on its antidepressant reboxetine. Eventually, it emerged that the company had withheld three-quarters of its patient data from unpublished trials. After these hidden data were finally handed over, the Institute concluded that the drug was "overall an ineffective and potentially harmful antidepressant".
There's no way to determine the full extent of such dirty research, although one review concluded that as much as three-quarters of every journal is ghosted. As Dr Joseph S. Ross of New York's Mount Sinai School of Medicine put it: "It's almost like steroids and baseball. You don't know who was using and who wasn't; you don't know which articles are tainted and which aren't."
These disclosures undermine the entire edifice of modern medicine. The BMJ now plans to encourage efforts to "re-evaluate the integrity of the existing base of research evidence"-in other words, virtually the whole of existing medical research needs to be done all over again.
The most insidious aspect of this story is the topic of this month's special report-that the extraordinary disease-fighting power of a simple nutrient like vitamin C has been virtually ignored by the modern medical press. The published medical evidence was promising 70 years ago-long before MECCs were around to tinker with the data.