The Ethics of Medical Writing: Wyeth Pharmaceuticals Used Ghostwritten Articles to Promote Product

As someone who writes on science and medical subjects, this recent report* in PLoS (Public Library of Science) Medicine disturbs me greatly.

Dr. Adriane J. Fugh-Berman of the Department of Physiology and Biophysics, Georgetown University Medical Center, analyzed ghostwritten reviews and commentaries published in medical journals and journal supplements that “were used to promote unproven benefits and downplay harms of Prempro—a brand of menopausal hormone therapy (HT)—and to cast competing therapies in a negative light.”

As a writer, it makes sense to me for a pharmaceutical company to hire professional writers to assist in editing, or even creating, articles for publication (the key word being “assist”). However, Fugh-Berman reports that academic physicians were invited to “author” prewritten articles that Wyeth had paid the medical writing and marketing company DesignWrite to produce. In addition, Wyeth paid for numerous reviews, commentaries, and opinion pieces for publication in medical journals—where they are not under the strict FDA regulations seen elsewhere. These types of articles are not usually peer-reviewed, but they can still have an immense influence on physicians’ understanding of disease and its treatment.

According to Fugh-Berman’s analysis Wyeth’s ghostwritten articles were designed to “Mitigate perceived risks of hormone-associated breast cancer”; “Promote unproven, off-label uses, including prevention of dementia, Parkinson's disease, and visual impairment”; “Raise questions about the safety and efficacy of competing therapies (competitive messaging)”; “Defend cardiovascular benefits, despite lack of benefit in RCTs”; and “Position low-dose hormone therapy”. She also states that many physicians have been impacted by these reports, believing that the benefits of hormone replacement therapy outweigh the risks in asymptomatic women, despite clear evidence to the contrary.

I find medical writing to be fulfilling as well as lucrative—it feels good to be writing material that will help someone better understand breast cancer, for example—but the truth is that most medical writing is funded by the pharmaceutical industry, which definitely has selling drugs as its agenda. So where did DesignWrite cross the line in their medical writing business? How can other medical writers avoid doing the same thing?

I think the answer lies in that DesignWrite intentionally designed a marketing strategy that incorporated these ghostwritten articles as means to promote the product—and to promote off-label use of the product. Pre-writing articles for academic physicians to “author” rather than beginning with material from the expert also seems to cross that line from medical writing into medical marketing. One thing is clear: any time a company pays someone to write an “informational” article for them, there’s the possibility that the article will be slanted in that company’s favor. Writers beware.

Cheryl

 

*Fugh-Berman AJ (2010) The Haunting of Medical Journals: How Ghostwriting Sold ''HRT''. PLoS Med 7(9): e1000335. doi:10.1371/journal.pmed.1000335.