The Pharma Paradox: Ghostwriting and Other Pharma Information


Two recent reports highlight what has become, in the last decade or two, a bitter paradox of the pharmaceutical industry.

Last week the Project on Government Oversight (POGO), an independent foundation, published a comprehensive discussion that detailed the wide extent and the pernicious implications associated with ghostwritten journal articles under pharma sponsorship. Among other problems with the practice, the POGO authors contend that ghostwritten articles distort what prescribers and consumers think about drugs. This causes the dual effect of driving up healthcare costs and encouraging potentially dangerous, off-label usage. From a larger context, POGO claims ghostwritten journal articles betray the overall purpose of the medical literature, which is "to produce a reliable body of medical knowledge essential to evidence-based medicine."

The POGO discussion follows last fall's publication of a more detailed study by Australian researchers who assessed the effects of exposure to pharma information on prescribing behavior. The Aussies wanted to see "the relationship between exposure to information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing." To do so they analyzed several hundred published studies that included, as part of the potentially influencing information from pharma, rep visits, journal ads, attendance at pharma-sponsored meetings, mailed information, prescribing software, and participation in pharma-sponsored clinical trials.

As one might expect, the Aussies concluded that information provided directly by pharmaceutical companies is associated "with higher prescribing frequency, higher costs, or lower prescribing quality." Given this finding, they recommended "practitioners follow the precautionary principle [of]...avoid[ing] exposure to information from pharmaceutical companies."

In other words, it is plausible to say that communication from pharma companies is a blight on the healthcare landscape. And that is paradoxical because pharma is an industry ostensibly dedicated to developing products that improve the quality and length of life.

It means something if one can accurately characterize the central mission of an industry as both necessary and socially constructive. After all, a market economy nurtures some industries, such as tobacco, that are based on entirely harmful purposes. Freebooting private enterprise also fosters many more industries, such as automotives, that may create a net benefit while also producing destructive effects. In that example, plus-or-minus 40,000 Americans are killed in car crashes every year and the internal combustion engine contributes to climate change.

What remains especially galling about pharma's communications is that the lies and corruption are not necessary parts of the package, the way smashups are inevitable in a car culture. As the English teachers might put it, one can have a lean version of this Falstaff. With many consumer products that lack intrinsic differentiation (think of beer, clothes, cars and cosmetics), promotions convey the wish-fulfillment message that a particular brand will enhance one's sex appeal. Conversely, pharma's customers have historically been physicians whose therapeutic decisions are based on more rational and utilitarian considerations, thereby reducing the need for fantasy. The fact that pharma companies found it useful to lard their promotions with distortions only reinforces the notion that their drugs lacked the benefits to justify the higher brand prices.

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