Shady Practice of "Ghostwriting" Surfaces in Articles About Hormone Replacement Therapy

Dorian Martin Health Guide October 06, 2010
  • One would assume that a peer-reviewed medical journal would provide straight information based on a study that would inform physicians about drugs without marketing to them. However, it seems that isn’t always the case.


    A study by Dr. Adriane Fugh-Berman, who works in Georgetown University Medical Center’s Department of Physiology and Biophysics found that “ghostwriters” were used in research articles about hormone replacement therapy in some medical journals. The study was published on PLoS Medicine on Sept. 7, 2010.


    In her study, Dr. Fugh-Berman analyzed approximately 1,500 documents that were revealed as part of a lawsuit against the pharmaceutical giant Wyeth concerning the menopausal hormone therapy Prempro (which is conjugated equine estrogens and medroxyprogesterone acetate). These documents “provide unprecedented insights into how pharmaceutical companies promote drugs, including the use of vendors to produce ghostwritten manuscripts and place them into medical journals,” according to PLoS Medicine. “Dozens of ghostwritten reviews and commentaries published in medical journals and supplements were used to promote unproven benefits and downplay harms of menopausal hormone therapy (HT), and to cast reloxifene and other competing therapies in a negative light.” The study found that Wyeth used these articles to lower the public’s perception of risks related to breast cancer that were associated with hormone therapy. In addition, these articles defended benefits of this therapy to the cardiovascular system that were unsupported. The ghostwritten articles also advocated for unproven uses of hormone replacement to prevent dementia, Parkinson’s disease, vision problems, and wrinkles.


    Some pharmaceutical, biotech, and medical device companies utilize writers instead of academic physicians to develop articles to submit to medical journals and poster sessions to market various drugs. These companies then invite the academic physicians to be named “authors” on the pre-written articles. “It is unknown how many academics participate, or how many articles in peer-reviewed medical journals are ghostwritten, but there is concern that the practice may be extensive,” Dr. Fugh-Berman wrote.


    In this case, Wyeth worked with DesignWrite, a medical education and communication company, to promote the Premarin therapies.   DesignWrite wrote the initial article which was sent to Wyeth for review. Wyeth’s comments were incorporated into the article, which was then sent to the unpaid “author” for review. From 1997-2003, DesignWrite placed these “ghostwritten” articles in more than 50 peer-reviewed publications.


    Unfortunately, this deceptive practice is not against the law. “It is illegal for pharmaceutical companies to promote a marked drug for off-label use, i.e., for uses other than those approved by the U.S. Food and Drug Administration (FDA) or equivalent national agencies,” Dr. Fugh-Berman wrote. “Articles in medical journals, newsletters, and magazines, however, are not considered promotional.”


  • I hope that journals and researchers take a strong stand against this practice of “ghostwriting.” Journals should provide sound medical evidence that is the result of research and not a marketing team trying to drum up business.  And researchers should not stoop to the shady ethics in lending their name to an article that they did not actually write. I believe this practice of “ghostwriting” taints the process that informs my physician about medical advances and puts my well-being, as well as those of family and friends, at risk.