Ghostwriting As Marketing Tool

An article in the latest issue of PLOS Medicine, The Haunting of Medical Journals: How Ghostwriting Sold “HRT”, details the use of ghostwriting as a marketing tool for pharmaceutical companies. It is a chilling discussion of how at least one pharmaceutical company, Wyeth, used the peer-reviewed literature as a method of distributing marketing messages to physicians.

The author, Adriane J. Fugh-Berman, details a practice that cuts at the heart of science-based medicine – the exploitation and distortion of the literature. The medical profession needs to jealously guard the legitimacy and purity of the peer-review process and the medical scientific literature. I am never one to gratuitously bash “Big Pharma” – this is often used as a method of casually dismissing inconvenient scientific evidence. But at the same time, pharmaceutical companies are in the business of making money. While they are a carefully regulated industry, some in the industry seek ways to skirt around regulations that limit their ability to market their products.

While most physicians consider themselves savvy with respect to pharmaceutical marketing, the story told by Fugh-Berman is one of profound naivete. I guess it should not be a surprise that some academics were bamboozled by expert salespersons who spent a lot of time and effort, apparently, figuring out ways to deceive and manipulate them. But now that the story is out, naivete is no longer an excuse. Here is what happened:


Posted in: Medical Ethics, Pharmaceuticals, Politics and Regulation, Science and Medicine

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Write for Oprah? Wrong for Me

From January through June of 2010 I wrote a column entitled “The Health Inspector” in O, The Oprah Magazine. Now, apparently, I have been fired; although they have not had the common courtesy to tell me so. The whole thing has been a bizarre, frustrating experience. 

It started last fall, when I got an e-mail from Tyler Graham. He introduced himself as the new health editor for O, The Oprah Magazine, saying he had only been on the job for 2 weeks. He had read my work in Skeptic magazine and wanted me to write a column for O. I thought long and hard before accepting. I told Mr. Graham my opinion of Oprah and of her chosen medical expert Dr. Oz and why I was hesitant to associate my name with theirs, and he seemed to understand. Oprah has been widely criticized recently, even in the pages of Newsweek, for endorsing pseudoscientific and non-scientific health advice on her TV show.   As for Dr. Oz, while he mostly gives good medical advice, he has appalling lapses into non-science-based practices like Reiki, and he has even invited energy healers into his OR to assist in open-heart surgery cases by waving their hands over the patients. I foolishly assumed Mr.Graham was trying to improve Oprah’s image by introducing more science and skepticism to the magazine.  I decided to accept, for three reasons:

  1. It was a chance to get my name and a mention of the Science-Based Medicine blog before a large readership (O’s circulation is nearly 3 million).
  2. I could make sure that at least my one little corner of the magazine was scientifically rigorous.
  3. They were going to pay me. Not much, and I didn’t need the money, but you must understand that I had never before been paid a single penny for writing anything. My writing has been entirely pro bono. The idea of my writing finally being recognized as having monetary value was seductive.

 The skeptical community was delighted to learn that the SkepDoc had infiltrated Oprahdom. One young man tweeted, “Dude, Hell just froze over!” I’m afraid the celebration was premature.  (more…)

Posted in: Science and the Media

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“Complex, multi-component therapy” can be studied well

This August was a tough month for SBM bloggers reading The New England Journal of Medicine (NEJM). Just one week after a review of acupuncture for back pain—in which the authors recommended referring patients to traditionally trained acupuncturists despite data showing that traditional needling does not outperform a blinded sham control (click here here here for the trifecta takedown)— NEJM featured an original article about a study of Tai Chi for fibromyalgia. As critiqued by Dr. Gorski, the control intervention for the Tai Chi study was arguably inappropriate: the test and control groups experienced different intensities of exercise, for different durations of time, led by different instructors with different levels of enthusiasm. The special pleading and the weak design were not of themselves surprising, only their presence in such an august journal.

A group of editorial authors in that same NEJM issue preemptively address the SBM critics by describing Tai Chi as a “complex, multi-component therapy” and thereby implying that an appropriate sham cannot easily be designed. I agree that studying Tai Chi must be trickier than matching drugs to sugar pills. But “complex, multi-component” interventions can indeed be studied in a way that leads to convincing conclusions, as illustrated in the August 25, 2010 issue of The Journal of the American Medical Association (JAMA). A team of Boston psychologists studied a complex, multi-component intervention for attention deficit-hyperactivity disorder (ADHD) and reported their findings in “Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms: A Randomized Controlled Trial.” The abstract: (more…)

Posted in: Clinical Trials

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Mike Adams on Dr. Mehmet Oz’s colon polyps: “Spontaneous” disease?

Given that it’s a holiday and I debated whether or not I even wanted to post anything today, I think I’ll keep things light and uncharacteristically brief today. After all, not every post can be like last week’s epic on Avastin or the week before’s epic on peer review. That’s a lot of work, and it is a holiday, after all. Besides, sometimes a perverse mood overtakes me, and I feel the need to go slumming.

Bring on Mike Adams.

Mike Adams, as regular readers may know, runs the website from deep in the jungles of Ecuador. His website is a one-stop shop, a repository if you will, of virtually every quackery known to humankind, all slathered with a heaping, helping of unrelenting hostility to science-based medicine and science in general. True, Mike Adams is not as big as, say, Joe Mercola, whose website, as far as I can tell, appears to draw more traffic than, but what Adams lacks in fame he makes up for in sheer crazy. If you don’t believe me, check out his latest hip-hop video Vaccine Zombie:

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Personally, if I had anything to do with the Michael Jackson estate, I’d be suing for copyright infringement. Still, grudgingly, I have to admit that the animation is pretty good, although when Mike Adams raps, “‘Cause livin’ without a brain ain’t half bad,” I don’t think he realizes that he is apparently living proof of that. In fact, so full of crazy is Mike Adams, that there has even been disagreement among SBM bloggers over whether we should lower ourselves to deal with some of his loonier stuff. Guess which side I took?

The reason I argue that, even at the risk of wrestling the proverbial pig in mud, we should not shy away from taking on some of Mike Adams’ lunacy from time to time is because he illustrates certain aspects of the mindset that allows unscientific so-called “alternative” medicine to remain popular. Sometimes, articles on Adams’ website bring up the question of whether Adams really believes the utter nonsense he lays down or whether he is simply a scammer, much like Kevin Trudeau is a scammer, and doesn’t believe a word of it but has such contempt for his followers that he thinks nothing of lying to them to sell them whatever nostrums he’s hawking on his website. You’ll see what I mean in a minute. I hope.

On Friday, Adams decided to attack “America’s doctor” and a promoter of woo whom we have from time to time taken on here at SBM, Dr. Mehmet Oz because, of all things, Dr. Oz apparently underwent colonoscopy and was found to have a precancerous polyp. That this might have happened to him is not at all surprising given that Dr. Oz recently turned 50 and current guidelines recommend commencing screening by colonoscopy at age 50. Indeed, I’m only a couple of years from needing to submit to the same screening myself. In any case, Adams decided to write one of his patented screeds, entitled, Dr. Oz colon polyps raises question of “spontaneous disease” without cause. In it, he inadvertently reveals a lot about alt-med thinking, making it worth a brief discussion.

Adams starts out:

Posted in: Cancer, Health Fraud

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Yes, drug companies do pay attention to herbal medicine

I’m only a monthly contributor here but between being a SBM reader and having my own blogs, I often grow weary of the blind criticism that researchers and drug companies couldn’t care less about traditional folk medicines as drug products. My laboratory spends every single day working on natural product extracts in the search for compounds that may have selective effectiveness against cancer. So, this is a bit of a sore spot for me.

Two papers this week from Cancer Prevention Research on the potential anticancer effects of a diabetes drug (Nathan Seppa story here) remind me to tell the story of a Middle Ages European herbal medicine used to treat polyuria that gave rise to one of the most widely prescribed drugs in the world, metformin (Glucophage in the US). Metformin, known chemically as a biguanide, dimethylguanide to be precise, traces its roots to the plant Galega officinalis. Known as goat’s rue, French lilac, or professor weed, this plant was shown to be a rich source of guanidine and a less toxic compound later called galegin or galegine (isoamyline guanidine).


Posted in: Herbs & Supplements, History, Pharmaceuticals

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Direct-to-Consumer Genetic Testing: Road Map or Tarot Cards?

A topic of growing interest (and concern) at SBM is laboratory and diagnostic test pseudoscience. Bogus tests are everywhere, and Kimball Atwood recently discussed several of them. But over the past several years, diagnostic tests have emerged that appear to be science-based and offer gene-level insights into your health. And these tests don’t even require a physician’s visit – just a swab of saliva and a credit card get you reams of information on your genetics, traits, and risks of dozens of diseases. It looks like the ultimate in consumer health information, with the potential to offer truly personalized treatment strategies. Companies like 23andme, deCODEme, and Navigenics all promise “genetic insights” to improve your health. How could this information be anything but helpful?

Personalized medicine describes medical practices that use information about a person’s genes, proteins, and environment to prevent, diagnose and treat disease. Science-based practice has routinely incorporated environmental advice (e.g., diet and exercise) into medical management. And there are a number of genetic tests in routine use that are well established, clinical validated, and are highly predictive of future outcomes, such as tests for Huntington’s disease and hereditary breast cancer.

Posted in: Diagnostic tests & procedures

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WHO Partnering with Traditional Healers in Africa

There is an AIDS epidemic in Africa, and efforts to fight it are hampered by the endemic social problems of that continent. Chief among them are the lack of sufficient modern health resources, the spread of destructive rumors and myths about HIV/AIDS, and even the persistence of HIV denial in Africa (although this last factor is better than in the past).

The World Health Organization (WHO) and the International HIV/AIDS Alliance are teaming up with the Traditional Health Practitioners Association of Zambia (THPAZ) to address the first problem – the lack of health services. Most Zambians use traditional healers for primary health care. The WHO has therefore decided to utilize traditional healers in the fight against AIDS. There are interesting pros and cons to this policy, but it must first be recognized that there is no ideal solution to the problem. The resources to provide optimal modern health care to treat and prevent HIV/AIDS (which would need to include a massive education program) in Zambia and the rest of Africa simply do not exist. One might argue that the world should provide those resources, but let’s put that issue aside and focus on what to do in the meantime.

The arguments given in favor of this WHO strategy are:

Traditional healers far outnumber biomedical workers in the rural areas.

They are consulted, not only because they are closer and more affordable than their Western-trained counterparts, but also because they are embedded, extensively and firmly, within Ugandan culture.

Traditional healers are highly respected and widely consulted by communities.


Posted in: Public Health, Science and Medicine

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Kaiser Rejects Neck Manipulation

Despite quackademia, anti-vaccine propaganda, and other discouraging trends, the news is not all bad. A major HMO has taken a decisive action in support of science-based medicine. 

Kaiser Permanente Mid Atlantic States and Mid-Atlantic Permanente Group recently announced the elimination of neck manipulation from their chiropractic coverage. The revised policy states,

Given the paucity of data related to beneficial effects of chiropractic manipulation of the cervical spine and the real potential for catastrophic adverse events, it was decided to exclude chiropractic manipulation of the cervical spine from coverage. 

Their decision was applauded by some  but was predictably attacked by chiropractors. (more…)

Posted in: Chiropractic

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Avastin and metastatic breast cancer: When science-based medicine collides with FDA regulation

One of the most frustrating aspects of taking care of cancer patients is that in general, with only a few specific exceptions, we do not have good curative therapies for patients with stage IV cancer, particularly solid tumors. Consequently, patients with stage IV disease are viewed as “incurable” because, the vast majority of the time, they are incurable. Over the years, we have thrown everything but the kitchen sink at patients with stage IV disease, largely with dissapointing results. That’s not to say that the few specific exceptions to which I alluded are not a reason for hope. After all, patients with colorectal cancer and liver metastases used to have a median survival of around 6 months, but these days, with newer chemotherapeutic regimens like FOLFOX plus Avastin, median survival has more than tripled. While expecting to live less than two years is cold comfort to cancer patients with this particular clinical situation, the prognosis is far better than it was.

Of course, I specifically mentioned Avastin because it’s been in the news a lot recently with respect to my area of clinical specialty, breast cancer. Specifically, beginning in July there started appearing a spate of stories about the FDA considering revoking the approval of Avastin for advanced breast cancer based on recent studies that demonstrate that it does not prolong survival in these patients. Many lay people and patients find this reconsideration of Avastin to be quite puzzling, given that the drug was granted accelerated approval in 2008 and has since gone on to be used fairly widely. Given that the case of Avastin in breast cancer is rapidly becoming a classic case study of how messy science-based medicine can be when practiced in the public eye and debated among pharmaceutical companies, the government, and patient advocacy groups.

Posted in: Cancer, Clinical Trials, Pharmaceuticals, Politics and Regulation

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A pox on your bank account: failure to vaccinate and its legal consequences

Here’s a question anti-vaxers may want to consider:

Can the parents of an unvaccinated child be held liable if their child becomes infected with a vaccine-preventable disease which then spreads from their child to another child or children?

Yes, they can.

In fact, for over 125 years, courts in this country have recognized a cause of action for negligent transmission of an infectious disease. In the first reported case (New York, 1884) the defendant infected the plaintiff with whooping cough. Cases since then have run the gamut: smallpox, tuberculosis, unspecified “venereal disease,” typhoid fever, scarlet fever, diphtheria, hepatitis, herpes, gonorrhea, HIV. If your favorite infectious disease is not on this list, don’t worry. The disease may vary, but the legal principles remain the same.

Posted in: Legal, Medical Ethics, Public Health, Vaccines

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