- Ghost-Managed Medicine: Big Pharma’s Invisible Hands by Sergio Sismondo
Sergio Sismondo coined the term “ghost-management” to characterize the broad behind-the-scenes activities of the pharmaceutical industry after he successfully infiltrated publication planning conferences and seminars from 2007 to 2017 as sort of academic spy. His academic espionage mission provided valuable intelligence. In addition to revelations from lawsuits against the pharmaceutical industry and accounts from former ghostwriters turned whistleblowers, Sismondo’s information from within has been crucial to understanding the corruption in the conduct and reporting of industry-sponsored medical research. Ghost-Managed Medicine exposes the conspiracy to conceal the players in the marketing of drugs, including ghostwriters, key opinion leaders, patient advocacy organizations, contract research organizations, publication planners, and even medical journal editors and publishers. The credibility of the claims conveyed by the industry depends on the invisibility of these players.
Publication planning of ghostwritten articles is the bedrock of this scheme. It is conducted by pharmaceutical companies working in conjunction with medical communication firms to plant marketing messages in medical journal articles. Medical communication firms also produce continuing medical education programs, medical conference [End Page E-12] presentations, and lunch and dinner drug talks from the same content that produced the journal articles, all delivered by physicians who have the greatest influence on prescribers, namely, the key opinion leaders or thought leaders.
Sismondo’s main example of the harm done to patients is the case of OxyContin (oxycodone), now infamous for its part in the opioid epidemic in North America which has taken over 200,000 lives (30–31). Sismondo begins his book describing a common scenario in which a patient takes a drug as prescribed by his physician. For prescribing strategies, the physician relies upon an article she read in a medical journal and a presentation at a medical conference. From this point Sismondo describes how the patient and physician’s trust that they are operating rationally is largely misguided because of a system designed to conceal all of the invisible forces of marketing which influenced the information available. But now let us suppose that the patient suffers a serious adverse event or even death as a result of the drug’s side effects. It turns out, as is so common in these situations, that the drug company concealed the adverse event in the articles published in the medical journals and was able to do so because the critical data from the clinical trials is the intellectual property of the company. Neither the ghostwriters nor the nominal “authors” on the articles ever see that data. In the case of OxyContin, one of the influential ghostmanaged medical journal articles was reprinted 10,000 times for distribution to prescribing physicians (34).
One of the most alarming revelations of this book is Sismondo’s discussion of the role of medical journal editors as co-conspirators in the corruption of medicine. Sismondo, who attended meetings of the International Society of Medical Planning Professionals and the International Publication Planning Association, reports that in addition to ghostwriters and medical communication executives, publishers and medical journal editors attended these meetings and gave lectures as stakeholders in the business of publishing the results of industry-sponsored clinical trials. Some medical journal editors gave sales pitches at these meetings, essentially soliciting publication planners to submit ghosted articles to their high-impact journals (91–94). Medical journals in this respect continue to be part of the problem rather than the solution to the problem. Instead of demanding rigorous peer review of submissions and an independent analysis of the data, most editors are eager to publish favorable articles of industry-sponsored trials and rarely publish critical deconstructions of ghostwritten clinical trials. This is due to the simple [End Page E-13] fact that medical journals and their owners have become dependent upon pharmaceutical revenue that comes in the form of advertising, reprint sales and, more recently, fees for open access.
Commenting on the role of ghostwriters in the process, Sismondo writes:
Articles are produced by teams, perhaps no one member of which meets requirements for authorship. In...