Thursday, 5 May 2005

Princess Health and Ghosts of Days Long Past. Princessiccia

Princess Health and Ghosts of Days Long Past. Princessiccia

I have managed to track back the ghost-writing story to at least 1993.
In 1993, an editorial appeared in Lancet entitled "Ghost With a Chance in Publishing Undergrowth." (Anonymous. Ghost with a chance in publishing undergrowth. Lancet 1993; 342: 1498-99.) It clearly describes the ghost-writing phenomenon, "a typical sequence of events beigns with a publisher agreeing to prepare a review article for a drug company to 'raise awareness/profile' of a certain subject that is broadly related to the company's product. " Then, "a staff writer prepares the review to the sponsor's satisfaction, whereuponthe publishing house contacts a doctor with a special interest in the relevant topic to inquire whether he or she would like to be the guest author, subject to approval of the content, for an honorarium." The editorial noted, "negotiations between publishing house and guest author tend to be conducted over the telephone or in person. The final version, when submitted to the journal, may contain no clues about its origin. " Sounds familiar?
In 1994, an editorial in JAMA warned, "there are ghosts lurking in the bylines - shadowy figures who, increasingly, are in fact the actual writers (the authors, some old-fashioned folk would say) of what we editors receive." (Rennie D, Flanigin A. Authorship! authorship! guests, ghosts, grafters and the two-sided coin. JAMA 1994; 271: 469-470.)
A letter in response to the JAMA article briefly described a case very similar to the one Dr. Fugh-Berman described recently in the Journal of General Internal Medicine. (Kasper CK. Authorship! authorship! JAMA 1994; 271: 1904.) In reply, Rennie and Flanigin stated, "it should be obvious that this is both deceptive and disgraceful. The academic whose name appears on the printed paper, and on whose brow no laborious sweat has appeared, must surely know that the exchange of money takes place solely because the deception is seen by some company to be commercially worthwhile."
However, despite these earlier warnings, the practice of ghost-writing seems to have continued, and now involves not only editorials and reviews, but also reports of original research. The practice remains deceptive and disgraceful, and not only the physicians and scientists who serve as "guest authors," but also the shadowy legions of ghost-writers and their even more shadowy sponsors should be ashamed of it.
Princess Health and  Ghosts of Days Long Past.Princessiccia

Princess Health and Ghosts of Days Long Past.Princessiccia

I have managed to track back the ghost-writing story to at least 1993.
In 1993, an editorial appeared in Lancet entitled "Ghost With a Chance in Publishing Undergrowth." (Anonymous. Ghost with a chance in publishing undergrowth. Lancet 1993; 342: 1498-99.) It clearly describes the ghost-writing phenomenon, "a typical sequence of events beigns with a publisher agreeing to prepare a review article for a drug company to 'raise awareness/profile' of a certain subject that is broadly related to the company's product. " Then, "a staff writer prepares the review to the sponsor's satisfaction, whereuponthe publishing house contacts a doctor with a special interest in the relevant topic to inquire whether he or she would like to be the guest author, subject to approval of the content, for an honorarium." The editorial noted, "negotiations between publishing house and guest author tend to be conducted over the telephone or in person. The final version, when submitted to the journal, may contain no clues about its origin. " Sounds familiar?
In 1994, an editorial in JAMA warned, "there are ghosts lurking in the bylines - shadowy figures who, increasingly, are in fact the actual writers (the authors, some old-fashioned folk would say) of what we editors receive." (Rennie D, Flanigin A. Authorship! authorship! guests, ghosts, grafters and the two-sided coin. JAMA 1994; 271: 469-470.)
A letter in response to the JAMA article briefly described a case very similar to the one Dr. Fugh-Berman described recently in the Journal of General Internal Medicine. (Kasper CK. Authorship! authorship! JAMA 1994; 271: 1904.) In reply, Rennie and Flanigin stated, "it should be obvious that this is both deceptive and disgraceful. The academic whose name appears on the printed paper, and on whose brow no laborious sweat has appeared, must surely know that the exchange of money takes place solely because the deception is seen by some company to be commercially worthwhile."
However, despite these earlier warnings, the practice of ghost-writing seems to have continued, and now involves not only editorials and reviews, but also reports of original research. The practice remains deceptive and disgraceful, and not only the physicians and scientists who serve as "guest authors," but also the shadowy legions of ghost-writers and their even more shadowy sponsors should be ashamed of it.
Princess Health and Merck CEO Quits. Princessiccia

Princess Health and Merck CEO Quits. Princessiccia

Merck CEO Raymond V Gilmartin has just announced his resignation. The new CEO will be Richard Clark. Clark first served as a quality control inspector in 1972, then joined management. He was President of Medco Health from 2000 to 2002, and then CEO until 2003. His most recent job was head of Merck's manufacturing division. (See typical reports in the NY Times and TheStreet.com.)
We have previously posted about Merck's questionable marketing strategies for the promotion of Vioxx (here), how it attempted to discredit reports of Vioxx's adverse effects (here), how it oversold Vioxx as a first-line analgesic, thus exposing more patients to its risks (here), and most recently, how the published report of a key trial of Vioxx was ghost-written (here). Thus, Gilmartin's resignation seems the honorable thing to do.
The question is now whether Clark, who evidently has no clinical or scientific experience, will be able to restore Merck's once pristine ethical reputation. We hope he does.
Princess Health and  Merck CEO Quits.Princessiccia

Princess Health and Merck CEO Quits.Princessiccia

Merck CEO Raymond V Gilmartin has just announced his resignation. The new CEO will be Richard Clark. Clark first served as a quality control inspector in 1972, then joined management. He was President of Medco Health from 2000 to 2002, and then CEO until 2003. His most recent job was head of Merck's manufacturing division. (See typical reports in the NY Times and TheStreet.com.)
We have previously posted about Merck's questionable marketing strategies for the promotion of Vioxx (here), how it attempted to discredit reports of Vioxx's adverse effects (here), how it oversold Vioxx as a first-line analgesic, thus exposing more patients to its risks (here), and most recently, how the published report of a key trial of Vioxx was ghost-written (here). Thus, Gilmartin's resignation seems the honorable thing to do.
The question is now whether Clark, who evidently has no clinical or scientific experience, will be able to restore Merck's once pristine ethical reputation. We hope he does.
Princess Health and Minnesota Hospital Systems Agree Not to Charge Some Uninsured Patients More than the Insured. Princessiccia

Princess Health and Minnesota Hospital Systems Agree Not to Charge Some Uninsured Patients More than the Insured. Princessiccia

USA Today reports that Minnesota Attorney General Mike Hatch has obtained agreements from four hospital systems not to charge uninsured patients with household incomes less than $125 K more than the discounted rates given large insurers. Hatch had threatened to sue the four systems, Allina, North Memorial, Park Nicollet, and HealthEast Care, and had called their policies of charging uninsured patients higher rates than those given to insured patients "consumer fraud." Hatch had previously gotten a similar agreement from Fairview Health Systems.
This seems to be a hopefully the beginning of a trend. However, it is upsetting that many not-for-profit hospitals and hospital systems still seem to be charging uninsured patients, who are often poor, much more than the rates they negotiate with big managed care organizations.
Princess Health and  Minnesota Hospital Systems Agree Not to Charge Some Uninsured Patients More than the Insured.Princessiccia

Princess Health and Minnesota Hospital Systems Agree Not to Charge Some Uninsured Patients More than the Insured.Princessiccia

USA Today reports that Minnesota Attorney General Mike Hatch has obtained agreements from four hospital systems not to charge uninsured patients with household incomes less than $125 K more than the discounted rates given large insurers. Hatch had threatened to sue the four systems, Allina, North Memorial, Park Nicollet, and HealthEast Care, and had called their policies of charging uninsured patients higher rates than those given to insured patients "consumer fraud." Hatch had previously gotten a similar agreement from Fairview Health Systems.
This seems to be a hopefully the beginning of a trend. However, it is upsetting that many not-for-profit hospitals and hospital systems still seem to be charging uninsured patients, who are often poor, much more than the rates they negotiate with big managed care organizations.
Princess Health and Two 'Perspective' Pieces in NEJM for 05-05-05. Princessiccia

Princess Health and Two 'Perspective' Pieces in NEJM for 05-05-05. Princessiccia

With enormous pleasure I have just read the 05-05-05 number of the New England Journal of Medicine. The journal's innovations, including 'front-ending' the so-called 'Perspectives' writings, here clearly pay off.

It is surely no accident that Aneez Esmail's piece, 'Physician as serial killer,' on the UK's good Dr. Shipman--surreptitious killer of well over 200 elderly patients between 1970 and 1998--and Abraham Verghese's piece, 'The calling,' on the physician as reader, appear back to back.

The issue in both cases is our old bugabear of 'professionalism,' refracted through the classic dual prisms of regulation and the self made man. Nurture versus nature.

Verghese wins.

Esmail calls for more regulation--otherwise how to 'equalize the power imbalance'?--but doesn't really say how to make such a thing work. In these blogger pages we have seen just how well the watchdogs perform. Do cattle chutes make better cattle?

On the other hand, Verghese's essay is enormously winning and worth a read by anyone who wants to understand what true professionalism is all about. This, from the pen of a writer brave enough--huzzah!--to call the usual pabulum by what is really is.

'I have marveled,' notes Verghese, 'at the way in which selected fiction discussed in a medical school class effectively conveys the tenets of professionalism and multiculturalism without ever invoking those soporific words.'

Indeed, the whole push to codify, regulate, and legislate 'professionalism' strikes us as just another bloviation in the ongoing Pogo Revolution in healthcare. My recommendation: the astute Dr. Verghese, or someone like him, should be the next Flexner. The prognosis for this happening: well, what day is it today and how do you feel today?