This week, the New York Times reports that between 1998 and 2005 the drug company Wyeth paid private companies to ghostwrite 26 scientific papers extolling the benefits of its hormone drugs Premarin and Prempro. The papers were then signed by doctors and medical researchers and published in medical journals without any disclosure of the financial role the drug company played in producing them.
Wyeth defends the papers, saying that everything in them was “scientifically accurate.”
Drug companies have manipulated the medical community to publish favorable data for years, and this is not the first time one of them has been caught. In 2001, Merck camouflaged (and may have deliberately excluded) data from the VIGOR clinical trial suggesting the blockbuster drug Vioxx could cause heart attacks. More recently, Merck and Schering-Plough delayed publication of very important data about the efficacy of the drug Vytorin, with the excuse that they were still trying to interpret the information. The delay was so long and so egregious that Congress finally had to order them to release the results. Turns out Vytorin doesn’t work.
In the 1990s, hormone replacement therapy (HRT) with medications like Premarin and Prempro was all the rage in primary care. Everyone seemed to think that giving postmenopausal women hormones would curb the progression of osteoporosis, and prevent both heart attacks and strokes. Some doctors advocated giving almost every post-menopausal woman hormones, no matter what her situation. For a time, this position was backed by a flurry of research papers, many of which we now know were little more than paid advertisements by Wyeth. However, in 2002 a major government-funded trial showed that hormone replacement therapy has no impact on heart disease, and may in fact increase it modestly. Worse, it was linked to a marked increase in breast cancer. At that point the HRT business started to fall apart. Now what’s left is to figure out is why HRT prescription writing got so out of hand in the first place, considering the scarcity of that good data proving its value.
What about Wyeth’s protest that all the articles it paid for were “scientifically accurate”? I don’t doubt they were. Most advertising is factually accurate also. The problem is, you can lead someone to believe a falsehood by telling him nothing but truths. For example, the following statements about arsenic are all absolutely true: (1) Arsenic is a naturally occurring chemical; (2) it exists in plants and animals; (3) humans consume arsenic when they eat mushrooms and fish. Knowing all this, one might be convinced to down a vial full of arsenic.
A bunch of little truths do not necessarily add up to one big truth, any more than a pile of sticks can ever be a log cabin.
Here’s an example from my personal experience. There is a class of drugs designed to suppress stomach acid called proton pump inhibitors (PPIs). The PPI market is very profitable and very competitive, and chances are you are familiar with the brand names: Prilosec, Nexium (the “purple pill”), Prevacid, Protonix. Blockbusters all. For the last 5 years, drug reps have bombarded me in my office with scientific papers that telling me the “facts” about PPIs. Our drug, one rep told me, has the highest healing rate for stomach ulcers. Another told me his drug was scientifically proven to have the fastest onset of action, implying quicker symptom relief. A third trumpeted higher serum levels after 16 hours, meaning its effects lasted longer. All of these claims had one thing in common — they were scientifically accurate. The problem was that these little truths didn’t tell me what I really wanted to know. Do the advantages any of these drugs justify their price, which is many times their generic equivalents? Or would a generic work 90% as well for 90% of the people, at 20% of the price? (Compare generic omeprazole, at $24, with branded Nexium, at $160.)
Wyeth, and the sorry doctors who signed their names to these ghostwritten papers, will defend themselves by arguing that they were truthful. But truth, in that strict sense, has nothing to do with it. The question is, was the “truth” they propounded intended to lead doctors and patients to make the right decisions, or was it intended to mislead?
To me, that big truth is pretty obvious.