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Posted on Sunday 5 December 2010


CASPPER, GlaxoSmithKline’s Friendly Ghostwriting Program
Wall Street Journal
By Jacob Goldstein
August 20, 2009

Drug makers have been taking heat for a while now over ghostwritten articles in medical journals. Basically, there have been instances where drug companies went out and found doctors willing to put their names on articles that the company paid someone else to write or make significant contributions to.

So it isn’t surprising to learn from the Associated Press that GlaxoSmithKline used this sort of program several years back to generate articles favorable to its antidepressant Paxil. But the company gave the program a name too clever for us to pass up: CASPPER. Think of it as your own friendly ghostwriter…
It’s a little hard to understand why the doctors exposed for ghost-writing in the recent POGO letter are even mounting denials. The campaign for GSK‘s drug, Paxil, involving ghost-written pro-Paxil medical literature is already common knowledge, and has been for a over a year.
Evelyn Pringle‘s article chronicles the trial where much of this information became available – a successful suit against GlaxoSmithKline by the family of a child born with a heart defect linked to the drug. Dr. David Healy, a prominent British Psychopharmacologist, testified about the ghost-writing process at GSK – naming names and backed up by incriminating subpoenaed documents from the company. In that trial, Dr. Healy laid out how the makers of the drug [GlaxoSmithKline] marketed it through physicians – speaking and writing as experts – who promoted Paxil while minimizing its adverse and sometimes dangerous side effects. He pointed specifically to the marketing firm Scientific Therapeutic Information [STI] as the ghostwriters in this campaign. He named Dr. Charles Nemeroff, Dr. Zach Stowe, and Dr. Jeffry Newport [of Emory University Medical School, Department of Psychiatry] as figuring prominently in GSK’s marketing scheme. Dr. Healy has a personal story of his own about the interference of Pharma in academic medicine. If you don’t know the story, here’s a start:
Like Dr. Healy, I have some personal reasons for being upset about all of this. In 1974, I changed careers from Internal Medicine to Psychiatry and Psychoanalysis because of an interest in the mind, and I never looked back. I was in academic medicine at Emory University after retraining. In the early 1980’s, a new Chairman arrived, and it was clear that my interests were not compatible with the wave of Biological Psychiatry that was sweeping the specialty, and I left for private practice, continuing to teach in the Psychoanalytic Institute, but no longer involved with the Psychiatry Department. At that time, I wasn’t bitter and enjoyed my private practice. A few years later, Dr. Nemeroff became Chairman. I had little to no contact with him, but heard plenty. During the decade that followed, Psychiatry changed so much I hardly recognized it. The journals were filled with drug research and meetings became monotonous and boring.

I learned about the new drugs, and found that the SSRI’s were effective in controlling depressive and obsessive compulsive symptoms in certain cases, and so I prescribed them, but my main work was as a psychotherapist and psychoanalyst. I personally thought that the "Biological Wave" was something of a fad that would pass in time – finding its appropriate place. But then I began to realize, along with lots of other colleagues, that the "Biological Wave" was more than a fad, it had a motor – the Pharmaceutical Industry looking for profit. I resented the intrusion of Drug Companies into the practice of Psychiatry and into academic medicine – the place where practitioners looked for guidance. As time went on, I further learned that the intrusion had reached criminal proportions with university physicians in on the the game. That is absolutely infuriating! And a lot of it was centered at my University [Emory], in my town [Atlanta, Georgia], where I practiced – so I’m hardly unbiased in this matter. That is my own conflict of interest statement in toto.

The more I read these stories, the more it just seems like a racket, the stuff of flim-flam men and bilko artists. The newer drugs are real – they aren’t snake oil or magic bracelets. But they’re certainly not all there is to treating mental illness. And they are potentially dangerous. We physicians have a covenant with our patients to do no harm in our efforts to help them. And these distortions and manipulations of scientific information directly impede our ability to keep that bargain. It’s a practical matter. There was a time when books like Nemeroff and Schatzberg’s Recognition and Treatment of Psychiatric Disorders: A Psychopharmacology Handbook for Primary Care would have kept us abreast of advances and dangers of newer medications. But not so much any more. If that book had said "Commissioned by the makers of Paxil," I would’ve known how to read it [or not read it]. But it didn’t say that. This kind of thing has become way too common and made us appropriately suspicious of our own literature. Industry financed ghost-writing has regularly found its way into our best journals.

When the POGO letter came out, the Dean of the Miller School of Medicine in Miami, Dr. Pascal Goldschmidt, defended Drs. Nemeroff and Schatzberg saying:
"It is unfortunate that two individuals who have contributed so much to the medical discipline of psychiatry, Drs. Charles Nemeroff and Alan Schatzberg, and to the health of so many patients with dreadful psychiatric illnesses here in the U.S. and beyond, are exposed to such an unreliable and unfounded challenge to their reputation.”
Well Goldschmidt’s defense is "unreliable and unfounded." I would have a very different take on the "contributions" of Drs. Nemeroff and Schatzberg. The evidence is mounting daily that there has been something very rotten in the state of academic Psychiatry for a very long time – at Emory, at Stanford, at Yale, at Penn, at Brown, in Miami – and it’s high time it comes to an end. Biological Psychiatry is actually too important to the practice of medicine and Psychiatry to leave in the hands of compromised academicians, ghost-writers, and Pharmaceutical Marketing departments. So I find myself falling into the ranks of people who stalk this topic – hoping to spread the alarm.
I’m fine with being there. It’s a pretty decent group to be with – and it’s certainly a worthy cause…
  1.  
    1 Boring Old Man… & Chuck Nemeroff « seroxat secrets…
    December 5, 2010 | 1:55 PM
     

    […] retired Doctor (the 1 Boring old Man) writes about Nemeroff and Ghostwriting: Like Dr. Healy, I have some personal reasons for being […]

  2.  
    Lynn
    December 9, 2010 | 7:52 PM
     

    May I ask if you are writing to doctors in your area who probably claim to be too busy to know about this?
    Are you or anyone you know writing an accurate textbook or considering coming up with a website with that “textbook’s” title on it to draw med students to the correct information? I know my doctor sees too many patients to be able to do any research. Anything you can do to spread the word to doctors would be greatly appreciated. Anti-depressants and Xanax have permanently damaged me.

  3.  
    LeoB
    December 10, 2010 | 6:02 AM
     

    Thanks for this very interesting article.

    I wonder if you have any thoughts of the problem with biased research articles (or any other research articles with bad conclusions etc). They seem to live along with the real research articles without any marking of any kind.

    Are there perhaps some open alternative trying to mark them in some way?

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    – Gurken subscribe to comments
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