Obsessively Yours

Exploring the social and cultural roots of personality and its disorders.

Lennard J. Davis is professor of disability studies, medical education, and English literature at the University of Illinois at Chicago, and the author of Obsession: A History. See full bio

August 5, 2009, Psychiatry

Ghostwritten Medical Articles Cast Doubt on Reliability of Psychiatric Drugs

Don't trust peer-reviewed articles especially if they are ghostwritten.

The New York Times reported on Wednesday that Wyeth, the drug company that made Premarin used in estrogen replacement therapy, commissioned 26 ghostwritten articles that appeared in major medical journals. The articles hyped the value of estrogen replacement and downplayed the negatives. Evenutally, this therapy was discontinued as a routine way of treating menopausal women because of the dangers involved. The ghostwritten articles were actually not written by the doctors whose names appeared on the articles, and for the most part those doctors seemed to have played no major roles in the production of these articles other than endorsing a paycheck. Further, the journals were not informed that those doctors whose names appeared did not write these works,

This fact is a scandal in itself, but the idea of ghostwriting articles has been well documented earlier. Particularly in the hype around Prozac and similar SSRI's, scholars have called our attention to the fact that many articles were ghost written and published in prestigious journals to make it seem as if those drugs were incredibly effective in treating depression, OCD, and other difficult to treat disorders. The early days of Prozac were euphoric, with statistics indicating that over 70 per cent of people taking those drugs were helped dramatically. While there were very few randomized, double-blind experiments with such drugs, anecdotal and other types of articles appeared that touted these high rates of cure. Instrumental in this mix were the ghost-written articles with the names of well-known experts in the field published in significant and prestigious journals.

Now that the dust has settled, the New York Times and other journals have pointed out that the early estimates of the efficacy of SSRI's was skewed by over-eager researchers. The actual efficacy rates for Prozac-like drugs is more like 37 percent, a thirty percent drop from the initially enthusiastic rates. It's worth noting that 37 percent is only four points above the placebo effect, which is generally agreed on as being about 33 per cent effective. This fact, of course, doesn't discount the beneficial effects of SSRI's to those individuals for whom they work.

My point is that we need to be extremely careful when we read that "experts have said" or that "experiments have shown"-particularly when we are looking at difficult-to-treat affective disorders. Even when we note that articles have been peer-reviewed (and all these ghostwritten articles had been peer-reviewed) we are still dealing with human being capable of making flawed judgments. Herd mentality exists not just in bovine groups but even in academic and scholarly ones as well. Some studies have shown (caveat emptor) that almost 50 per cent of peer-reviewed articles eventually turn out of be wrong. Science attempts to reach certainty, but certainty never attempts to reach science.