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Inside Pfizer's Ghostwriting Shop: Friendly Drug Studies for Just $1,000

How much does it cost to hire a respected academic to slap his name on a friendly drug-study report? At Parke-Davis, later acquired by Pfizer (PFE), managers paid academics $1,000 per paper, according to a document released in litigation over the company's Neurontin anticonvulsant. That seems pretty cheap, but of course the supposed author isn't doing a whole lot for the money.

Most companies have sworn off the practice of writing "research" papers for doctors and then paying them to add their names as authors even when they had little involvement or the results were trivial. Merck (MRK), Forest Labs (FRX), and GlaxoSmithKline (GSK) have all been caught doing it.

Pfizer has a policy against ghostwriters, but when it acquired Parke and its Neurontin blockbuster it apparently bought an enthusiastic ghostwriting shop within it.

In the 1997 Neurontin "tactical plan," one executive suggested that "fictionalized case histories could be written based on real situations."

"All articles submitted will include a consistent message emphasizing the proper use ... as well as emerging uses," one memo states. "Emerging uses" is often a euphemism for "off-label" use, or those not approved by the FDA. (It's illegal for drug companies to promote off-label use.)

At the same time, the company drew up a list of proposed authors for articles. That list included Charles Nemeroff, Big Pharma's top gun-for-hire, formerly of Emory University Hospital and now of Miami's Miller School of Medicine.

Executives proposed he write a paper titled "Case Reports: Gabapentin as a New Alternative in Psychiatry." (Given that Neurontin/gabapentin is an anticonvulsant, it should not have had any use in psychiatry at the time.) This slide was prepared by plaintiffs summing up their case against Pfizer:

It's not clear whether Nemeroff wrote the paper, but he did write an article for the Journal of Clinical Psychiatry -- one of the journals suggested in the ghostwriting list. That article was titled "An ever-increasing pharmacopoeia for the management of patients with bipolar disorder" and, as this citation indicates, it mentioned gabapentin.

Here's the economics of ghostwriting:

The actual cost of preparing and writing such papers was $12,000 per article. On top of that, "honorarium to author" only costs $1,000 per article -- a fairly clear indication that the author was the least-involved person in the article's writing.

The system didn't always work smoothly. One of Pfizer's own studies showed a placebo was more effective than Neurontin on neuropathic pain. The paper on the study was to be written by John Reckless of Bath, England. A September 2000 email -- written after Parke was acquired by Pfizer, says:

(Click to enlarge.)

We are using a medical agency to put the paper together which we will show to Dr. Reckless. We are not allowing him to write it up himself.
The paper was never published.


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