Quickie Must-Read Link …
In brief: court documents reveal that big Pharma co. Wyeth paid a medical communication firm to ghostwrite 28 review articles slanted in support of hormone replacement therapy for menopausal women for seven years between 1998 and 2005. That effort supported a boom in the sales of Wyeth’s products in that area, up to the point when this happened:
But the seeming consensus fell apart in 2002 when a huge federal study on hormone therapy was stopped after researchers found that menopausal women who took certain hormones had an increased risk of invasive breast cancer, heart disease and stroke. A later study found that hormones increased the risk of dementia in older patients.
Read the article as a whole. It is important as a public policy issue, and it is perhaps even more so as a deep challenge to science as a civic enterprise.
A couple of thoughts there, very quickly, as this is a big area and I actually want to think and research a bit before charging in.
Mostly, I’d agree with one comment, I think from the Balloon Juice thread, that this is the science community’s answer to the steroid scandal in baseball.
It makes it almost impossible not to question any result published in even the most seemingly prestigious journal; certainly any research report and especially any review article on an area in which major financial interests are at play has to be read with a “who benefits” filter on high.
There’s no way to pretend that the myth of science as a disinterested truth community is an accurate description of the world we live in any more. (If ever it was). Of course, individual by individual and lab by lab — and lots of people I know personally — would not countenance the kind of deception in which Wyeth and its enablers indulged. But science is a big country, and the amount of cash flowing through some of its provinces is enough to compel not just the ordinary skepticism that is part of the scientist’s toolkit, but that worldly reality check that tells us to follow the money.
The other thought, and its really half a thought, bears on an argument I’ve had running with Bora over at PLoS — one of the parties whose legal action brought this scandal to light — about the question of story telling and science communication. He’s written repeatedly of his view that the construction of a story structure around a body of information distorts and even can smother the actual scientific result that should be what is being communicated.
I’ve told Bora that this is, to me, nonsense. Information without context and data presented without some vector to carry it into the mind of its intended audience will simply disappear.
Part of our dispute lies in the very different sense of audiences we have. Bora is concerned both with communication between researchers and the communication of research to a broader audience. I’m interested in the former, but am really concerned with the latter.
In communication between scientists working within fields, the data really is the key. I was speaking to a friend recently who works in a senior position at a major drug company, directing one of the major areas in which basic science and medical applications ram right into each other. That researcher/manager told me that all that matters to the decision making process is the data. The discussion, the interpretation, the “spin” a scientist might put on their data is secondary, or even worse, special pleading. What matters is the pure info about what was done, with what methods and instruments, to produce what measurements.
But in communicating to lay audiences — and even, as the Wyeth story suggests to somewhat more broadly constructed scientific ones — that doesn’t seem to me to be a plausible approach. You have to tell a tale that a reader not necessarily either interested or informed about the context of the work will be able to follow, and that will hold her or his interest sufficiently to keep them reading graf to graf, until the story’s end.
But as I understand him, for Bora the problem — and it’s a real one — is that it’s terribly easy to construct of essentially false narratives that distort the meaning of the science from the start. See, e.g. all the writing that has floated the autism-vaccine woo for so long. For me the issue lies with finding a way to express as narrative the key ideas to be communicated without distorting them — and thereby hangs a much longer tale than I’m going to write here. Doing that is, in essence, what we try to teach our students at the Graduate Program in Science Writing at MIT, and I deeply believe that this is an essential civic-society endeavor.
That’s all by-the-by to what made my ears perk up in this story of Wyeth’s and their tame “authors” misdeeds . Apparently, most of the astroturfed articles were review articles — summaries-and-interpretations of the state of research in hormone replacement therapy. Review articles are, of course, a genre of scientific literature wrapped up in storytelling. By its nature, it demands the collation of a range of incidents — individual research reports — into a sequence logically and narratively designed to lead the reader to the interpretation of the state of the field that its author wants to advance.
There is nothing wrong with such a genre; quite the reverse. It exists in part to provide gateways into bodies of work and ideas, and it is all the more necessary in fields in which sub specialties throw up information useful to practitioners within the field but beyond the speciality…which pretty much describes all of molecular biology, for one.
But as the Wyeth story reconfirms, the writing of review articles is prone to precisely the kind of abuse that Bora and many others have decried in popular writing about science: distortion based on constrained or disputed points of view, misinterpretation or misunderstanding (ignorance of the subtleties) of works under discussion, mis-emphasis on one point or another … and outright corruption, as above.
I’m not trying to defend popular science writing and its discontents here by saying that similar problems exist within the scientific literature. What I am saying is that the Wyeth case is an extreme version, a morally bankrupt one, of two facts of life.
One is that money talks. The other is that the way human beings tell each other important things contains within it real vulnerabilities. But any response that says don’t communicate in that way doesn’t make sense; the issue is not how to stop humans from organizing their knowledge into stories; it is how to build institutional and personal bullshit detectors that sniff out the crap amongst the good stuff.
As I said — only half thoughts for now. And rather meta at that. The real story is, of course, that drug companies really, always, do have our best interests at heart. Right!? (And I won’t link to the latest Megan McArdle foolishness on this score, noting only that she has qualified another of my favorite real fitness reports for British military officers: “Since my last report, (s)he has hit bottom and started to dig.”
Image: Sir William Fettes Douglas, The Alchemist, before 1891