Pens and clipboards are so 1997. Attractive sales reps are so 2001. They might both still be commonplace, but pharmaceutical companies have also been sinking cash into a more obscured vehicle of persuasion: peer-reviewed medical journals.

One drug company—Wyeth, maker of the hormone therapy drugs Premarin and Prempro—paid for substantial ghostwriting of 26 medical research papers published in major scientific journals between 1998 and 2005, according to The New York Times. And these writers weren’t just polishing prose. They shaped the articles from start to finish.

Since the dangers of hormone-replacement drugs began to surface in 2002, thousands of women have sued Wyeth. And according to court documents that have surfaced in ensuing legal battles, the drug company would often hire a medical communications company (for something to the tune of $25,000) to generate an outline for an article, enlist a doctor to sign on and then finalize the draft (with the physician's approval). Neither the fees nor the communications company would be noted in the published article. And because the product of these partnerships was often a review article—weighing various treatment options—no original experiments were required and conclusions could be company-friendly, but they could have wide influence on medical practitioners who read the journals.

Although the published articles passed peer review, many insist that the ethics behind them still render them unacceptable. "The filter is missing when the reader does not know that the germ of an article came from the manufacturer," James Szaller, a lawyer involved in some of the hormone therapy lawsuits, told the Times. 

Some suspect that Wyeth might just be the tip of the iceberg. "It's almost like steroids and baseball," Joseph Ross, an assistant professor of geriatrics at Mount Sinai School of Medicine, told the Times. "You don’t know who was using and who wasn’t; you don’t know which articles are tainted and which aren’t."

Wyeth notes that it now discloses when it has put money toward an article or employed editorial assistance from outside firms. And some journals, including JAMA The Journal of the American Medical Association, according to the Times, are taking a closer look at the role authors have in conceiving and writing papers they consider. 

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