Journal of Bioethical Inquiry

, Volume 7, Issue 1, pp 13–29 | Cite as

From Evidence-based Medicine to Marketing-based Medicine: Evidence from Internal Industry Documents



While much excitement has been generated surrounding evidence-based medicine, internal documents from the pharmaceutical industry suggest that the publicly available evidence base may not accurately represent the underlying data regarding its products. The industry and its associated medical communication firms state that publications in the medical literature primarily serve marketing interests. Suppression and spinning of negative data and ghostwriting have emerged as tools to help manage medical journal publications to best suit product sales, while disease mongering and market segmentation of physicians are also used to efficiently maximize profits. We propose that while evidence-based medicine is a noble ideal, marketing-based medicine is the current reality.


Evidence-based medicine Marketing Marketing-based medicine Pharmaceutical industry Olanzapine Quetiapine 



The authors wish to acknowledge the work of journalist, Philip Dawdy, who has written much on these documents and whose website is one of the main hosts of internal industry documents. We also recognize the work of journalist Jim Edwards (, who has written much about several of the documents discussed in this paper.


Glen I. Spielmans has holdings of less than $10,000 in a mutual fund (Vanguard Health Care), which invests nearly exclusively in pharmaceutical companies. Dr.Parry is a member of Healthy Skepticism.


  1. Alam, E.S.K., and L. Jeffries. 2008. Discussion document: Seroquel/Seroquel XR and weight gain. AstraZeneca document available from authors.Google Scholar
  2. Angell, M. 2008. Industry-sponsored clinical research: A broken system. Journal of the American Medical Association 300: 1069–1071.CrossRefPubMedGoogle Scholar
  3. Applbaum, K. 2008. Where supply meets demand: Comorbidity and channel stabilization in the creation of a psychopharmaceutical blockbuster. Paper presented at the Rethinking Economic Anthropology conference, January, in London, UK. Available: (Accessed March 10, 2008).
  4. Arvanitis, L. 1997. Weight gain (email). Retrieved March 3 2009 from
  5. AstraZeneca. 2000. Seroquel (quetiapine) commercial support team technical document (TD004): BPRS meta-analysis. Retrieved March 3, 2009, from
  6. AstraZeneca. 2001. Seroquel (quetiapine) speakers slide kit. AstraZeneca document available from authors.Google Scholar
  7. AstraZeneca. 2003. Untitled. Retrieved March 3, 2009, from
  8. Aubuchon, N.W. 2002. Re: Request (email). Retrieved February 15, 2007, from
  9. Baker, R.W. 2000. Meeting with endocrinologic consultants (email). Retrieved February15, 2007, from
  10. Bandick, M. 2001. Zyprexa primary care presentation. Retrieved February 15, 2007, from
  11. BBC. 2007. Panorama: Secrets of the drugs trials. Retrieved March 30, 2007, from
  12. Berk, M., L. Berk, K. Moss, S. Dodd, and G.S. Malhi. 2006. Diagnosing bipolar disorder: How can we do it better? Medical Journal of Australia 184: 459–462.PubMedGoogle Scholar
  13. Brecher, M., I.W. Rak, K. Melvin, and A.M. Jones. 2000. The long-term effect of quetiapine (Seroquel) monotherapy on weight in patients with schizophrenia. International Journal of Psychiatry in Clinical Practice 4: 287–291.CrossRefGoogle Scholar
  14. Breier, A. 1999. Olanzapine-associated weight changes (email). Retrieved February 15, 2007, from
  15. Brodie, T.M. 2000. Re: Meeting with endocrinologic consultants (email). Retrieved February 15, 2007, from
  16. Carlson, G.A. 2009. Treating the childhood bipolar controversy: A tale of two children. American Journal of Psychiatry 166: 18–24.CrossRefPubMedGoogle Scholar
  17. Cavazzoni, P. 2002a. Re: ZYP: Diabetic coma and neuroleptic malignant syndrome (case no. 200201953) (email). Retrieved February 15, 2007, from
  18. Cavazzoni, P. 2002b. MHLW PI (email). Retrieved February 15, 2007, from
  19. Chan, A.-W. 2008. Bias, spin, and misreporting: Time for full access to trial protocols and results. PLoS Medicine 5: e230.CrossRefPubMedGoogle Scholar
  20. Clary, C. 2000. Zoloft: PSC update. Pfizer document available from authors.Google Scholar
  21. Current Medical Directions. 1999. Worldwide publications status update. Retrieved May 27, 2007, from
  22. Dawdy, P. 2008, April 2. Bitter pill. Willamette Week. Available at:
  23. Dianthus Medical. Undated. Untitled. Retrieved September 21, 2009, from
  24. Edwards, J. 2009a. CASPERR was GSK’s friendly ghostwriting program on Paxil. Retrieved September 18, 2009, from
  25. Edwards, J. 2009b. Email: AstraZeneca knew in 1997 that Seroquel caused weight gain. Retrieved March 5, 2009, from
  26. Eli Lilly. 1994. Olanzapine lifeplan. Retrieved February 15, 2007, from
  27. Eli Lilly. 1995. The third United States schizophrenia advisory panel meeting. Retrieved February 15, 2007, from
  28. Eli Lilly. 2000a. Note from one of our speakers about Zyprexa and primary care. Retrieved February 15, 2007, from
  29. Eli Lilly. 2000b. Untitled. Retrieved February 15, 2007, from
  30. Eli Lilly. 2001a. Global positioning strategic imperatives and tactical directions: Final report. Retrieved September 1, 2009, from
  31. Eli Lilly. 2001b. Hyperglycemia/diabetes data on demand resource guide. Retrieved February 15, 2007, from
  32. Eli Lilly. 2001c. Zyprexa product team off-site. Retrieved February 15, 2007, from
  33. Eli Lilly. 2002a. Janssen meeting feedback—Chris Fear. Retrieved February 15, 2007, from
  34. Eli Lilly. 2002b. Managed care—June 2002. Retrieved February 15, 2007, from
  35. Eli Lilly. 2002c. Zyprexa (olanzapine) brand council III: Zyprexa US 2003–2004 marketing and business. Retrieved September 2, 2009, from
  36. Eli Lilly. 2003. CSF # 1 review. Retrieved February 15, 2007, from
  37. Eli Lilly. 2004. Weight task force. Retrieved February 15, 2007, from
  38. Eli Lilly. Undated-a. Medical press: Pre-launch feature outline. Retrieved August 20, 2009, from
  39. Eli Lilly. Undated-b. Key player playbook. Retrieved February 15, 2007, from
  40. Eli Lilly. Undated-c. Weight gain management marketing verbatims. Retrieved February 15, 2007, from
  41. Eli Lilly. Undated-d. Olanzapine core medical efficacy and safety beliefs. Retrieved February 15, 2007, from
  42. Eli Lilly. Undated-e. Adverse reactions. Retrieved February 15, 2007, from
  43. Eli Lilly. Undated-f. Regulatory activity. Retrieved February 15, 2007, from
  44. Eli Lilly. Undated-g. Zyprexa retail implementation guide. Retrieved February 15, 2007, from
  45. Elsevier. 2007. Pharma solutions: The preferred medical publishing partner for healthcare worldwide. Document available from author.Google Scholar
  46. Feather, K.R. 1996. Re: NDA#20–592. Retrieved February 15, 2007, from
  47. Flanagin, A., L.A. Carey, P.B. Fontanarosa, S.G. Phillips, B.P. Pace, G.D. Lundberg, et al. 1998. Prevalence of articles with honorary authors and ghost authors in peer-reviewed medical journals. Journal of the American Medical Association 280: 222–224.CrossRefPubMedGoogle Scholar
  48. GlaxoSmithKline. Undated. Effect of Paxil CR tablets and Paxil tablets on suicidal ideation and behavior in adults. Retrieved May 10, 2009, from
  49. Glenmullen, J. 2007. Untitled. Retrieved March 13, 2008, from
  50. Goldberg, J.F., J.L. Garno, A.M. Callahan, D.L. Kearns, B. Kerner, and S.H. Ackerman. 2008. Overdiagnosis of bipolar disorder among substance use disorder inpatients with mood instability. Journal of Clinical Psychiatry 69: 1751–1757.CrossRefPubMedGoogle Scholar
  51. Hagger, S. 2003. IIT benchmarking report (email). Retrieved September 2, 2009, from
  52. Hawkins, Z. 2001. To all sales representatives selling Paxil (memo). Retrieved August 10, 2009, from
  53. Healy, D. 2006. The latest mania: Selling bipolar disorder. PLoS Medicine 3: e185.CrossRefPubMedGoogle Scholar
  54. Healy, D., and D. Cattell. 2003. Interface between authorship, industry and science in the domain of therapeutics. British Journal of Psychiatry 183: 22–27.CrossRefPubMedGoogle Scholar
  55. Healy, D., and J. Le Noury. 2007. Pediatric bipolar disorder: An object of study in the creation of an illness. International Journal of Risk & Safety in Medicine 19: 209–221.Google Scholar
  56. Hofland, P. Undated. Optimizing brand success through effective publication planning & management. Retrieved September 21, 2009, from
  57. Hough, N. 1999. Re: ECNP abstract ‘weight gain & diabetes management’ (email). Retrieved March 3, 2009, from
  58. Jefferson T., M. Rudin, S. Brodney Folse, F. Davidoff. 2007. Editorial peer review for improving the quality of reports of biomedical studies. Cochrane Database of Systematic Reviews 2.Google Scholar
  59. Jureidini, J.N., L.B. McHenry, and P.R. Mansfield. 2008. Clinical trials and drug promotion: Selective reporting of study 329. International Journal of Risk & Safety in Medicine 20: 73–81.Google Scholar
  60. Keller, M.B., N.D. Ryan, M. Strober, R.G. Klein, S.P. Kutcher, B. Birmaher, et al. 2001. Efficacy of paroxetine in the treatment of adolescent major depression: A randomized, controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry 40: 762–772.CrossRefPubMedGoogle Scholar
  61. Kerr, J.G. 2002. Re: Japan: Glucose—teleconference review (email). Retrieved February 15, 2007, from
  62. Kinon, B. 1998. Re: Wishing/Goldstein articles (email). Retrieved February 15, 2007, from
  63. Lexchin, J., L.A. Bero, B. Djulbegovic, and O. Clark. 2003. Pharmaceutical industry sponsorship and research outcome and quality: Systematic review. British Medical Journal 326: 1167–1170.CrossRefPubMedGoogle Scholar
  64. Mathieu, S., I. Boutron, D. Moher, D.G. Altman, and P. Ravaud. 2009. Comparison of registered and published primary outcomes in randomized controlled trials. Journal of the American Medical Association 302: 977–984.CrossRefPubMedGoogle Scholar
  65. McHenry, L.B., and J.N. Jureidini. 2008. Industry-sponsored ghostwriting in clinical trial reporting: A case study. Accountability in Research 15: 152–167.CrossRefPubMedGoogle Scholar
  66. Moffat, B., and C. Elliott. 2007. Ghost marketing: pharmaceutical companies and ghostwritten journal articles. Perspectives in Biology and Medicine 50: 18–31.CrossRefGoogle Scholar
  67. Moreno, C., G. Laje, C. Blanco, H. Jiang, A.B. Schmidt, and M. Olfson. 2007. National trends in the outpatient diagnosis and treatment of bipolar disorder in youth. Archives of General Psychiatry 64: 1032–1039.CrossRefPubMedGoogle Scholar
  68. Mowatt, G., L. Shirran, J.M. Grimshaw, D. Rennie, A. Flanagin, V. Yank, et al. 2002. Prevalence of honorary and ghost authorship in Cochrane reviews. Journal of the American Medical Association 287: 2769–2771.CrossRefPubMedGoogle Scholar
  69. Moynihan, R., I. Heath, and D. Henry. 2002. Selling sickness: The pharmaceutical industry and disease mongering. British Medical Journal 324: 886–891.CrossRefPubMedGoogle Scholar
  70. Olson, J. 2009. U doctor scrutinized over drug research. St. Paul Pioneer Press. 18 March.Google Scholar
  71. Paris, J. 2009. The bipolar spectrum: A critical perspective. Harvard Review of Psychiatry 17: 206–213.CrossRefPubMedGoogle Scholar
  72. Phoenix International Research. 2000. Awareness of diabetes in association with antipsychotics. Retrieved February 15, 2007, from
  73. Ross, J.S., K.P. Hill, D.S. Egilman, and H.M. Krumholz. 2008. Guest authorship and ghostwriting in publications related to rofecoxib: A case study of industry documents from rofecoxib litigation. Journal of the American Medical Association 299: 1800–1812.CrossRefPubMedGoogle Scholar
  74. Sackett, D.L., W.M.C. Rosenberg, J.A.M. Gray, R.B. Haynes, and W.S. Richardson. 1996. Evidence based medicine: What it is and what it isn’t. British Medical Journal 312: 71–72.PubMedGoogle Scholar
  75. Scarpuzza, J. Undated. Scientific publications build brand success. Retrieved September 23, 2009, from
  76. Sismondo, S. 2007. Ghost management: How much of the medical literature is shaped behind the scenes by the pharmaceutical industry? PLoS Medicine 4: e286.CrossRefPubMedGoogle Scholar
  77. Smith, R. 2005. Medical journals are an extension of the marketing arm of pharmaceutical companies. PLoS Medicine 2: e138.CrossRefPubMedGoogle Scholar
  78. Smith, R. 2006. Lapses at the New England Journal of Medicine. Journal of the Royal Society of Medicine 99: 380–382.CrossRefPubMedGoogle Scholar
  79. SmithKlineBeecham. Undated. CASPERR: Case study publications for peer review. Unpublished manuscript.Google Scholar
  80. Spielmans, G.I. 2009. The promotion of olanzapine in primary care: An examination of internal industry documents. Social Science & Medicine 69: 14–20.CrossRefGoogle Scholar
  81. Steinman, M.A., L.A. Bero, M.M. Chren, and C.S. Landefeld. 2004. Narrative review: The promotion of gabapentin: an analysis of internal industry documents. Annals of Internal Medicine 145: 284–293.Google Scholar
  82. Sunvalley Communication. Undated. Writing and editorial services. Retrieved September 21, 2009, from
  83. Tollefson, G.D. 1997. Zyprexa product team 4 column summary. Retrieved February 15, 2007, from
  84. Tumas, J. 1999. Re: 2 EPS abstracts for APA. Retrieved February 29, 2009, from
  85. Tumas, J. 2000. FW: Meta analyses (email). Retrieved February 28, 2009, from
  86. Turner, E.H., A.M. Matthews, E. Linardatos, R.A. Tell, and R. Rosenthal. 2008a. Selective publication of antidepressant trials and its influence on apparent efficacy. New England Journal of Medicine 358: 252–260.CrossRefPubMedGoogle Scholar
  87. Turner, E.H., A.M. Matthews, E. Linardatos, R.A. Tell, and R. Rosenthal. 2008b. Supplement to: Selective publication of antidepressant trials and its influence on apparent efficacy. Retrieved January 19, 2008, from
  88. Velligan, D.I., J. Newcomer, J. Pultz, J. Csernansky, A.L. Hoff, R. Mahurin, et al. 2002. Does cognitive function improve with quetiapine in comparison to haloperidol? Schizophrenia Research 53: 239–248.CrossRefPubMedGoogle Scholar
  89. Ventura County Behavioral Health Department. 1999. Untitled. Retrieved February 15, 2007, from
  90. Villarroel, E.P. 2007. March Master plan: The making of a successful publication strategy. PharmaVOICE, 1–5.Google Scholar
  91. Washburn, J. 2005. Rent-a-researcher. Slate. Retrieved February 10, 2007 from:
  92. White, H. 2001. RE: Publication date for Paroxetine Adolescent Depression Study (email). Document available from authors.Google Scholar
  93. Whittington, C.J., T. Kendall, P. Fonagy, D. Cottrell, A. Cotgrove, and E. Boddington. 2004. Selective serotonin reuptake inhibitors in childhood depression: Systematic review of published versus unpublished data. Lancet 363: 1341–1345.CrossRefPubMedGoogle Scholar
  94. Williamson, D. 2002. Re: Clinical summary update (email). Retrieved February 15, 2007, from
  95. Zimmerman, M., C.J. Ruggero, I. Chelminski, and D. Young. 2008. Is bipolar disorder overdiagnosed? Journal of Clinical Psychiatry 69: 935–940.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  1. 1.Department of PsychologyMetropolitan State UniversitySt. PaulUSA
  2. 2.Department of PsychiatryFlinders UniversityAdelaideAustralia

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