This week, Mad in America explores three new articles around pharmaceutical industry corruption. The first examines industry’s hidden influence over medical research and healthcare decisions. The second presents a case study of a paper published in an academic journal and presented as independent research that was actually written by industry agents pushing industry propaganda. The third explores industry influence over medical students.
Industry Uses “Ghost Management” to Influence Medical Research, Regulatory Agencies, and Healthcare Professionals
A new article published in the Journal of Pharmaceutical Health Services argues that corruption in the pharmaceutical industry is much broader than illegal bribery, fraud, and kickbacks. The authors, led by Marc-Andre Gagnon from Carleton University in Canada, contend that industry uses legal means to influence medical research, scientific evidence, healthcare professionals, regulatory agencies, and public health policy. This invisible “ghost management” often results in commercial interests taking priority over the needs and well-being of patients and service users.
“Ghost management” is a term used to describe the hidden influence industry exercises over scientific knowledge and healthcare decisions. These activities, while legal, threaten to undermine public health and patient welfare. The authors point to seven major mechanisms of ghost management:
- Research manipulation – Industry sponsors research designed to produce results favorable to its products.
- Selective publication – Industry uses its influence to ensure findings that are positive for its products are published, while negative findings are suppressed.
- Ghostwriting – Industry publishes research written by its agents under the name of complicit academics, allowing propaganda to masquerade as legitimate research.
- Influencing medical professionals – Industry makes payments and gives “gifts” to medical professionals to influence prescribing practices.
- Influencing clinical guidelines – Industry makes payments and gives gifts to experts and organizations that shape clinical guidelines.
- Regulatory influence – Industry lobbies policy makers and makes payments to FDA advisory committee members to shape regulations in favor of industry profits.
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Influencing civil society – Industry makes payments to patient advocacy groups and charities, as well as conducting direct-to-consumer advertising, to influence civil discourse and policy decisions in favor of industry profits.
The authors give three recommendations for addressing pharmaceutical industry corruption. They call for greater transparency in clinical data. All clinical trial results, including unfavorable findings for industry products, should be disclosed. This would reduce selective publication and the suppression of critical findings.
Industry profits should be separated from sales volume. They suggest a model in which compensation to pharmaceutical companies is determined by the therapeutic benefits of their products rather than the volume of sales. This could encourage innovation while reducing incentives for unnecessary prescribing and aggressive promotion of industry products.
The medical profession should become independent of industry influence. This would include ending industry sponsorship of medical education and marketing directed at medical professionals, as well as increasing public funding for independent medical research.
Additionally, the authors support broader reforms, including stronger anti-corruption legislation, criminal prosecution of industry employees when appropriate, greater protections for whistleblowers, greater transparency in healthcare institutions, and ethics education and cultural changes within healthcare organizations.
How Pharmaceutical Companies Manufacture Scientific Evidence Through Ghostwriting
A new case study published in Social Studies of Science traces the creation of a ghostwritten academic paper from 2014. This paper was created by industry employees with the explicit objective of increasing sales of its products, but was presented as impartial research and published in an academic journal. The authors of the case study, led by Maud Bernisson from the Université Gustave Eiffel in France, argue that beyond concealing the true authors, pharmaceutical industry ghostwriting of research can influence how diseases are defined, how doctors understand their responsibilities, how patients are represented, and which treatments are considered appropriate.
The goal of this study was to examine how pharmaceutical ghostwriting operates in practice and how commercial interests shape “independent” research. The authors used internal documents from the pharmaceutical company Mallinckrodt to explore how the 2014 paper titled Acute Pain: Effective Management Requires Comprehensive Assessment was produced with the assistance of a medical education and communications company to serve industry interests. Theses documents were made publicly available after Mallinckrodt settled lawsuits related to their marketing of opiates. In total, the authors examined 164 internal documents, including emails, contracts between Mallinckrodt and the company hired to produce the paper, successive manuscript and draft outlines, meetings and minutes reports, and internal communications about the development, revision, and publication of the paper.
Mallinckrodt first developed a marketing strategy to expand the category of acute pain that could be treated with opioids. They then hired a medical education and communications company to develop the paper examined in the current work and provided strategic direction, terminology, and preferred messaging for the manuscript. Mallinckrodt brought in medical researchers to appear as authors of the paper largely produced by the company they hired. The paper was subsequently published in Postgraduate Medicine.
The authors identified three interconnected themes from the paper. (1) Constructing identities and assigning responsibility dealt with the images of doctors, patients, and pharmaceutical companies presented in the paper. Doctors were presented as being overly cautious about opioid addiction and providing inadequate pain treatment. Patients were presented as needlessly suffering from inadequate pain treatment that could be remedied with stronger opioids. The industry influence on the paper was hidden, with the medical education and communication company said to have only provided secondary editorial assistance.
(2) Manufacturing scientific legitimacy. Medical communications professionals produced the manuscript outline as well as substantial portions of the manuscript. Mallinckrodt employees actively influenced the arguments and terminology used in the paper. Despite substantial industry involvement, the paper was presented as independent research. The authors refer to this process as a performance of scientific integrity.
(3) Distorting the reality of pain management. The authors argue that this paper sought to construct a particular narrative around pain and its treatment. This paper attempts to redefine acute pain as a condition that requires continuous, sustained treatment with opioids. This narrative would create a larger market for Mallinckrodt’s products.
The authors note that Mallinckrodt employees made about the same number of corrections to the manuscript as the academic authors. In early versions of the manuscript the objective of increasing the market for Mallinckrodt’s products was explicitly stated. However, this explicitly stated goal was removed from later versions of the paper.
This study had three main limitations. This research was a case study of a single paper. While the authors provide compelling evidence for how industry crafts research to serve its purposes, these findings may not be generalizable to other pharmaceutical companies, medical communication organizations, and industry-sponsored publications. The authors had access to a limited number of internal documents. There may be other documents, as well as undocumented discussions, that could have influenced the findings. This study did not evaluate clinical consequences of industry ghostwriting, such as changing physician prescribing practices, influencing clinical decisions, or contributing to specific patient outcomes.
How Industry Influence Shapes Medical Students’ Attitudes and Future Prescribing Practices
A new paper published in the Journal of Law, Medicine & Ethics argues that interactions between medical students and the pharmaceutical and medical device industries can influence how future physicians think, prescribe, and make clinical decisions. The authors, led by Joshua D. Hauser from the University of California, contend that medical schools do not have appropriate policies for protecting students from industry influence. If medical students become accustomed to accepting benefits from industry, these attitudes and practices may carry over into their future medical careers.
The authors present evidence from previous research that industry exposure is widespread among medical students. Between 40% – 100% of medical students have some interaction with pharmaceutical companies. Between 89% – 98% of clinical students have accepted food from industry representatives. While accepting a meal from a pharmaceutical company may not seem significant, the authors argue that small gifts, such as meals and branded stationary can influence students’ attitudes towards industry.
This is supported by the evidence that interacting with the pharmaceutical industry influences physician prescribing behavior. Past research has found that even small gifts, such as a $20 meal, are linked to increased prescribing of promoted drugs over generic alternatives. Physicians receiving industry payments are more likely to prescribe the payers products. Industry exposure in medical school has been associated with more favorable attitudes towards pharmaceutical companies.
The authors believe that existing conflict-of-interest (COI) policies are inadequate in reducing industry influence over prescribing and clinical decisions. Only 38% of US medical schools have adopted formal COI policies in line with the Association of American Medical Colleges’ (AAMC) 2008 recommendations. In 2014, 50% of medical schools in the US prohibited faculty participation in industry sponsored speakers bureaus. That number has shrunk to 38% in 2026.
The authors argue that in addition to acquiring clinical knowledge, medical schools instill professional values, attitudes, and ethical standards in its students. When students regularly interact with industry during medical school, they may begin to normalize commercial relationships as a routine part of practicing medicine. This can lead to compromised clinical independence, reduced evidence-based decision making, and patient welfare concerns.
They recommend strengthening COI policies, enforcing AAMC recommendations around medical student industry exposure, teaching medical students how industry funding can influence research findings and prescribing decisions, and using the Open Payments database, which tracks payments made from industry to physicians, to help students identify and understand financial relationships between healthcare professionals and industry.
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Bernisson, M., & Halffman, W. (2026). Imaginaries of writing and pain: The backstage of a ghostwritten paper. Social Studies of Science. (Link)
Gagnon, M.-A., & Dong, B. M. (2026). Rethinking pharmaceutical corruption in the age of ghost management: A broader approach to combating corruption. Journal of Pharmaceutical Health Services Research, 17(3). (Link)
Hauser, J. D., Kesselheim, A. S., & Redberg, R. (2026). Industry exposure in medical training: The case for a conflict-free learning environment. Journal of Law, Medicine & Ethics, 54(3), 417–419. (Link)
