Background:
Previous studies have documented strategies to promote off-label use of drugs, using journal publications and other means. Few studies have presented internal company communications that discussed financial reasons for manipulating the scholarly record related to off-label indications. The objective of this study was to build on previous studies to illustrate implementation of a "publication strategy" by the drug manufacturer for four off-label uses of gabapentin (Neurontin(R), Pfizer, Inc.): migraine prophylaxis, treatment of bipolar disorders, neuropathic pain, and nociceptive pain.
Methods:
We included in this study previously undisclosed internal company documents, email correspondence, memoranda, study protocols and reports that were made publicly available in 2008 as part of litigation brought by consumers and health insurers against Pfizer for fraudulent sales practices in its marketing of gabapentin. We reviewed documents pertaining to 20 clinical trials, 12 of which were published. We categorized our observations related to reporting biases and linked them with topics covered in internal documents, i.e., deciding what should and should not be published and how to "spin" the study findings (re-framing study results to "explain away" unfavorable findings or to over-emphasize favorable findings); and where and when findings should be published and by whom.
Results:
We present extracts from internal company marketing assessments recommending that Pfizer and Parke-Davis (Pfizer acquired Parke-Davis in 2000) adopt a "publication strategy" to conduct trials and disseminate trial findings for unapproved uses rather than an "indication strategy" to obtain regulatory approval. We show internal company email correspondence and documents revealing how publication content was influenced and "spin" was applied; how the company selected where trial findings would be presented or published; how publication of study results was delayed; and the role of ghost authorship.
Conclusions:
Taken together, the extracts we present from internal company documents illustrate implementation of a strategy at odds with unbiased study conduct and dissemination. Pfizer and Parke-Davis’s "publication strategy" had the potential to distort the scientific literature, and thus misinform healthcare decision-makers.