105 Mapping ghost management in medical research and public health

Abstract

Objectives At the Preventing Overdiagnosis Conference 2017, Marc-André Gagnon (Carlton University, Ottawa) built on the concept of ghost management in science (Sergio Sismondo) to develop a reflection on corporate capture and institutional corruption in the biopharmaceutical sector. He postulates that because of the current business model, the activity of pharmaceutical firms is more oriented towards producing influence on medical knowledge and social determinants of value, than towards producing innovative treatments. We wanted to verify the validity of this hypothesis by mapping the strategies and issues highlighted in three long-form Re-Check investigations on 3rd and 4th generation oral contraceptives, systematic breast cancer screening and HPV vaccines. Method Search for documents as well as for scientific and mainstream publications, FoIA requests, journalistic investigative methods, Re-Check evaluation grids and mapping tools. Results The mapping of our investigations confirms the hypothesis put forward by Gagnon. Our maps show ghost management at work in the case of these three health measures targeting healthy girls and women. Ghost management is practiced by the pharmaceutical industry, but also by other players in the health system (health authorities, regulatory authorities, research centers, NGOs) as soon as the stakes reach a critical size. Our maps illustrate how this ‘new model of science (…) drawing its authority from traditional academic science’ (Sismondo) is an effective strategy for capturing the different levels identified by Gagnon: science, regulation, market, health professions, media, technology and civil society. Conclusions Re-Check mapping highlighting ghost management currently at work in medical research and public health confirms Gagnon’s hypothesis (Sismondo’s concept). Such methods deserve to be developed, enriched, validated and applied by academic research. They should also become part of an evaluation grid used by journalists investigating pharmaceutical companies and health system’s players: organizations devoted ‘to influence ideas and social structures in a way that maximizes commercial value’ (Gagnon) and strengthens their position. The more investigations and academic research document the phenomenon, the better it may enable to develop solutions and transform institutional structures and medical practices to stem this endemic corruption.