Let’s start this blog out with a good, old-fashioned example of manipulation with one twist – manipulation not of the great unwashed masses, but of an intellectual elite: doctors. Let’s dive in:

Last year, The Scientist reported a bombshell of a story. Basically, Merck, a large pharmaceutical company, had been paying a well-established publisher of medical and technical journals to publish a journal called Australasian Journal of Bone and Joint Medicine. The journal looked like a typical niche medical journal, complete with advisory board and articles that looked and felt fairly typical of peer-reviewed medical journals. But it was a complete fabrication – the articles, as it turned out, were either reproductions of other articles appearing elsewhere, or written by the “editors” of the journal – essentially Merck itself. The advisory board was full of doctors that were not aware of the publication. Of course, the articles were very favorable to Merck drugs, and were presumably quoted by reps to doctors as arguments in favor of prescribing those drugs to patients – “look at the results from the Australasian Journal of Bone and Joint!”. What Merck had done was publish a marketing brochure under the appearance of a real medical journal to manipulate doctors into prescribing their drugs. Do read the whole story – it’s a great yarn.

What’s interesting about that story is what happened next: namely, nothing. Merck made some noise about the fact that the journal was not pure marketing, since it reproduced real articles, and stopped commenting on the issue. Elsevier, the publisher, acknowledged that Merck was the funder behind the journal, agreed that it should have disclosed the fact that the journal was basically made up, and generally seemed to feel awkward about the whole thing (despite the fact that it published at least six more similar rags). Neither company was sued, the mainstream press didn’t pick up the story, and doctors as a group didn’t ban Merck drugs or stop reading Elsevier publications.

This is odd. The two drugs that were lauded by the fake journal were not harmless: one was linked to cancer, the other was Viox that was later pulled from the market because of increased risks of strokes and heart attacks. Here was a drug company basically passing off fake reports of marginal drugs as research to try to manipulate doctors. Where was the outrage? And why would doctors even fall for this kind of stunt?

To answer the second question, why did doctors fall for this trick, well, manipulations aim to shift perceptions and behavior only by a slight amount, and rely on the fact that small influences usually don’t warrant huge expenditures of skeptical efforts from the targets. In this case,  this journal was obviously not the sole support for these drugs – it was one of dozens of sources reps probably used. It would be very unusual for a doctor to go through the individual sources of a marketing pack, and it would take way too much amount of effort to ferret out the truth for any individual doctor. The only reason the scam was discovered was a lawsuit brought on against Viox.

So, why didn’t you read about this in the press? Why didn’t the crowds storm Elsevier and Merck headquarters? Well, manipulations are not illegal – what Merck and Elsevier did is immoral, ethically bankrupt, and reprehensible, but not strictly illegal. Even from a PR standpoint, Merck could (and did) blame Elsevier, and Elsevier could mumble something about adding more disclaimers, and that was basically it. There were no victims here (what doctor would claim to have prescribed drugs on the basis of an article that he had not read in a journal that he never obtained?) and the mainstream media has little interest in this type of complex, victimless story. So, within a few weeks, the story blew over, and as far as we know there could be several of these ‘publications’ still being delivered to doctors today – just probably better disguised.