A survey in 2001 identified 182 MECCs in the United States, up from 153 in 1998 [25
]. A number specialize in producing, placing, and tracking journal articles, known in the trade as “publication planning” or “strategic communication planning.” While these firms hide details of their work—from potential critics and competitors—they also energetically promote themselves and their services. Many have flashy Web sites highlighting their ability to prepare meeting presentations and publish articles.
In preparing this article, I spent six hours searching web pages for MECCs offering publication planning or similar or overlapping services to the pharmaceutical industry, and found 23 (list available from the author). This is not an estimate of the number of such firms, but indicates how common they are. There may be many more firms providing publication planning, including some not uncovered in this search, and some not advertising these services on the Internet. For example, CMD was not among the 23 found, as its current Web site lists only medical education and meeting services as core capabilities. Pharmaceutical companies also do publication planning in-house, though one industry source estimates that in-house planning makes up only 20% of this business [26
]. On the other side, it is possible that some of the identified firms misrepresent themselves, and perform only minimal publication planning.
Pharmaceutical companies control an immense quantity of data. The industry provides twice as much funding for clinical trials and related research as do not-for-profit agencies [27
]. Of industry funding, 70% goes to CROs that neither make ownership claims on data nor expect to publish the data themselves: CROs perform research to order [28
]. By its nature CRO research tends to be ghostly. The 30% of industry funding that goes to academic researchers often also comes with strings attached that can allow sponsors to prepare drafts, edit drafts, delay publication, prevent full access to data, and so on—in short, creating conditions that allow for ghost management [29–31
In a primer on publication planning, the director of one MECC defines the activity as: “gaining product adoption and usage through the systematic, planned dissemination of key messages and data to appropriate target audiences at the optimum time using the most effective communication channels” [32
]. These channels are such things as: “publications, journal reviews, symposia, workshops, advisory boards, abstracts, educational materials/PR.” Influencing scientific opinion in the service of marketing is the clearly stated goal here. The author of this article therefore makes scientific and commercial goals equal stakeholders in communication: in a chart he juxtaposes “Where shall we publish this study?” with “Who are our customers?” and “What can we claim from the results?” with “What are our customer needs?”
Complete Healthcare Communications (CHC) claims on its banner that it “has honed the systems and skills needed to develop the intellectual heart of pharmaceutical marketing—the publication plan. The result for your product? A continuum of awareness, interest, and prescriber confidence” [33
]. CHC will manage article submissions to meetings, and as samples of its service it provides hypothetical lists of abstracts and presentations, with their status, dates of presentation, etc. On its Web site is a list of ten hypothetical trials and at least 24 articles that can be written from them, which will lead to a completed bibliography of publications [34
CHC includes among its clients Pfizer, Sanofi-Aventis, Ortho Biotech, Wyeth, Schering-Plough, Shire, AstraZeneca, and other pharmaceutical companies. It provides testimonials from sponsors and authors. A Johns Hopkins author writes “Very nice outline! You guys are quite organized!! I think it's superb. Very fair and balanced. I'm not used to working with such excellent writers!” CHC claims to have written and submitted over 500 manuscripts, with an acceptance rate of 80%. CHC is able to achieve such a rate with resources far beyond the reach of most researchers: not only are all of its studies fully supported by the largest of pharmaceutical companies, but it boasts a team of 40 medical writers, editors, and librarians.
Other agencies offer very similar services. As described in an article by three of its managers, the Medical Knowledge Group starts publication planning with a phase of exploring “key messages” and “author/journal options” before designing any publications to incorporate those messages [35
]. It then tracks those and competitors' messages using its own information management tool. (Like CMD, the Medical Knowledge Group was not included when I conducted my web search, underscoring the limitations of that search.) Another MECC, Envision Pharma, says that “data generated from clinical trials programs are the most powerful marketing tools available to a pharmaceutical company.” Envision will work from early on in the process to ensure “consistent message dissemination,” will plan and track the “data dissemination plan,” and will produce “scientifically accurate, commercially focused abstracts, posters, and primary and secondary publications” [36
In addition to the publication planners, a much higher number of medical writing companies and individual writers create articles and presentations without engaging in broader publication planning; these may be adjuncts to publication planners. To provide an indication of the scale, the American Medical Writers Association boasts a membership of more than 5,000 [37
]; judging from the organization's officers and the content of its conferences, it appears to be dominated by MECCs [38
Several of the publication planning firms identified are owned by major publishing houses. For example, Excerpta Medica is “an Elsevier business” and writes that its “relationship with Elsevier allows… access to editors and editorial boards who provide professional advice and deep opinion leader networks” [40
]. Wolters Kluwer Health draws attention to its publisher Lippincott Williams & Wilkins, with “nearly 275 periodicals and 1,500 books in more than 100 disciplines,” and to Ovid and its other medical information providers, emphasizing the links it can make between its different arms [41
]. Vertical integration is attractive in the industry as a whole: at least three of the world's largest advertising agencies own not only MECCs, but also CROs [13
Ghost management of medical journal publications is clearly a substantial business, employing thousands of marketers, writers, and managers. It is large enough that the industry has established the International Publication Planning Association. This organization, which appears to be dominated by pharmaceutical companies, organizes meetings, keeps a directory of experts, and gives awards to honor planners [42
]. In addition, the International Society for Medical Publication Professionals also organizes meetings, has committees to develop policy, and posts job advertisements [43
]. Both of these associations compete with for-profit companies offering similar services, such as the Center for Business Intelligence, which held forums for Strategic Publication Planning in 2005 and 2006 [44