Wednesday, December 16, 2009

Thoughts on Ghostwriting


There has been a lively and thoughtful discussion about ghostwriting in the comments section of my post on BlueSpark’s invitation to a doctor to write a review article on bupropion and depression. Here are some of the issues that have come up.


1. What’s in a name?

Michael Altus has been tenacious in his efforts to educate us in the still evolving vocabulary of this business.

“Ghostwriter”= A person who writes or otherwise assists in presenting the author's work without being acknowledged.

“Ghost author” = Identical to a ghostwriter.

“Guest author” = A person who is listed as an author without having made substantial contributions. This is what has also been called “identified author,” or “named author.”

Beyond this, there are acknowledged medical writers, usually listed at the end of an article, and typically described as providing “editorial assistance,” “assistance with data analysis,” etc…. These are not really ghostwriters, because they are visible. However, they are often spectral writers, or semi-ghost writers, because in some cases they have essentially done all the work, including the conception (in conjunction with the company’s marketing team), the outlining, the writing of the first draft, and the final editing. Anybody who does all that, or even part of that, should be listed as an official author. But it doesn’t look very legitimate to have a medical writer without an MD recorded as an author, and what the drug companies are looking for is legitimacy, whether genuine or fabricated.

2. So who should be listed as an “author”?

According to the web site of the International Committee of Medical Journal Editors (ICJME), in order to get your name up in lights as an author of a scientific paper, there are three specific criteria. To quote from their recommendations:

“Authorship credit should be based on 1) substantial contribution to conception and design, acquisition of data, or analysis and interpretation of data; 2) drafting the article or revising it critically for important intellectual content; and 3) final approval of the version to be published.”

As you can see, there’s quite a bit of wiggle room here. For example, what should count as “substantial contribution to conception”? If an academic has a brief phone conversation or an email exchange with a pharma-funded medical writing firm in which the topic of the article is discussed, the firm might later argue that this counted as a “substantial contribution to conception.” In fact these criteria do not require that an author do any actual writing—as long as they do some “revising.” As an editor myself, I know that “revising” is an expandable term, and can include everything from reading a draft of an article and saying “that looks great, I have no changes for you,” all the way to performing major surgery on the very organization of a paper.

3. Isn’t ghostwriting acceptable in some circumstances?

This is really the crux of the controversy about ghostwriting. Many commenters have pointed out that making science understandable is difficult, specialized work. It is unrealistic to think that scientists have the time or expertise to do the wordsmithing needed.

I agree, which is why I draw a bright line between industry-funded medical writing and academia-funded medical writing. Both ghostwriting and acknowledged editorial assistance are perfectly acceptable when the assistance is not arranged by a company that has a stake in the topic of the article. Most academic departments hire research assistants and editors whose jobs are to help write the many articles that get churned out by the more productive members of the departments. There is no incentive for such editors to bias the articles in any way.

But when an editor is paid, either directly or indirectly, by a drug company to work on an article, readers should be concerned, because now there is a powerful incentive for the editor to manipulate the content of the article to promote the sponsor’s product. If the final published article is not promotional enough, the writer won’t get a future assignment from the funding company. It’s as simple as that.

4. What’s the solution?

I have two recommendations:

--Journals should not publish articles that are clearly written in order to promote the funder’s product. Generally speaking, this would exclude any articles involving medical writing companies, even when their involvement is acknowledged. After the many recent example of corrupted scientific literature by drug company/medical writing firm partnerships, we can no longer have any trust that such teamwork is anything other than marketing.

--Journals should continue to publish research funded by industry, as long as the researchers sign disclosure statements assuring editors that they had complete control and involvement in every aspect of the paper. This means essentially no contact with the drug company after having accepted the money. Obviously, such research can still be highly tainted by bias, but the degree of bias is likely to be less extreme. Furthermore, as the medical literature gate-keepers, editors will scrutinize such research with extra care in order to make sure they are not unwittingly publishing advertisements in guise of science.

7 comments:

SteveM said...

And how about this. Mandate that the originator of a paper's proposal be explicitly noted.

E.g., This paper was originally PROPOSED by Eli-Lilly. The associated research was SPONSORED by Eli-Lilly.

That way everyone knows who initiated the investigation and drove the publication.

P.S. Not that it matters anymore...

Michael S. Altus, PhD, ELS said...

Dr. Carlat >wrote> and I COMMENT:
>Michael Altus has been tenacious in his efforts to educate us in the still evolving vocabulary of this business.>
COMMENT: Thank you for your comment.

>“Ghostwriter”= A person who writes or otherwise assists in presenting the author's work without being acknowledged.>
COMMENT: Yes.

>“Ghost author” = Identical to a ghostwriter.>
COMMENT: NO! Again, from the American Medical Writers Association, “AMWA Ethics FAQs” (www.amwa.org/default.asp?id=466), which I wrote: “Ghost authoring" refers to making substantial contributions without being identified as an author."

>“Guest author” = A person who is listed as an author without having made substantial contributions. This is what has also been called “identified author,” or “named author.” >
COMMENT: Yes.

The term "ghostwriting" is often used to encompass all three of these practices (ghostwriting, ghost authoring, and guest authoring).

>So who should be listed as an “author”? [SNIP] For example, what should count as “substantial contribution to conception”? [SNIP]>
COMMENT: Per “AMWA Ethics FAQs”: “The phrase ‘substantial contribution’ is often used with respect to determining authorship credit. A helpful explanation of what substantial contribution means is in the authoritative AMA Manual of Style 10th ed., 1007, p. 127-140):"A substantial contribution is an important intellectual contribution, without which the work, or an important part of the work, could not have been completed or the manuscript could not have been written and submitted for publication."

>Beyond this, there are acknowledged medical writers, usually listed at the end of an article, and typically described as providing “editorial assistance....”
COMMENT: Yes, ACKNOWLEDGED medical writers are NOT ghostwriters. I made this point on my comments in reply to the Carlat blog entry, “Ghostwriting Stays in the Spotlight”, Wednesday, August 19, 2009.

>However, they are often... semi-ghost writers, because in some cases they have essentially done all the work...”
COMMENT: “semi-ghost AUTHORS” is appropriate here. Yes, they should be listed as an author.

CL Psych said...

"Journals should not publish articles that are clearly written in order to promote the funder’s product. Generally speaking, this would exclude any articles involving medical writing companies, even when their involvement is acknowledged."

But then there would be barely any articles left in many journals. And that wouldn't necessarily be a bad thing.

Bruce said...

The best solution is to ban "authorship," an outdated concept in these days of multiple participation, and list each contributor according to their role, as they do in films. If the study was sponsored and managed by a pharma company, they should be listed as "director." The experts formerly listed as "authors" would be listed as "paid consultants" because that is their true role.

This would finally pull the curtain aside on the Wizard of Oz show of "authorship" and ghostwriting and reveal who truly controls research and publication. And if the medical profession and public are outraged, so much the better.

Carolyn Thomas said...

I think we're glossing over a fairly significant issue here.

Take this longstanding practice, for example, of assigning 'guest authorship' as a form of tribute to a senior faculty member or the colleague who arranged funding for the project - sort of a nice little 'thank you' gift, even though everybody is perfectly well aware that not one word in this paper orginated from the 'guest' author.

This means that when you see a name listed alongside any given medical journal article, it is essentially meaningless. Bestowing a “tribute” like false authorship to a department chair is like university students fraudulently putting their own names on purchased internet essays. The similarity: neither actually wrote them. The difference: the students are punished for their fraud. Department chairs are honoured for their fraud.

More to the point, academics get to add one more title to the all-important list of published papers on their CVs, without all that bother of actually doing the work.

How is this fraud any more palatable than medical ghostwriting, in which the actual drug company-paid author’s name is missing from the article credits entirely?

Maybe it's just widely accepted in academia; the AMA Manual of Style defines this as "substantial contribution... without which the work, or an important part of the work, could not have been completed or the manuscript could not have been written and submitted for publication."

Sounds like drug companies could qualify under this definition!


More on guest authorship at http://ethicalnag.org/2009/09/22/guest-athors/

Anonymous said...

I was just reading some posts on CL Psych's wonderful website. One poster (sounded like a psychiatrist) stated that he or she cannot read an article in the American Journal of Psychiatry without wondering which drug company paid for the study by inference, the results. Folks: We are in the Dark Ages of academic American Medicine and Psychiatry. I just pray that there are enough "Irish Monks" who can keep the flame of truth alive as we try to separate fact from Big Pharm fantasy (and profit motive) as to what ails us, and how best to treat it.

Vancouver Therapist said...

Great post. I agree with both of your assessments. They really seem common sense, but unfortunately people trying to erode away at that kind of thing is a tide that will never stop coming.