Wednesday, June 23, 2010

Latest Issue of Bioethics Journal Spotlights Ghostwriting

The current issue of the journal Bioethics focuses on the problem of ghostwriting in the medical literature and is well worth a read. At this point, the main three articles on the topic appear to be free (at least I was able to gain full text access today, and I have no subscription to the journal.)

The first article, by Tobenna D. Anekwe at Harvard School of Public Health, argues that ghostwriting is in fact a form of plagiarism. While ghostwriting is sometimes called "honorary authorship" in order to make it seem acceptable, Anekwe makes the following interesting point:

"Yet honorary authorship is a form of plagiarism
because it entails claiming authorship for work that
was done by others. The twist is that, here, the corporation
(the willing ‘victim’ of plagiarism) actually wants the
scientist to ‘steal’ its work and publish it as his or her
own. But surely this one difference makes industry ghostwriting
no more acceptable. Honorary authorship should
be frowned upon by the research community in the same
way that other types of plagiarism are frowned upon. Yet
it remains unclear from their policies whether universities
view this practice as being as serious as other forms of

The second article, by Sismondo and Doucet at Queens University in Ontario, describes the insidious process known as "ghost management:"

In this article, we present evidence that pharmaceutical companies engage in the ghost management of the scientific literature, by controlling or shaping several crucial steps in the research, writing, and publication of scientific articles. Ghost management allows the pharmaceutical industry to shape the literature in ways that serve its interests."

This fascinating trifecta is rounded out by a commentary penned by Carl Elliot and Amy Snow Landa at the University of Minnesota. The authors conclude that both ghostwriting and ghost management are unethical practices and will be difficult to regulate until the medical education companies and physicians who collude with the process feel the sting of litigation:

"Given the amount of litigation against the pharmaceutical industry in recent years, some of which has resulted in record-breaking penalties, it is surprising that no litigation has been directed towards medical writers, medical communications agencies, or the physicians who sign their names to ghosted articles. Maybe this is because these players are seen as mere instruments in a much larger marketing enterprise, or maybe it is simply that their pockets are not as deep. But if a few high-profile lawsuits were successfully aimed in their direction, it is a good bet that the practice of ghostwriting would come to a sudden halt."

Well said.


Uma said...

well said. Or maybe it will give another boost to the insurance sector lol

Uma said...

Isn't this a form of celebrity endorsement?

Anonymous said...

Unethical is one thing, but that doesn't easily translate into a civil or criminal action that is punishable under the law. Exactly what are they planning to charge med-ed companies with?

And do they plan to extend this to speechwriters as well? When was the last time a President wrote his own speech?

David M. Allen M.D. said...

Ghostwriting a journal article is scientific fraud pure and simple and should be criminalized at every level. Certainly universities should have faculty rules against such practices.

SteveM said...

Medicine generally, and psychiatry specifically already have the administrative and social tools to indirectly but effectively halt the practice.

E.g., suspension from professional societies and publication, censure, shunning, disallow to present at meetings, etc.

Only Big Medicine is a "go along to get along" Leviathan. Like the government. So the above would never happen. That's why Schatzberg, Biedermann and Nemeroff are still fat, happy and chummy with their professional pals. And why a Mina Dulcan can be a vulgarian to colleagues and get away with it.

Sure, playing Quixotic gnat buzzing around the Beast can be entertaining. (I mean what the heck, that's why I do it.) But it is beating your head against a wall or pushing on a rope. Because in the end, "They" always win...

Anonymous said...


Let's hope that "they" not always win. If you care about medical profession and patients then inaction is not an option.

moviedoc said...

Agree with Anon. I suspect few docs among us are not committing some felony or other every day we practice already. And more civil suits we don't need either. If a practice is unethical, those with knowledge ethically should expose it and file ethics complaints. We will then likely see that the psychiatric ethics process has itself bogged down because of fear of still other kinds of litigation.

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

The difference between authorship and writership, and the ethical responsibilities of authors and of editors and medical writers, are well explained in the following sentence:

“Editors and medical writers have a responsibility to hold authors to the principle that, in science—even though the author of a paper may not actually write it—the physician-scientist must truly be the author of the ideas, the data, and the conclusions if he or she is to claim authorship.”
Source: Eastwood S, Liberthson D. The Author-Editor Relationship. In: Witte FM, Taylor ND, eds. Essays for Biomedical Communicators: Volume 1 of Selected AMWA Workshops. Bethesda MD: American Medical Writers Association; 2001:79-91. (Available from AMWA [American Medical Writers Association] at

It’s no matter that a President does not write his own speeches. What matters is that a speechwriter understands what his or her “client”--the President—wants communicated, and then communicates appropriatly.

SteveM said...

Re: "Only Big Medicine is a "go along to get along" Leviathan."

Upcoming Georgia psychiatric convention:

Star of the show? Why Charlie Nemeroff of course. (I'm sure he'll get an enthusiastic ovation.)

Anonymous said...

I agree with Dr. Altus. Indeed, the ability to write well and conduct research are two separate skill sets. How many times have we been asked to review a manuscript only respond that while the work is of significant scientific merit it cannot be published in it's current grammatical form?

Writing papers acceptable to the handful of top tier journals must now seemingly be of general public interest - and most "lab-rats" simply don't have the required writing style.

I'm fully convinced that because I've never used a writer, my CV has certainly suffered - and more than one manuscript orphaned.

Anonymous said...

Dr. Altus:
Where were you when I had to write my dissertation? I sure could have communicated my intent to you and had you do the rest!

David Behar, MD, EJD said...

In order to sue someone, the plaintiff must have suffered an injury.

What is the injury suffered by anyone from ghost writing?

A statement is false in an article. The patient uses a medication after being misled. Damage results. The article still has Freedom of the Press immunity. Most news articles contain some false information.

Examples of litigation. A cookbook recipe made people sick. A lab manual instruction caused an explosion. A mushroom text misidentified a mushroom, and the consumer of the mushroom went into renal failure. All immune, affirmed by appellate courts. One would have to prove the text is not a writing, but a tool, like an airmap mistake that caused a crash.

The debate should involve professional ethics and standards. If the profession deems it unethical to lie about who wrote an article, to maintain the credibility of scientific journals, that is valuable. However, sanctions should remain within professional societies and medical journal countermeasures. Job actions by medical employers are also appropriate to maintain the credibility of our medical schools.

Leave the courts and licensing boards out of this internal matter.