Ethical reflections: how to solve a problem like… ghostwriting

Claire Nicholson

Red Health

The topic of ghostwriting in the medical / scientific sphere is not new – it has been written about widely in both the medical literature and in the lay press – for example a piece in The Guardian this month reported on Simon Stern and Trudo Lemmens’ article in PLoS Medicine which stated that scientists credited on ghostwritten articles ‘should be charged with fraud’.

The majority of articles claim that ghostwriting (defined here as ‘the unacknowledged influence of a pharmaceutical company or industry-sponsored medical writer in a published article whereby the reader would assume that the article is written by independent academics’) manipulates the scientific community as it is likely to mask conflicts of interest and is deemed dishonest.

“…it is likely to mask conflicts of interest and is deemed dishonest.”

So, why does it matter? Well, aside from the points mentioned above, at the most basic level it goes against the Declaration of Helsinki, Basic principles for all medical research (1964) which notes that “Authors.. are accountable for the completeness and accuracy of their reports…Sources of funding, institutional affiliations and conflicts of interest should be declared in the publication.”

Few people would disagree that, in its most severe form (which is often written about as the only form), ghostwriting is highly unethical. However, the issue is more complex than: Medical writer authors biased article, Top scientist puts their name to it, Article published, Community fooled. For example, how much of an article does the doctor or scientist have to have written before they can legitimately have their name as an author? Similarly, how much of an article does the medical writer have to have written before they should be included in the byline?

“…how much of an article does the medical writer have to have written before they should be included in the byline?”

I think there is little doubt that professional medical writers’ expertise in presenting scientific data can be very beneficial in producing good quality scientific papers. However, if they do any more work to the manuscript than a journal editor would (e.g., proof reading), then they should be included as an author.

Linda Logdberg, a former medical writer, offers an interesting possible solution to the issue of ghostwriting – that of having the medical writers employed by the academic research centres rather than by pharmaceutical companies directly (though the cost would be covered by a grant from pharma). She sees the pharmaceutical company’s role to be one of fact checking only, with the submission to the journal handled by the research company. While there may problems with this suggestion, for example it could just be transferring the problem rather than actually addressing it, it may be certainly be worth exploring in more detail.

With its history (e.g. the much written about Vioxx case), ghostwriting is an easy tool to throw at the pharmaceutical industry to supposedly highlight its dishonesty – now is the time to set this right so that it can no longer be used as ammunition against the industry. In order to do this, the responsibility lies equally with the scientist / healthcare professional, the publication and the pharmaceutical company / medical writer.

“… the responsibility lies equally with the scientist / healthcare professional, the publication and the pharmaceutical company / medical writer.”

As a starting point, here are my suggestions on how we can help to once and for all stamp out the problem of ghostwriting…

1. Ensure that any person who makes a contribution to a manuscript over and above what a journal editor would make should be listed as an author

2. Require all monies the author receives from pharmaceutical companies to be reported and made available to readers – this would help to ensure that the term conflict of interest cannot be subject to interpretation

3. Encourage the reporting and exposure of any persons that do not adhere to the above.

About the author:

Claire works for the specialist health communications agency Red Health. Any views expressed are her own.

She can be reached at Claire.Nicholson@redconsultancy.com or via Twitter – @clairenics.

What can be done to help eliminate ghostwriting?