The New York Times recently reported (see here): "A growing body of evidence suggests that doctors at some of the nation's top medical schools have been attaching their names and lending their reputations to scientific papers that were drafted by ghostwriters working for drug companies -- articles that were carefully calibrated to help the manufacturers sell more products."Senator Charles E. Grassley, an Iowa Republican who has led a long-running investigation of conflicts of interest in medicine, is starting to put pressure on the National Institutes of Health to crack down on the practice."
Meanwhile, fellow pharma blogger Rich Meyer, doesn't see things that way. "Medical journal articles sponsored by drug companies are part of marketing," says Meyer. "That is a fact of a capitalist business that has to market to medical professionals. 'Ghostwriting' has been around for over 20 years and is standard industry practice for the drug industries. I personally see nothing wrong with ghostwriting as long as it is made clear at the beginning of the article who wrote it and who endorses the content." (see "Ghostwriting: What is right and wrong").
Before giving you my opinions, I would like to know what YOU think. To make that easy, I've created the Pharma-Sponsored Medical Journal Article Ghostwriting Survey. Please take 2 minutes to answer a few short questions relating to medical article ghostwriting practices sponsored by pharmaceutical companies.
Specifically, I'd like to know to what degree you agree or disagree with the following statements:
- Medical journal articles sponsored and ghostwritten by drug companies are a legitimate part of marketing to physicians.
- Drug companies provide ghostwriting services primarily because academic researchers are busy and some may not be skilled writers. I.e., it's NOT a marketing tactic.
- There is nothing wrong with ghostwriting as long as it is made clear at the beginning of the article who wrote it and who endorses the content.
- Medical journal articles sponsored and ghostwritten by drug companies are often biased (eg, emphasize the benefits of a drug and de-emphasize the risks).
- Pharma-sponsored ghostwritten medical journal articles are ethically suspect when physicians are paid by the pharma company to add their names as authors even though they have not made a substantive contribution.
- Physicians would never sign on as an author of a ghostwritten article that they did not review thoroughly.
- Medical schools should prohibit their faculty, trainees and students from being authors or co-authors of articles written by employees of commercial entities if the author's name or school title is used without substantive contribution.
- The federal government should revise research grant terms to prohibit grantees from being authors or co-authors of articles written by employees of commercial entities if the author's name or grant title is used without substantive contribution.
- Most physicians do not care that medical journal articles are ghostwritten.
Your comments are confidential (anonymous) unless you specifically provide your contact information at the end of the survey and allow us to attribute comments to you personally.
At the end of the survey you will be able to access a de-identified summary of the results to date.
Take the survey here.
Senator Grassley and his partisans are hypocrites of the purest, most feculent sort. These are professional politicians who emphatically do not write the contents of the bills they sponsor or sign, and yet they object to physicians making use of trained, experienced, talented professional medical writers participating in the creation of lucidly readable, properly researched, and publishable peer-reviewed scientific articles in the clinical literature.
ReplyDeleteI would ask that the readers - and the writers commenting on this "scandal" - turn their attention to legislators like Sen. Grassley and their derelictions of responsibility with regard even to reading the contents of the bills they vote upon, and forget about the Potemkin Village fraud of these "Malevolent Jobholder" hand-waves over medical ghostwriting.
As both a physician and a medical writer, I'd be happy to have my name included on the list of authors in cases where I've made substantive contribution to the content of any such publication. Those of my colleagues in medical writing - most of them with doctorates or other advanced degrees in the sciences, pharmacologists, nurses, and other clinically experienced individuals - would qualify also for authorship credentials.
But in most cases, I freely acknowledge that all I'd contributed to the manuscripts that came under my hand was some fiddlin' research work (tracking down and citing references, etc.) and fixing errors of grammar, spelling, format, and the like. The research and thought in each instance was that of the authors I was supporting, and I've never felt the need to take any of the credit that was rightfully theirs.
That would have been unethical.
I give up. Is there any controversy here? Doesn't signing your name mean that you wrote it? I've been writing for yrs and every word that appeared under my name was my own. Good luck defending the spooky ghostwriting policy. See www.MDWhistleblower.blogspot.com for some advice for these academics who are considering signing away their integrity.
ReplyDeleteDr. Kirsch, there are a lot of people in the profession - many of them talented, diligent researchers - who can't put words on paper to save their lives. I didn't believe that such things could happen until I'd been in practice for a couple of years and had a colleague come to me asking me to "look over" a manuscript he'd been sweating over for months. It was a simple review paper, and it was easy to hammer into shape.
ReplyDeleteEasy for me. For him? Not so. And yet I didn't have his familiarity with the literature, or his perception that such a review paper would be useful to his colleagues in his area of specialization.
He knew what needed to be said, and why it was needed. I didn't. I knew how it could be written so the information could be understood and appreciated.
That's what medical "ghostwriting" really is, insofar as I've had experience as such a ghostwriter. The authors with whom I've worked have either been too damned busy or (believe me) too damned inept at putting black on white to do what I do with minimal effort.
At the same time, I acknowledge that I haven't got their grasp of the areas in which they work, their understanding of the research in the field, their abilities to innovate, to investigate, to crack things open and peer inside and make sense of what they find.
I could no more ghostauthor in these folks' areas of expertise than I could play offensive line for the Chicago Bears.
But I can help them express themselves, and in so doing I get to work with some of the smartest people in the medical profession.
I've found that a lot of American physicians - especially the people who go into research - are grown-up "science geeks." You knew them in college, didn't you? The geniuses who skewed the curve in biochemistry and calculus, but who had to lean on Cliff's Notes to get through the dumbest courses in the English Department.
Well, if we shut off these people from the help they need to write lucidly on the research they do (and the knowledge they gain in the course of attacking those research areas), we're just screwing ourselves out of access to information we need as a profession.
As for crediting ghostwriters like me, be advised that if that were the case, then I'd wind up with my name all over the literature in a bunch of therapeutic areas where I'm no more entitled to be called an "expert" than is my Aunt Emily's pet poodle. Senator Grassley wants people citing me - or any other nuts-and-bolts medical writer - as an "authority" simply because I've done some word processing and know how to make reference management software work properly?
Between the journalism school root weevils of The New York Times and the bloated popularity contest winners in Washington, I think the stupidity level has passed "flaming" right into "incandescent."
Hi Rich,
ReplyDeleteFirst, there is a difference, at least in my mind, between ghostwriting and editing. When you are unraveling an MD's tangled syntax and molding the manuscript into standard written English, I regard this as editing. You are not providing the facts and interpretations, merely packaging them. I think, however, we both agree that such 'editors' should not be undisclosed hired scriveners by drug companies who are angling for a favorable light to be cast onto these medical studies. www.MDWhistleblower.blogspot.com
Dr. Kirsch, I don't mind being "disclosed" when I've done the necessary work to get a manuscript into shape for submission to a journal and help bring it through peer review, but if boilerplate medical writers wind up getting cited on the "authors" line in NLM indexing, you're going to start seeing essentially unqualified wordsmith types (like me) showing up in literature searches as if we were "experts" in clinical areas all over the map.
ReplyDeleteI'm a primary care grunt. I've participated in a couple of low-impact Phase IV studies, recruiting and following a few patients now and then. But I've never written a research grant application or done any of the hard work that resulted in the clinical trials data I've helped to mold into journal articles.
You want me showing up on a PubMed search as a respectable and noteworthy "author" in a field like hepatology or infectious diseases?
Pardon the expression, but are you nuts?
Regarding your concluding inquiry, I will leave it to others to assess my psychiatric state. No, I don't think you, or other editors or proofreaders, should be listed with the authors. My more important point remains on my prior comment. A party with a vested financial interest in a study should not hire writers to 'assist' authors. When this arrangement is not disclosed, it only deepens the ethical misconduct.
ReplyDeleteMany institutions limit access to their online information. Making this information available will be an asset to all.
ReplyDeleteOh, without doubt. And when an institution like the Climate Research Unit at the University of East Anglia has scientists like the ones who'd deliberately destroyed study data and criminally refused to comply with Freedom of Information Act requests for such materials, isn't it nice to have hackers (or was it insiders at the CRU who couldn't stomach the deceit any more?) ripping off the perpetrators' e-mail records and making massive information dumps accessible on untouchable Russian file transfer sites?
ReplyDelete"Making the information available" may well become a standing requirement in clinical research as well as in the climate sciences before the dust from this blow-up settles.
The intellectual integrity and honesty of the peer review process throughout the scientific world has now been called into question, and I suspect that this call is both warranted and long overdue.
We'll all be the better for it, and of that I have no doubt at all.