Medical papers. How ghostly is ghostwriting?

by Xavier Tello

Yesterday, the New York Times published an article commenting on of the discovery of a new case of ghostwriting, apparently paid by Wyeth for papers published between 1998 and 2005.

GhostwritingThe title: “Medical Papers by Ghostwriters Pushed Therapy” immediately raises eyebrows.

It is very important to thoroughly analyze the meaning and the context of the ghostwriting. It is important as well, to consider the reality that surrounds the environment of an investigator or group of investigators who finally sign as authors.

Firstly, for all involved in the scientific / medical community, it is no secret that the process of writing, reviewing, approving and –finally- publishing a scientific paper is a tough one. Within that setting, there are hundreds of scientific investigators’ teams, which would be very happy about looking their papers published if there would be enough time for writing… full time.

In the other hand, the Pharmaceutical companies need to produce as much as “scientific evidence” as possible in order to validate their products before the eyes of physicians. These companies do have the muscle (the money) enough, to pay for a full-time team of ghostwriters to produce and write.

In this case, authors become “validators” of these papers if they approve the content.

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Is this wrong?

The question should be answer –perhaps- in the context of the paper’s content itself.

Is the paper a bibliographical review or a meta-analysis?

Well, let’s face it; in lots of cases these kind of papers are not written by the author’s themselves, but by their teams, research associates, residents or any other kind of work groups specifically gathered and organized for such purposes, with the keen participation of young (and resilient) scientists, who want their names published as co-authors. Thus, a company who hires ghostwriters to do such a work, is providing the author with the “personnel” and resources he or she would finally need to accomplish the same task, but in less time.

In other cases, groups of investigators have spent months or years solely in the research phase of a clinical study; and the compilation, analysis and proper writing of results has to be made… within a timeline. When this work is properly sponsored, ghostwriters become handy.

It is obvious at this point, to assume that the basis of clinical and scientific content and the basics of a clinical report could not be ghostwritten. That would be fraud, period.

The questions that perhaps, we have to ask in a case-by-case scenario are:

  1. Do the author or authors really reviewed, supported and approved every single fact and every single word written in the paper?
  2. Is there a clear and proper disclosure on sponsors and possible conflicts of interest?
  3. Is this morally accepted? Well, this is a personal issue, I think.

At the end of the day we have to remember that there’s always a validation process and an editorial committee within the Journal. (Another discussion rises when Scientific Journals “push” or favor certain contents pro or against certain topics… or products).

And at the very last, there’s always the reader’s criteria, who would need to judge to which point, the content is acceptable or not to him or her.

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8 Responses to Medical papers. How ghostly is ghostwriting?

  1. Enrique Asensio says:

    Ghost-writing is another unethical sort of behaviour induced by the savage competition among pharma labs and “the other scientists”.
    I would say that “ghostwriting” has more “tentacles” than the ones depicted: Ghost writing can also hide vital information (The vioxx issue) or overreact to known phenomena (baycol).
    Such scandals are always “smelly” from the standpoint of a clinician. You can’t trust everything you read, but you can’t neither distrust everything you read. The problem is that every time it becomes more difficult to tell the difference between the “good and the evil” and a renowned author is not a guaranty anymore.
    The fact that residents, co-workers or other people involved in the research work sign a paper as the first author is just right if they are involved in the research process. I guess that most of us readers (and also writers) can understand that a “sacred cow” has his own specialty papers or specific field of interest and other people (co-workers) can explore a reasearch line related to that main stem and generate side branches.
    You can understand that there’s also an enormous reasearch infrastructure in universities and academic sites that fall under the leadership of someone that has to be the visible face, and so tha visible face has the possibility to be a part of multiple published works. But the things you can’t understand is that someone like that sacrifices his prestige “just money”.
    Pharma Industry invests a lot of money on research, they do it for a linig in every sense, but it has to understand too that unethical practices just diminish their credibility, taking them to the level of “dr. Simi’s” (in Mexico) credibility, ethics and practices.
    We want to see more serious strategies than “scoundrels” fighting for the playground.

  2. Xavier,

    Even when in the short term the ghostwritting technique may generate more buzz and positive traction for a given organization. In the long term it is detrimental for such organization because it will lead to a lost of credibility in any thing they publish or promote. There is enough negativity towards many companies in the pharma/biotech space, the result of some shady result published by them with the aim to get FDA and other regulatory bodies approval, even when they knew that such drugs had very nasty side-effects. What happened when people found that such companies had evidence of detrimental results for the target audience? They had to face massive recalls, fines and a large class action lawsuits, in addition the stock of such companies thanked. And also people became loyal customers of their competitors, which result in decrease market share, brand dillution and lower revenues.

    The take home message is do not do anything that can be perceived as murky or wrong. Always operate in an ethical way the market place will reward you, as far as the young scientist who are trying to leave a mark. Remember that the most important commodity that you will ever have is your reputation. If you do something wrong today even when you may gain some fame and glory. Sooner or later people will find your errors and mistakes and you will pay for it. As the old Chinese proverb indicates “The reputation of 1000 years can be lost in a few seconds”

    Cheers
    Rogelio

  3. I think you’ve made some useful distinctions, here, but I worry about the idea of case-by-case analysis. When a government minister gives his cousin an important government contract, the question is not whether the minister considered his cousin’s qualifications carefully. The point is that conflict of interest casts serious doubt on the entire process. I think the same goes in the case of ghostwriting.

    Regards,
    Chris.

  4. Mi estimado Xavier:
    Estoy de acuerdo con tu análisis sobre el tema, en realidad la producción literaria es importante tanto a los investigadores básicos o académicos como quienes hacen investigación dirigida. En el primer caso, el “único” producto que se tiene de la investigación puede ser un artículo publicado en una buena revista, en el caso de los que buscan un producto para vender, el “paper” tiene un gran valor comercial. Así pues, siempre hay un gran estímulo para publicar, Como bien mencionas, el investigador en ocasiones debe enfrentar el dilema entre investigar y dedicar el tiempo a escribir. Quienes por placer o por oficio publicamos ya sea nuestras investigaciones o simplemente nuestras ideas, sabemos lo demandante de tiempo y de recursos que es escribir. Todo este preámbulo vale sólo para enmarcar y destacar la importancia de publicar y su gran dificultad. En este orden de ideas viene como anillo al dedo el “gosthwriting”, hace que se junte el hambre con las ganas de comer. ¿Conflicto ético? Por supuesto en muchos casos, no tanto en otros, me explico: No es lo mismo firmar y validar un artículo producto de una investigación que no realicé o que si bien participé en el estudio no lo hice ni en el análisis ni en su reporte que ser “auxiliado” por uno o más colaboradores como sucede en la mayoría de los casos. ¿Es una práctica común? Yo creo que no, al menos no lo creo en términos del porcentaje de publicaciones en un periodo de tiempo dado ¿en términos absolutos, son muchos? No lo sé, pero el sentido común me dice que no.
    Como siempre, es un tema polémico más que por su justificación (en realidad la falta de ella), por los alcances que puede tener un sólo artículo publicado de esa forma, es decir, no necesitamos que sea frecuente ni que sean muchos para indignarnos cuando nos enteramos.
    Saludos,
    GHV

  5. jc mornod says:

    This is as unacceptable as unprofessional, especially since we are dealing with people health.
    If this should continue there would be no other ways as revoke PMA’s or impose any clinical to be executed by tghird party without any link whatsoever with the pham. companies .

  6. I cannot believe this will work!

  7. Jesús Guzmán Moya says:

    Xavier, me hiciste recordar varios escándalos dentro de las publicaciones médicas, entre ellos uno muy famoso hace más de 20 años donde el autor publicaba a diestra y siniestra sin tener tiempo ni para respirar.

    Difícil acabar las relaciones con la industria farmacéutica, por lo que lo más importante es saber “leer” un artículo médico y no seguir “modas”.

    Saludos, Chucho.

  8. Marcela Saeb Lima says:

    Very interesting topic, that needs special analysis in the way you have just done. And questions appear just as I read it.
    Who would be interested of giving the permission or “green light” to let a paper such as this to get published?
    Who would be the one writing this papers?
    Who might ask for someone to write papers like these?
    It is obvious that money and power again get into the scientific arena, and finds the right unethical people to perform such a disgusting and damaging job.
    This is just like a mob scenario where corruption finds its way.
    Really nice job you have done Xavier.

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