A form of ghostwriting has been in the news lately, shining a less-than-flattering light on the practice. So-called medical ghostwriting--where pharmaceutical or medical device companies pay ghosts to independently write journal articles and papers, then seek out researchers, professors and other experts who are compensated for allowing themselves to be named the authors of these papers and articles--is being challenged as unethical. The New York Times recently reported that Senator Charles E. Grassley (R-Ohio), ranking Republican on the Senate Finance Committee wrote to the top 10 medical schools and asked what they were doing about their professors who put their names on these papers and comparing the practice to plagiarism.
Ghostwriting, however, is a longtime practice and most ghosting arrangements bear no likeness to the shenanigans that are currently under Congressional fire. There are two important distinctions that make such "medical ghostwriting" different than most traditional (and ethical) ghostwriting arrangements.
Intellectual Collaboration: First and foremost, any intellectual collaboration that went on--the crafting of ideas and making a case for a specific point of view--was not done between the named author and the ghostwriter. In my collaborations, I spend hours speaking with the author, making sure I understand his or her ideas, insights, experiences, and the information he or she wishes to convey through the work. And while the author may have a point of view that he or she wishes to use to influence a way of thinking, the difference is that it's obvious. The author's name is on the cover of the book or the by-line of the article. First, a commercial or special interest creates a body of work that will be published or presented in a medium that is supposed to be "objective" and then pays an expert to lend his or her name and credibility to the piece without any input from that expert. Invariably, that means the collaboration is biased in favor of the sponsoring organization and the persuasion does not come via the expert's own intellectual property, experiences and viewpoints. Since medical journals, papers, and reports often shape current medical thinking, this type of veiled promotional activity may have serious implications for the public at large.
Conflict of Interest. Whether it's true or not, it is often assumed that a writer's allegiance is to the entity writing his or her check. So, if a writer is crafting a paper to be presented at a medical conference and being paid by a pharmaceutical company, it's a safe bet that the paper will not contain negative information about the pharma co, even if it's valid. At the same time, the so-called "expert" is being compensated for lending his or her name to the piece. It's safe to assume that the organization footing the bill is not going to enthusiastically fund anyone who doesn't toe the company communications line. In traditional ghosting arrangements, the writer is paid by the named author. They're on the same team, working toward a common outcome in the work. And once a writer is compensated by the author for such a collaboration, that expert goes into the do-not-use file because of similar conflict-of-interest issues when the writer reports for other media. After having been compensated by a source, there is an inherent conflict of interest in using that source for objective reporting.
Alisa Bowman rightly pointed out to me that this is similar to advertorial creation, where a writer may very well work directly with the funder to craft the message and then someone else's name is put in the piece. The difference there is that those sections are clearly labeled "Advertisement," "Advertorial," or "Special Advertising Section" to distinguish them from objective editorial. That was not the case in these instances of medical ghostwriting.
When an author and ghost work together to create a piece of work based on the author's ideas and knowledge, the ghost is a facilitator, helping the author get the right words written. When the ghost collaborates with a special interest in secret and then uses the credibility of another to influence public health decisions without any kind of disclosure, a serious breach of ethics has occurred.
What are your thoughts on latest medical ghostwriting findings? Join the conversation in the comments section.