Enter the Ghostbusters

While I have been out to lunch recently (actually, out of town for part of the time) and not blogging, the Pharma/medicine news has kept rolling in. Fortunately my fellow bloggers have been on the job. One big story is a paper written by some of the editorial staff of JAMA, as yet not peer reviewed or published in a journal, but presented at a conference, and covered by the New York Times:

http://www.nytimes.com/2009/09/11/business/11ghost.html?_r=2&ref=health
http://www.nytimes.com/2009/09/18/business/18ghost.html?adxnnl=1&adxnnlx=1253297183-lE6NkNPm04y/UvAkfSXwJg

The study, by Joseph Wislar and colleagues, asked authors listed for 630 articles in 6 top medical journals to respond to an anonymous on line questionnaire. The results suggested that 7.8 percent of these articles had been ghostwritten. The New England Journal actually topped out the other journals at 10.9 percent, leading its editors to throw the most skeptical barbs at their rival journal's study. However, most believe that the problem in any study such as this is underreporting rather than over-, hence suggesting that the true rate is probably even higher.

In response to my earlier question about whether journal editors are taking this seriously enough and doing all they can to police themselves, the second Times article highlighted a nice editorial in Blood. (That's not a Halloween publication but rather the official journal of the American Society of Hematology.) There, editors Cynthia E. Dunbar and Martin S. Tallman reported back in January that one reviewer became suspicious of an unsolicited review manuscript submitted by "a prominent clinical investigator." The academic acknowledged the assistance of another peron, without specifying what role that other person played. The reviewer happened to know that the other person worked for a pharmaceutical company, whose product was prominently featured in the review article. (The pharmaceutical connection was also not disclosed.) Following more investigation, the editors decided this was actually a ghostwritten article and rejected it. The editors added, "Once we began to systematically seek clarification of the degree to which a pharmaceutical company had been involved in any aspect of writing, editing, or researching review articles, within 2 weeks we had rejected 2 additional unsolicited manuscripts. "

This bit of anecdotal testimony perhaps helps answer the question--just how common is ghostwriting--and tends to confirm previous reports that it is all too common. The poohbahs for the drug industry interviewed by the Times naturally insisted that the industry was doing all it could to implement new guidelines (expected in October) to bring industry practices in line with the international medical journal editors' proposed rules. To which the obvious reply is--why so late? Given that these rules were promulgated years ago, and the ghostwriting issue has also received publicity for many years, why is the industry only now taking action? For that they expect a pat on the back? (The industry also objected strenuously to proposals that any academic author caught signing a ghostwritten article be banned from further publishing in that journal for some period--it would "chill" research, they feared.)

The Blood editors also very kindly summarized for us an incident I wrote about in HOOKED which reminds us as to why all this is important:

"If our appeal to better instincts is insufficient, read the New York Times account of the Annals of Internal Medicine paper on a Vioxx clinical trial that failed to include the deaths of several patients. The paper's first author admitted that "Merck designed the trial, paid for the trial, ran the trial ... Merck came to me after the study was completed and said, ‘We want your help to work on the paper.’ The initial paper was written at Merck and then it was sent to me for editing." Documents made public in court indicated that Merck's marketing department initiated and managed this trial solely as a mechanism for exposing a wide swath of primary care physicians to the drug, instead of pursuing real research questions." [citations omitted]

Dunbar CE, Tallman MS. "Ghostbusting" at Blood. Blood 113:502-3, 2009.