Inside the Belly of the Medical Communications Beast

Here is another paper I should have been all over earlier this year--again apologies for my tardiness.

Sergio Sismondo is a philosopher and science-and-technology-studies (STS) guy at Queen's University, Canada. The paper here reviewed is primarily a report of his experience in attending the annual meeting (apparently in 2007) of the International Society of Medical Planning Professionals, one of two large organizations representing medical communications firms. These are the firms that sell their services to pharmceutical and other companies as being able efficiently to "manage" the publication and placement of scientific research papers for maximal marketing impact. When scientific publications are ghostwritten, these guys are the "ghost managers" as Sismondo puts it.

The report is hard to condense, so a few impressions and snapshots. It seemed clear from all the proceedings that ghostwriting was a no-no. Among the folks who do this sort of work, there appeared to be a level of genuine desire to believe that they were upholding the integrity of the scientific process (and there were regular references to the "marketers" with whom they had to work, implying how hard it was to deal with those neanderthals who only cared about money and sales and did not understand science and its requirements). Some speakers attempted to shift all blame to the academic physicians who leant their names to articles they did not write. The reasoning seemed to be--if these dudes were not so lazy (and in some cases, frankly dishonest), then they'd respond on time to our requests that they give us input early in the course of writing the article; then they could legitimately claim authorship and then there need not be any suggestion of ghostwriting; but as it is they force us into a position where the final article ends up ghostwritten. Other speakers responded, however, that the firms create these problems themselves, by not sending a draft to an "author" to review until it has been refined and perfected to get the company's preferred message out, and then with such a tight turn-around deadline that substantive input is impossible.

Perhaps most intriguing were several presentations at the meeting given by medical journal editors. The message they managed to convey was: 1) we are shocked, shocked that you people would ever turn to underhanded things such as ghostwiting; and 2) we really want you to send us your papers to publish, and oh, by the way, look at the impact factor numbers showing that my journal is the best one in which to place your articles. Sismondo captures very well the inherent financial conflicts of interest facing these editors, who benefit in so many ways from publishing randomized clinical trials favorable to the large drug companies, who will then rush to place a lot of ads in that journal and will buy 10s or 100s of thousands of dollars' worth of reprints for their sales reps to distribute. (Editors further will admit candidly that with all the dreck they have to read that is spewed forth by academic physicians who have no writing skills whatsoever, it's often a great relief to turn to an article written by a commercial medical writer who actually knows how to put sentences together.)

Sismondo summarizes the current state of affairs as an STS scholar: "In the ghost management of medical research by pharmaceutical companies, we have a novel model of science. This is corporate science, done by many hidden workers, performed for marketing purposes, and drawing its authority from traditional academic science. The high commercial stakes mean that all the parties connected with this new science can find reasons or be induced to participate, support, and steadily normalize it."

Sismondo adds that there was much talk at the meeting of ethics, but it's not the sort of ethics I learned about in philosophy grad school, but rather a corporate-compliance model of ethics: just tell us what the rules are and then leave us alone to get about our business. The possibility that "ethics" means that this business should not be conducted at all was not, apparently, an acceptable answer.

Sismondo S. Ghosts in the machine: publication planning in the medical sciences. Social Studies of Science 39:171-198, 2009.