Tuesday, February 9, 2010

Ghostwriting: Academic Medical Centers Need to Step Up

In HOOKED I referred to ghostwriting of medical journal articles as "a particularly egregious ethical violation" but said little about what should be done about it. Our friends Jeffrey Lacasse and Jonathan Leo have made up the deficiency nicely:

Lacasse and Leo began by searching the on-line policies (and contacting staff at the medical school if policies were unavailable on line) for the 50 highest ranking medical schools in the US according to US News and World Report. They were able to identify policies explicitly banning ghostwriting, or else authorship policies that effectively banned ghostwriting without naming it, at only 13 of these schools. They then argued that even some of the schools that had policies seem to lack critical elements of an enforcement mechanism. They conclude their paper with their own suggested academic policy to prohibit ghostwriting and to bring real consequences upon the heads of academics who allow their names to be attached to ghostwritten articles.

A number of solid observations in this piece:
  • L&L note that academics in non-medical fields are (appropriately) shocked and outraged when they come to learn the degree to which ghostwriting has been implicitly tolerated in medicine. They list in their endnotes specific documentation of cases where ghostwriting has been proven and yet no action was taken against the putative academic authors.
  • L&L as a policy matter call for a period of amnesty--they would allow academics who have participated in ghostwriting to come forward, identify the offending articles for potential later journal retraction, and essentially apologize and promise never to do it again, without penalty. I recommended something similar on a more general basis in HOOKED. Basically we need to recognize that a generation of academic physicians have grown up in an era when certain practices were widely accepted as the norm, that today we are belatedly coming to criticize and condemn. While we can take strong issue with those of our colleagues who try to defend the old practices as ethically acceptable, we must have some mercy on well-meaning colleagues who simply went along with the crowd and now are willing to acknowledge their previous errors.
  • L&L reinforce the basic point that I also alluded to in HOOKED, that unless bad behavior has real consequences for the individual directly involved, we can expect it to continue, at least so long as it pays. I am still at a loss to provide any list of names of academic physicians who have been found allowing their names to be attached to ghostwritten articles, and who have suffered any ill effects to their careers as a result.

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