Ghostwriting: From Journal Articles to Textbooks

Duff Wilson's piece in today's New York Times (disclaimer: I have a very small speaking part)--
http://www.nytimes.com/2010/11/30/business/30drug.html

--deftly tells the story of a 269-page textbook aimed at family physicians, written by two leading lights in psychiatry, and published by the American Psychiatric Association's press in 1999: Recognition and Treatment of Psychiatric Disorders: A Psychopharmacology Handbook for Primary Care. The listed authors were the dynamic duo well known to readers of this blog for accusations of unprofessional ties to Pharma--Dr. Charles Nemeroff, formerly chair of psychiatry at Emory and then taken in by University of Miami when Emory finally got fed up with him; and Dr. Alan Schatzberg, chair at Stanford (see for instance http://brodyhooked.blogspot.com/2010/06/dr-thomas-insel-and-rehabilitation-of.html and http://brodyhooked.blogspot.com/2009/06/will-psychiatrys-dsm-v-be-huge-growth.html).

According to Drs. Nemeroff and Schatzberg, they had an unrestricted educational grant from SmithKline Beecham (as it was then called; now GlaxoSmithKline unless they did another merger last week that I have not yet heard of). They wrote the whole book themselves and never gave the drug company any sign-off on the contents.

The documents unearthed by Wilson, as a result of ongoing legal action against the company forcing the release of internal memos, tell quite a different story. They show the drug company's money going to Scientific Therapeutics Information, a medical communications firm, to develop a detailed outline of the content and then to prepare drafts. The drafts were to be submitted back to the drug company for approval prior to publication. In short, it appears that the bulk of the book was ghostwritten, if not all of it.

While we've devoted a lot of space here to the ghostwriting of medical journal articles, Wilson quotes former FDA commissioner Dr. David Kessler: “To ghostwrite an entire textbook is a new level of chutzpah. ...I’ve never heard of that before. It takes your breath away.” A bioethicist with California State University-Northridge, Leemon B. McHenry, who consults for the law firm suing GlaxoSmithKline, told Wilson that while these documents have been released, many other equally damning documents remain sealed by the court: “This is only the tip of the iceberg.”

If there's a difference of opinion between what the (purported) authors of the textbook say and what the court documents show, who should we believe? Here I would return to some comments by the Welsh psychiatrist, Dr. David Healy, that I quoted in HOOKED. Dr. Healy was disturbed by ghostwriting, but he was equally disturbed by the emergence of an elite overclass of academic scientists who when confronted, expressed surprise that there were still peons who actually wrote their own papers to submit to journals. These dudes, according to Healy, flitted about the world from conference to conference, from one company consulting gig to another, flying first class, and simply never had time to write a paper on their own even if they wished to (and any longer had anything original to say). Now, I challenge anyone to look today at what it takes, timewise, to be a chair of a major university clinical department. (Most academics would say that when you accept the post of department chair, you can pretty much kiss your life as a serious research investigator goodbye, though you can still be active in getting grants and so on as a member of the team.) Next, look at the CV of a fellow like Dr. Nemeroff and count all the papers he is supposed to have published during the years when he was presumably that busy--as well as traveling about the world as described above. Then you be the judge of whether it was humanly possible for him to have written all that stuff on his lonesome.

Retraction: Nemeroff and Ghostwriting

In a previous blog post:
http://brodyhooked.blogspot.com/2009/11/u-miami-send-us-your-professionally.html
--I did too little factchecking and accordingly made an incorrect assertion regarding Dr. Charles Nemeroff and ghostwriting.

The facts on which I was relying, and which do not support what I said at first, can be found in two posts on Danny Carlat's psychiatry blog:
http://carlatpsychiatry.blogspot.com/2007/09/author-calls-his-own-cns-spectrums.html
http://carlatpsychiatry.blogspot.com/2007/09/devane-mounts-defense-of-cns-spectrums.html

Here's a recap. Dr. Nemeroff approached two of his academic psychiatry colleagues to participate in a discussion at a psychiatry meeting in Hawaii, to be videotaped by Bristol Myers Squibb, regarding the company's antidepressant patch, EMSAM. An article based on a transcript of that video was then published in the journal CNS Spectrums.

Critics noted apparent errors in that article, leading one of Dr. Nemeroff's co-participants (and listed co-authors of the article), Dr. C. Lindsay DeVane, to protest to Dr. Carlat that the article as a "piece of commercial crap" that did not accurately reflect his views. Dr. DeVane implied to Dr. Carlat that the first draft of the article had been written by a ghostwriter hired by the drug company, and contained numerous inaccuracies; Dr. DeVane denied having seen the final draft before publication. The former editor of CNS Spectrums, James M. La Rossa, Jr., then wrote a comment to Dr. Carlot's post, complaining about current company-sponsored practices in the publishing world, and adding, "I am willing to bet dollars to doughnuts that Nemeroff never saw proofs of the article either."

Dr. Carlat said in his later post that somebody must have gotten to Dr. DeVane, as he later retracted his comments and claimed that the CNS Spectrumsarticle was accurate, not ghostwritten, and that all three co-authors were "heavily involved in multiple edits." There were, as Dr. Carlat said, several reasons to regard Dr. DeVane's later retraction as disingenuous, especially because as he noted the first time out, his published research had stressed the lack of drug-drug interactions as a problem with antidepressants, whereas the CNS Spectrumsarticle seemed especially to claim that EMSAM was a superior product because it avoided drug-drug interactions.

Bottom line: others alleged (though one later retracted) that Dr. Nemeroff was involved with a ghostwritten article, but Dr. Nemeroff himself never admitted to this, in the specific instance that I was referring to.

I stand by my initial observation however in that anyone who claims to have written 450 articles, who keeps up the sort of travel and speaking schedule that Dr. Nemeroff apparently does, and who is well known to be extremely cozy with numerous pharmaceutical companies, has to be under suspicion of at least some of those articles being ghostwritten for him. Which is part of the reason why ghostwriting as a practice is such a basic threat to the integrity of medical science.