Sunday, December 6, 2009

A Solicitation to Ghost/Guestwriting, and More on Commercial Contamination of the Medical Literature

There's a small flap going on over at Dr. Danny Carlat's Psychiatry Blog that is quite instructive for our purposes:

Dr. Carlat received from a colleague a letter from a medical communications company, BlueSpark. There are two ways to interpret the letter to the colleague. Dr. Carlat favors the interpretation that the letter is an invitation to put one's name as guest author on an article that will be ghostwritten by BlueSpark. He contacted BlueSpark who, not surprisingly, vigorously denied this interpretation. They pointed to stipulations in the letter that required a phone conference between the colleague and their staffer; approval by the colleague of a detailed outline before a draft is completed; and final editing of the draft. They also added that if the role of their own writer met the official criteria for authorship of the medical journal editors' organization, then the staff writer's name would appear as a co-author.

To which Dr. Carlat replied that of course, in this day and age, no one is going to write a letter and say flat out, "Wanna put your name, for pay, on an article that somebody else actually wrote?" He suggested that by reading between the lines, one could discern the clues that this was in fact an invitation to participate in a ghostwriting venture.

All of this is sort of fun and entertaining, but in my opinion it is not the heart of the matter. To fully understand what is going on here you have to know psychiatry the way an expert like Dr. Carlat does (and admittedly I certainly do not). You have to know that BlueSpark has a contract with Sanofi-Aventis and that they are makers of a "brand new" antidepressant, which is really nothing more than a once-a-day version of an old standby generic antidepressant, bupropion. You need to know that bupropion is indeed well regarded as a useful and effective antidepressant, but that the older generic forms are dirt cheap compared to the nearly incredible price tag of this new drug form (would you believe $5.58 a dose, compared to 28 cents for the generic?). For this extra price you get exactly one benefit--if you need to take the highest daily dose of bupropion, instead of having to take two pills once a day, you can now take one pill once a day.

So the really critical point is this (from Dr. Carlat): "[L]et’s face it. No psychiatrist is going to wake up in the morning and say, 'I think today is the day I’ll work on a review article on bupropion and depression and how awful it is that the tiny number of patients who require the maximum dose have to take two pills in the morning instead of one. Yes—this will be a significant contribution to the medical literature.' This would never happen, because there’s nothing new or interesting in this topic. We know that bupropion works well for depression, and we’ve known it even since it was approved by the FDA in 1985.
No, the only reason a psychiatrist would get motivated to write such an article is if a cold-call email solicitation from BlueSpark gets pas[t] the spam filter. I’m guessing that BlueSpark hopes that eventually they will find an uncreative, mid-level academic who is treading water professionally, and who will jump at the chance to pocket a little extra money while simultaneously padding the resume with a publication that will require essentially no work to produce. ...
Whether or not this meets the formal definition of ghost-writing, it is clearly a manipulation of the medical literature, a kind of plastic surgery of science. The articles may look impressive, and they may look real, but in fact they will be phony."

I actually made a somewhat similar point in an earlier post:
(On that occasion, the utterly artificial excuse for writing an article about an antidepressant was to celebrate its birthday! Even I, as a nonexpert in psychiatry, could figure out that was scientifically bogus.)


Michael Kirsch, M.D. said...

The spooky practice of Ghostwriting is widespread in medicine and beyond. It lies in the same bed as its cousin, plagiarism. It will go on, but will likely have a more sanitized name. More thoughts at

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