Tuesday, November 30, 2010

Ghostwriting: From Journal Articles to Textbooks

Duff Wilson's piece in today's New York Times (disclaimer: I have a very small speaking part)--

--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.


Lori said...

I'm not one to take the issue of ghostwriting lightly, but I don't see where the doctors "hid" the involvement of the medical communications company. The NY Times article has an accompanying image that appears to be from the published book, which thanks SKB for giving a grant to STI to develop the book. They then thank a specific STI employee and STI in general for editorial assistance. It seems pretty clear to me that they *admitted* having received significant help with writing and editing. I could understand the brouhaha if this disclaimer were not in the book, but it doesn't look like they hid anything about where the money came from or who helped with the effort.

Michael S. Altus, PhD, ELS said...

Lori (November 30, 2010 10:09 AM),

Yes, the authors disclosed editorial assistance and the source of funding. However, this disclosure was far from sufficient.

The New York Times article noted, “But the drug maker, then known as SmithKline Beecham, actually had much more involvement than the book described, newly disclosed documents show. The grant paid for a writing company to develop the outline and text for the two named authors, the documents show, and then the writing company said it planned to show three drafts directly to the pharmaceutical company for comments and ‘sign-off’ and page proofs for ‘final approval’.”

That is, the drug company and the writing company had part of the responsibility for content, but were neither included as authors nor acknowledged for this responsibility. Hiding that sort of participation is unethical. Responsibility for content is at the essence of authorship.

For a primer on the ethical issues of ghostwriting, I suggest that you check AMWA Ethics FAQs (www.amwa.org/default.asp?id=466), which I wrote for the American Medical Writers Association.

Lori said...

Hi Michael, I wasn't really trying to comment on the ethics of any of this. I was simply expressing my surprise that people are surprised, if that makes sense.

Does Duff Wilson and the people he interviewed not know what that disclaimer means? A drug company gave money to a medical communication firm, and as a result, this book exists. Maybe I've worked at the interface of medicine and pharma too long because it's clear to me that this disclaimer means that STI wrote the book, and it surprises me that in 2010, so many people find this shocking. Even in the absence of the legal documents that have been unearthed, anyone following these issues could safely assume that STI wrote the book, with or without substantial input from the physicians.

I am in no way defending these physicians for their actions, and I have no way to judge how much or how little they did to contribute to the project. I simply think that the disclaimer should have been a tip-off to the company's involvement, and it's perhaps an oversight or a bit naive for people to act as if it's only through the litigation process that we now know who really wrote the book.

InformaticsMD said...


See my post "Has Ghostwriting Infected The "Experts" With Tainted Knowledge, Creating Vectors for Further Spread and Mutation of the Scientific Knowledge Base?",


I posted an explicit example of the ghostwriting 'assistant' vs. claimed author problem, with images.

........................... said...

I'm with the communications office at the American Psychiatric Association. Please not this correction from The New York Times:

Correct, December 8, 2010:

A headline on Nov. 30 with an article about SmithKline Beecham’s role in the publication of a book about treating psychiatric disorders overstated SmithKline’s actions. While documents show that SmithKline (now known as GlaxoSmithKline) hired a writing company for the book, they do not indicate that the company wrote the book for the authors, Dr. Charles B. Nemeroff and Dr. Alan F. Schatzberg. The article also described incorrectly, in some editions, events outlined in a letter from the writing company to Dr. Nemeroff. The correspondence proposed a timeline for the writing company to furnish the doctors and SmithKline with draft text and final page proofs for approval; the letter did not say that the company had already provided those materials for final approval. And the article misstated the context under which Dr. David A. Kessler, the former commissioner of the Food and Drug Administration, commented about the book’s production. The letter and other documents were described to him; he did not personally review the documents.