Thursday, August 4, 2011

Even More on Ghostwriting, Or, They Don't Get It in Toronto

Two big questions this time around--first, can academic medicine police itself regarding ghostwriting, or do we need to invoke the law? Second, does the Toronto Globe and Mail get it, or rather, who got to them?

First, on how to police ghostwriting, we start with an article by our old friends Jonathan Leo and Jeffrey Lacasse, this time aided by Andrea Cimino (subscription required). This group tells us that there has been a lot of huffing and puffing among academics and editors as to why ghostwriting really is not that at all, or if it is, well, it's still okay. So the authors try to simplify for us by saying--this is ghostwriting, and if it happens, then it's wrong and you should be throwing the book at somebody. They argue that the essence is: "If a person who should have been listed as an author was left off the byline, then the paper has been ghostwritten."

This would be a nice, concise formula if it were acceptable. I am fearful that it's not. As to why, stay tuned. But anyway, Leo et al. are optimistic that if we academics could just get clear on what ghostwriting really is, we could manage to police it properly. Now along come Simon Stern and Trudo Lemmens from Toronto:
--to say, no way. They review the various conflicts of interest that both journals and academic medical centers have with the drug industry, making it unlikely that either would find the backbone really to put an end to ghostwriting-related practices. They suggest that the only thing left is legal remedies, and they then develop specific legal arguments as to why ghostwriting is fraud, and drug companies conspiring with medical writers and academic "guest authors" is racketeering under the law. (Along the way, they dig up an interesting case from 1944, said to be the only U.S. Supreme Court decision on ghostwriting--it involves a patent on glass manufacturing, of all things.)

Okay, so there you have the debate on the first question. On to the second question. It is pretty unusual for the local newspaper to come out with an editorial that says that a paper just published by two members of the local university faculty, in an academic journal, is all wet. But that's just what the Toronto Globe and Mail did with the Stern-Lemmens paper:

Now, this editorial is such a serious misrepresentation of all the ethical issues in ghostwriting that you have to wonder what prompted it. The point of the editorial is that ghostwriting is good because academic physicians can't write worth beans (mostly true), so if professional writers take over and render one's article readable, then they are doing a great service, and how can you call this fraud and racketeering, etc. They admit grudgingly along the way that "guest authorship" is of course wrong, and if you did not truly contribute to the research or the writing, your name doesn't belong on the paper. But they act as if the ghostwriter is the innocent victim in such a case. They totally fail to address the basic problem, that ghostwriting and guest authorship, together, are part of a larger system by which the drug industry can manufacture "science" to its marketing specifications. They say they are opposed to this, and make this incredibly naive comment: "If, on the other hand, pharmaceutical companies are paying, in whole or in part, for the research, and they supply the ghostwriters, there is a need for particularly vigilant reading of the draft by the researchers, so that no advertising spin creeps in." This of course ignores the reason that the entire process exists, and that the money needed to hire the ghostwriter fell out of the sky to begin with--that "advertising spin" is not an accidental byproduct but the entire intent.

So where did such a wrongheaded and ignorant editorial come from? I can only relate back to our earlier post:
We saw that the medical communications companies that supply the ghostwriters for industry, and that helpfully coordinate the care and feeding of the guest authors, are tired of being sneered at and are launching their own PR blitz (which is, after all, what they are supposed to be good at), trying to take back the ethical high ground. All I can imagine is that some of these dudes captured the ear of a gullible editor at the Globe and Mail and managed to plant their own advertising spin into the editorial. Which tells you a little something about the ethical integrity of that industry.

Back to my comments on Leo et al, in case you're not asleep yet. Why do I doubt that they got it right on their crisp definition of ghostwriting? Here's a case we talk about in an "Ethics of Scientific Research" course we teach here. Prof A goes to do a sabbatical in Prof B's lab. He does an experiment there, using Prof B's lab equipment and support team. Later he goes back home and then works with Prof B to write up the results of his experiment. When he gets the final draft of the paper for his review, he's shocked to see Prof C's name on it, who works at a distant university and had nothing to do with the experiment. Prof B explains that he and Prof C have a deal. They worked together in the past and they simply agreed always to list the other as co-authors of any future papers. When Prof A objects, quite correctly, that this is an unethical violation of the rules of authorship, Prof B retorts that if Prof A will not honor his deal with Prof C, then the B lab will simply take A's name off the paper and publish the results themselves.

Okay, imagine that B carries out his threat. C is a guest author, which is unethical. A, who should ethically have been listed as an author, is not so listed on the paper. Does this make the paper a ghostwritten paper? There is no ghost writer. The people who wrote the paper, B and his colleagues (except for C who's being included unethically), did in fact do the experiment along with A, and legitimately are part of the scientific team responsible for the data. Plus, the case has nothing whatever to do with commercial spin. Yet by the Leo et al. definition, this is an example of ghostwriting. So I think their definition needs more work.

Leo J, Lacasse JR, Cimino AN. Why does academic medicine allow ghostwriting? A prescription for reform. Society (epub July 21, 2011)


jon leo said...

Dr. Brody, Your comments on this are much appreciated. I would like to add one thing to the discussion. I hope this is the type of conversation that is happening with journal editors. Stern and Trudo’s article is interesting however I am a little reluctant about their suggestion because I think that it would be nice if academics could work out this problem on their own - I have my doubts though. The fact that such a basic concept of who is an author should be left to the judicial system is a huge indictment of the entire medical literature. Lots of people have looked the other way for way too long. One of the driving forces behind our article was all the excuses being put forth by academics that articles should not be considered ghostwritten even though they had unnamed authors who made substantial contributions to a paper. One of the more common defenses is that the named authors signed off on it. But as a reader shouldn't I be told that there was also a pharm company employee involved? And mentioning someone who did ninety percent of the work as an editorial assistant, which often happens, is also not a solution. We also know that our proposal is a baby step forward and doesn't solve all the problems with financial conflicts. But the fact that it still has objections from much of the academic community speaks volumes. Our proposal might seem simple to call an author an author might seem simple, but it is unclear to us why it should be complicated. For the most part it is what goes on in the rest of academia. I am not sure that it needs to be complicated just for academic medicine. To come up with a solution that allows unnamed authors on papers and then say they are not ghostwritten seems to be a contradiction.

Trudo Lemmens said...

Very good intuition. Perhaps the following explains why the Globe even bothered to spend an editorial in defense of ghostwriting: ghostwritten supplements about medicine bring in money . This link came up when I searched "Globe and Mail and Ghostwriting"

D Bunker said...

"The point of the editorial is that ghostwriting is good because academic physicians can't write worth beans (mostly true)"

Then What are the Illiterate Louts doing cranking out academic blather on Any heading if they've missed the English Language along the way to their wrongly tenured sinecure at the public trough?

The idea of treating the problem as "Fraud on the Court" & civil RICO violations I heartily applaud, HOWEVER:

The authors of the PloS treatise missed the Post Master General.

Since Fraud is being perpetrated upon the consumer, Medicare, Medicaid, Private Insurers, & Social Security, the Courts, the General Public (in the cases of violence caused by psychiatric drugs), ..... and demands for Payment are being tendered through the US Mail & online Billing services,

Both physical & electronic mail fraud is being committed, and those are 20 year trips to the no-key hotel.

Trudo Lemmens said...

And the Globe & Mail may even be a client of ghostwriting company Type A: see the at