Recent attention to the practice of ghost writing was covered in the LA Times concerning Drugmaker GlaxoSmithKline. Ghost writing was focused on in the article because “Baum Hedlund PC law firm of
The firm “alleges that GlaxoSmithKline downplayed several risks connected with its drug, including increased suicidal behavior and birth defects,” by using ghostwriters.
Articles from the company's program appeared in five journals between 2000 and 2002, including the American Journal of Psychiatry and the Journal of the
According to court documents obtained by The Associated Press, GlaxoSmithKline “used a sophisticated ghostwriting program to promote its antidepressant Paxil, allowing doctors to take credit for medical journal articles mainly written by company consultants.” Apparently, included in the memo were instructions for GlaxoSmithKline salespeople “to approach physicians and offer to help them write and publish articles about their positive experiences prescribing the drug.” What is wrong about that? As a patient and consumer, wouldn’t you want to know about the positive experience doctors had in prescribing a drug from the company that made it?
A spokeswoman for London-based Glaxo said “the published articles noted any assistance to the main authors,” and the ghost writing program known as CASPPER, “was not heavily used and was discontinued a number of years ago."
Critics such as Dr. Leemon McHenry, who works for Baum Hedlund, tried attacking Glaxo’s practice of ghostwriting based on its name, “CASPPER,” also a familiar cartoon ghost. While he also asserted that Glaxo's program was “unusually intertwined with its internal sales and marketing department,” the LA Times failed to show any evidence of where and when these ‘tangles’ took place.
Although McHenry noted that it would be “illegal to include information that is misleading and causes harm,” he cited no evidence of those practices by Glaxo. Instead he only asserted, separate from his own childish attacks, “that ghostwriting is legal in principal.”
The New York Times also focused on a similar story that claimed that “the nation’s top medical schools have been attaching their names and lending their reputations to scientific papers that were drafted by ghostwriters working for drug companies.” As a patient and consumer, who else would you want to write these articles, journalists and Ph.D.’s who have no medical expertise or training?
The practice of ghostwriting is not only legal, but it is necessary and essential in producing timely information to the public about drugs and devices. Without such a practice, patients, doctors, and science itself would be at a standstill because the timing of such articles would be severely altered without ghostwriting. Moreover, the Times believes that these articles, were “carefully calibrated to help the manufacturers sell more products,” rather than serving the interests of public good to educate patients and consumers.
There is no evidence of how ghostwriting has helped any manufacturer sell more products, and even if a manufacturer sold more products, that does not suggest something wrong, unethical, or illegal. It means that the public and consumers read those articles and made educated decisions, knowing from the disclosures made in those articles that ghostwriters were used, and that ghostwriting is a common practice.
In fact, increased sales would suggest that more people trust such articles, and the value of ghostwriting supersedes any present concerns about conflict, at least until evidence shows the drugs and devices being written about are ‘unsafe’ or the comments being written are ‘misleading.’
In a letter last week to the National Institutes of Health, Senator Grassley (R-IA) put pressure on NIH to crack down on the practice of ghostwriting, which he defined as “a practice in which drug and device companies hire medical communications and education companies to draft journal articles and then have “independent” academics sign onto them as the lead author.” Contrary to Senator Grassley’s wishes, universities and other institutions “that employ researchers are responsible for setting and enforcing their own ethics policies.”
Other critics of ghostwriting feel that any academics that are complicit in a certain drug or device should be punished in cases that arise along with manufacturers and industry. Such allegations however are uncalled for, especially when “the full scope of the ghostwriting problem is still unclear.” In fact, while some suggest that the practice is widespread and that “dozens of medical education companies across the country draft scientific papers for drug makers,” they forget two important facts: it is legal to do so, and it results in benefits for patients.
Although some cases of ghostwriting, such as Wyeth, who did not disclose that articles were drafted by “outside writers paid to advance the drug company’s views,” one bad example should not be an end all to the practice. Reform or any regulation of medical writing should focus on making certain that 1) articles disclose that outside writers were used and 2) protections for those writers. Accusations about impropriety or misleading statements in such ghostwritten publications needs to be crystal clear before politicians try to ban not only speech and press, but valuable information to patients.
Ultimately, until recently ghostwriting was a standard industry practice and has been around for 40 years. Furthermore, the process of ghostwriting must be better understood before it is attacked. Ghostwriting is not simply “here read this and sign, and then publish process.” Ghostwriting usually involves several drafts with a lot of changes between the writer and the sponsors or additional authors.
As long as any article ghostwritten specifically states at the beginning of the article who wrote it and who endorses the content, there should be no issue, the public, doctors, and patients can decide what is best for them. Preventing this type of information and publication is limiting access to valuable information to patients, in a time when media commercials and bias confuse patients constantly.