JAMA: Ghost Writing Declines, But Still Out to Discredit the New England Journal of Medicine (No Bias Here)

A recent article published by the New York Times questions the practice of ghostwriting based on a recent study only released by the editors of the Journal of the American Medical Association (JAMA).

Three JAMA editors, Annette Flanagin, Phil B. Fontanarosa and Catherine D. DeAngelis, joined Joseph S. Wislar in the study. The new study, which has not yet been peer-reviewed or published in a medical journal, was made public Thursday morning at an international meeting of journal editors in Vancouver.

According to the study, “six of the top medical journals published a significant number of articles in 2008 that were written by ghostwriters. Among authors of 630 articles who responded anonymously to an online questionnaire created for the study, 7.8 percent acknowledged contributions to their articles by people whose work should have qualified them to be named as authors on the papers but who were not listed.”

The article asserts that “ghostwriting usually refers to medical writers, often sponsored by a drug or medical device company, who make major research or writing contributions to articles published under the names of academic authors.”

The authors imply that anyone getting help on his paper is a criminal and that the medial authors in this country are engaging in wide spread deception.  

So what exactly is wrong with sponsoring a highly trained and experienced physician to make major research or writing contributions?

The Times and JAMA researchers seem to believe that “the work of industry-sponsored writers has the potential to introduce bias, affecting treatment decisions by doctors and, ultimately, patient care.” Just because something has the potential to introduce bias does not mean there will be bias, and with strict disclosure and reporting guidelines in every journal published, ghostwriting should not be blamed.

It is the responsibility of every journal and editor to monitor the articles they publish, and investigate the contributions both from writers and ghostwriters to determine if that potential does in fact affect treatment decisions. What journals and editors will find overwhelmingly is that any potential for bias is significantly outweighed by the benefits physicians bring to patients by making such contributions and carrying out important research.

The JAMA study reported that The New England Journal of Medicine reported a 10.9 percent rate of ghostwriting, the highest rate among the journals. The study also reported a ghostwriting rate of 7.9 percent in JAMA, 7.6 percent in The Lancet, 7.6 percent in PLoS Medicine, 4.9 percent in The Annals of Internal Medicine, and 2 percent in Nature Medicine. In 1996, a similar reported ghost authorship rates of 16.2 percent in The New England Journal of Medicine, 15.3 percent in The Annals of Internal Medicine, and 7.1 percent in JAMA.”

The new survey shows a significant decrease in the practice of Ghost Writing and that JAMA is still on the hunt to discredit the New England Journal of Medicine.

We find it interesting that JAMA would try to show NEJM as worse than JAMA, this is not an independent study with three JAMA editors as named authors.  Could this unpublished study have a potential for bias? According to one source the NEJM folks were livid by this and concerned by the definition and methodology of this unpublished report.

Another article focusing on the JAMA study was found in the ScienceNews, where they reported so called “frustration and anger” at the meeting from the 400 journal editors and clinical research scientists who listened to the JAMA presentation.   

Mr. Wislar, a survey research specialist (who’s claim to fame is studies on Club Drug Use among Adults) lead author of the 2008 study recommended that these journals “take more action to require that all contributors be listed in acknowledgments if they are not named as authors.” What Mr. Wislar does not seem to understand is that medical writing and editing is not simply “here read this and sign, and then publish process.” Medical writing and editing usually involves several drafts with a lot of changes between the writer and additional authors.   The main reason that medical writers are brought into working on papers is to ensure their readability and help to speed up the process.   In any field no one works in a vacuum and large clinical trials require massive amounts of collaboration from writers and statisticians.

For a physician to have their name published for a small contribution to a final product that may be significantly different from their initial contribution is problematic.

What is more troublesome is how this JAMA study improperly used a broad definition of ghostwriting, according to editors of the journal. As a result, The New York Times even came out with a correction the day after publishing its article stating that they had “misstated the role of drug companies in the reports examined. The Times further asserted that the JAMA “study in question did not look for or find evidence of drug industry involvement in the ghostwritten articles.”

While this story tried to explain the concern with ghostwriting is that authors “will describe research findings in ways that aid their benefactors, drug or biomedical device companies,” the JAMA article did not research this topic.

Interestingly, this article thought it surprising that although ghostwriting has existed for a long time, increasing efforts to eliminate the practice “seems to have changed little over the past decade.” What has changed over the past decade are more breakthroughs in medicine and technology, better treatments and devices for patients, and better outcomes and options for patients. Seemingly, what should surprise anyone is that journalists are still criticizing a practice that is almost commonplace in media as well (e.g. According to an undisclosed source).

The article also quoted Ginny Barbour, chief editor of PLoS Medicine saying that any author who goes unacknowledged “is presumably someone whose work was paid for by a company … and trying to hide that fact, she maintains, immediately “throws into substantial doubt the whole study.”

Ms. Barbour, along with Karen P. Buckley, spokeswoman for The New England Journal of Medicine, were both shocked at the high rate of ghostwriting reported by the authors of the JAMA study.

The idea that not publishing a name for paid work has a very similar analogy: how many staff members of the U.S. House of Representatives and the Senate will be paid for work they do on the Health Care bills? Whose names will we see published for that work, and how is that bill going to save lives as immediately as publishing opinions on research for new drugs and devices?

 

As we have stressed before, the practice of medical writing 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 medical writers.