This past week we have received several journal editorials around the “evils of ghost writing”.
On the writers defense it does not take much intellectual work to make something framed and titled “ghost” sound sinister. We all grew up with visions of Ghosts waking us up at night from our dreams only to run into or parent’s rooms screaming. This was re-enforced by attending endless horror movies which in from 1960 – 1980’s were released at a pace of once a week.
In one recent article in the Mens Sana Monographs titled “Of Sophists and Spin-Doctors: Industry-Sponsored Ghostwriting and the Crisis of Academic Medicine,” makes the claim that “Ghostwriting for medical journals has become a major, but largely invisible, factor contributing to the problem of credibility in academic medicine.”
The author, Leemon McHenry, uses a one sided approach to only “explain the harm done to academic medicine and to patients,” instead of considering the benefits. Most likely, McHenry has chosen to criticize ghostwriting practices because he has been a research consultant to the law firm of Baum, Hedlund, Aristei & Goldman, Los Angeles, California, since 2003. The firm specializes in “Drug Product Injuries” and has a list on its website. The article reads more like a trial lawyer’s newsletter on how to prosecute companies who use ghostwriters.
McHenry also acknowledged funding support from the Prescription Project and the Pew Charitable Trusts.
Ghostwriting
His article starts off by asserting that “pharmaceutical companies commonly employ ghostwriters to write or draft manuscripts that subsequently appear in peer-reviewed medical journals under the name of one or more academic researchers.” He goes on to claim that such ghostwriters create articles that “obscure the contributions of industry,” which as a result, “undermines scientific integrity and jeopardizes public health.”
It remains hard to see how providing valuable input on research, development, and clinical data at various stages, to expedite the timely publication of data “jeopardizes public health.” We find giant leaps of logic common in these types of commentaries.
McHenry goes on to discuss how early in the process of drug development, a pharmaceutical company will develop a “publication strategy” to identify target journals and "key messages" tied to the promotion of the drug. Such a practice is no different than any other business venture: if no one is going to buy or use a product, then why make it? In fact, television shows for decades have been screened by audiences to determine whether people will watch. Yet no one complains about the violence, inappropriate behavior, or the constant branding of products seen on television.
The author claims that the publication strategy is a problem because “manuscripts are developed with a focus on marketing goals and with little or no consultation from the eventual authors.” McHenry goes on to claim that such manuscripts that appear in “medical journal articles, letters to the editor and abstracts for professional conferences are designed to give the sales force tools to drive prescriptions."
Such a claim however, forgets that these prescriptions are the very same medicine and treatments that have reduced the death rate of cancer for decades, helped millions with heart disease, and made HIV a livable condition. Perhaps it is easier for the author to talk about prescriptions, since the company that pays him, often sues the doctors and drug company’s who make the medicine being prescribed.
Further evidence of McHenry’s bias towards plaintiff’s attorneys is the fact that although he believes ghostwritten articles are objective, “they conceal pervasive conflicts of interest.” In contrast, numerous articles we have published discuss at lengths the practices of journals, academic medical centers, and drug companies who all have strict guidelines for transparency and disclosure.
The article tries to account for the prevalence of ghostwriting by associating it with “legislation which allows drug and medical device manufacturers to claim that their business practices are protected from revealing secrets to competitors.” While the "Trade Secrets Act" certainly helps protect companies who take significant risks and make tremendous investments, any secrets McHenry is talking about are no different from the information and data protected by a patent, trademark or copyright.
Although the article goes on to claim that “financial relationships compromise the credibility of the medical literature,” evidence of such bias is problematic. While the disclosure of financial interests has had a few recent mix-ups, the use of ghostwriting to help develop content produced by pharmaceutical companies does not compromise the integrity of the data or research. Does a law clerk who helps write an opinion or a staffer who helps write a bill compromise the integrity of our democracy? All are working for the common goal of helping more people.
In the end, ghostwritten papers do not undermine the integrity of science or the trust placed on individual clinicians and researchers because these professionals are aware of the contributions and work they receive.
Since McHenry acknowledges that “it is less than clear how many journal editors are seriously concerned about the ghostwritten papers they publish,” his position should call for more discussion, instead of criticism.