How could you be misquoted in your own autobiography? Well, it happened to basketball player-turned-broadcaster Charles Barkley who explained the matter simply, “It was my fault. I should have read it before it came out.” In all likelihood the problem was that Sir Charles employed a ghostwriter, nothing to be ashamed of since it puts him in decent company with the likes of Ronald Reagan (Robert Lindsey) and David Beckham (Tom Watt).
Athletes, politicians and celebrities are often short on time, not to mention writing ability, and while they may be reluctant to admit it, ghostwriters are indispensable to telling their stories.
But what’s commonplace in the publishing industry has permeated the medical profession. In what has become a widespread practice, ghostwriters are substituting for doctors by writing articles for medical journals about important research. In some cases, it has reached the level of outright deception.
The Senate Finance Committee has been investigating “medical ghostwriting,” as part of its examination of pharmaceutical company influence on the health-care industry. During the current probe Sen. Charles Grassley (R- IA) was given internal company documents showing that pharmaceutical giant Wyeth hired ghostwriters to write favorable medical journal articles about one of its widely marketed drugs.
According to the documents, Wyeth developed in-house concepts for medical articles and hired a company that employs medical authors, who are not doctors, to write the manuscripts. Wyeth then recruited prestigious physicians to put their names on the articles as authors. Once the articles were ready, they were submitted to medical journals as if the doctors had written them. None of this was disclosed to the journals’ editors or readers.
This is the second time this year that medical ghostwriting has become a prominent issue. Last spring, the Journal of the American Medical Association (JAMA) revealed that Merck had research studies prepared and written by non-physician ghostwriters before arranging to have academic physicians put their names on the articles as authors. Recruited authors were frequently listed as primary authors and paid for their participation. Some manuscripts about the pain medication Vioxx were prepared by unacknowledged ghostwriters and attributed to prestigious physicians who failed to disclose their payments from the company. (In an unrelated matter, Vioxx became the subject of lawsuits and was pulled from the market).
Merck has acknowledged that on occasion it hires outside medical writers to assist the doctors whose names eventually appear on the articles. It maintains the doctors do contribute research and analysis, and sign off on the final draft of all articles.
None of this means that published medical research is necessarily inaccurate or biased. Most articles are approved by independent peer review before publication. But it does raise questions for both the scientific and lay communities about the process of medical authorship and the integrity of everyone involved including physicians who market their names and reputations posing as authors for articles they simply have not written.
The problem is the result of the increasing complexity of medical research. Today, medical studies, whether they come from universities or private industry, involve teams of researchers including investigators, statisticians, and the writers. In the case of pharmaceutical companies, where there are large sums of money at stake in new drug development and approval, the actual credits for a final paper, if published, might resemble those of a major motion picture.
Unfortunately many physicians today have neither the time nor the training to write the type of prose necessary to publish these studies. The process of training doctors is in part to blame. Most medical students no longer take writing courses, as undergraduates or in medical school. Whereas once, medical journals were once filled with doctors’ entertaining, well-written accounts, journals today are filled with dense, turgid articles incomprehensible to outsiders (and not infrequently to those in the field).
Enter the medical ghostwriter. Most are professionally trained writers with a scientific background. Of course, as in any field, there are shills among them, but the majority are proud of their contribution to advancing the quality of medical research. Without them, many studies simply would not get published.
But full disclosure is the key to ending the current deception. The ghosts must be expunged and to do so, pharmaceutical companies and physicians must identify those people who actually write the words for them. In addition, as an editorial in JAMA noted, “(Medical) journal editors also bear some of the responsibility for enabling companies to manipulate publications.”
Conflicts of interest are a serious problem in the medical profession today but ghostwriting is not necessarily a bad thing - when acknowledged and openly identified. The professional approach to medical ghostwriting should be that of the Ghostbusters’ theme - “I ain’t afraid of no ghosts”. Even if it is a double negative no self-respecting ghostwriter would ever tolerate.
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