Many industries, including biography publishing and even rap, employ ghostwriters without significant concerns. However, the use of ghostwriters in medical writing has raised ethical concerns. The medical industry uses ghostwriters to edit, revise, and polish the writing of physicians and scientists whose writing may not adequate convey ideas clearly.
First, one must ask how pervasive the practice is in the pharmaceutical industry. In an August 5, 2009 article in the New York Times, Joseph Ross, MD said referring to ghostwriting: "It's almost like steroids and baseball. You don't know who was using and who wasn't; you don't know which articles are tainted and which aren't".
Does ghostwriting determine scientific integrity? The most vocal critics say that research findings can be skewed by contributions from writers who are employed by pharmaceutical companies and don't disclose these relationships. A September 18, 2009 NYT article explains that the editors of Blood determined that a pharma employee had contributed significant portions to an article published under the name of prominent researcher. The editors believe that the ghostwriter should have been listed an author, and not merely listed in the acknowledgments as was the case. In another case, Wyeth employed ghostwriters to down play the risk of hormonal therapy for menopausal women. Articles were published in 18 well-respected medical journals between 1998 and 2005. Later research uncovered the truth: the therapy caused an increased risk of breast cancer, heart disease, and stroke.
Who loses in these scenarios? Wyeth's revenue rose to almost $2 billion from sales of Premarin and Prempro. It is not clear if Wyeth's reputation suffered as a result. Women taking these medications were certainly losers. Experts also agree that medical research as a whole suffers. Jeffrey Francer of the Pharmaceutical Research and Manufacturers notes that ghostwriting transgressions and the resulting restrictions put in place by journal editors to identify ghostwriters could "chill research and chill support for research". So we all lose.
What solutions exist? Journal editors and legislators are pushing for requirements that require lead authors disclose all other contributors or risk being barred from writing for academic journals for an indefinite time period. Other journals no longer publish "opinion" or editorial articles from writers who have ties to pharmaceutical companies.
Ghostwriting in the pharmaceutical industry is pervasive and fulfills a necessary role. However, relationships to drug manufacturers should be disclosed and should not stop negative information about drug side effects from being published.
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Ghostwriting has been in the news for quite a while now. You've cited examples of it being detrimental to pharmaceutical research in general.
ReplyDeleteFrom the first time that I was introduced to the concept of ghostwriting (after reading the article on ghostwriting and Rofecoxib in JAMA), I was of the opinion, and still am of the very same opinion, that ghostwriting is unethical. Everybody who contributes to research: the investigators, the sponsors, the statisticians, the writers....everybody... should be mentioned in a research article. It would obviously be tedious and lengthy to do so, but it definitely beats having to fight cases in court because a pharmaceutical company hired ghostwriters to mellow down (or ignore) the ill-effects of a drug and that drug ends up being a disaster.