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Ghostwriting

As much as I defend the industry I work in, I have to talk about things that we do that I don’t think are so defensible. Another one of those has come up thanks to the New York Times and PLoS Medicine, who obtained a pile of records from a current court case.
This article has the details. Wyeth seems to have contracted with a medical writing outfit (DesignWrite) to produce and place a number of review articles covering hormone therapy for menopausal women. (Wyeth, of course, was the main player in that market). The articles seem to have been entirely written by the staff at DesignWrite – authors are listed as “TBD”, and then academics were recruited to serve as lead authors and to submit the papers to journals.
No mention was ever made in the published papers of the medical writing group’s role, nor of Wyeth’s (who were paying them for this service). As far as the readers could see, these were the standard sorts of review articles that show up in the medical literature all the time. And that’s the part that bothers me. For all I know, these articles were reasonable reviews of the field – I’m no great expert in the field, so I can’t judge if they’re truly fair summaries. But even if they are, the readership of a journal is entitled to know that a drug company was the impetus behind them, and they’re also most certainly entitled to know the actual authors (as opposed to the people who would appear to have been the authors, but just signed off on the stuff).
I think that drug companies are entitled to promote their products. But full disclosure should be the the standard to try to reach in any market: put it all out on the table, and let physicians make their own decisions. It doesn’t help, not one bit, to get papers into the journals this way – because when a company goes to such lengths to hide its participation, it almost looks as if it has something to hide. . .

25 comments on “Ghostwriting”

  1. Anonymous says:

    Gives us all a bad name an makes it harder for real scientists in industry to publish their work. Not all of it is so blatent, but just as insidious… Marking groups defining/approving a publication plan & “messaging”. Legal groups holding back papers to avoid disclosing “the” compound -while at the same time including a kg scaleup in the patent the year before. Clinical groups wanting to put their high enrollers as speakers/authors who have less intellectual input than the intern who washes glassware…
    One more example of marketing destroying the industry.
    Suggestions as to how to fix it?

  2. Elizabeth B. says:

    As a science writer, I have been approached several times by pharmaceutical companies and other similar groups to do writing like this. I have, each time, refused, because I think it’s unethical. I’ve also worked as a research scientist. If I’m going to author a paper, I’m going to author a paper. I wouldn’t want my name on something I hadn’t worked on and believed in, and on the other side the people reading it should know who is to blame/credit/whatever.

  3. Hap says:

    1) If you have good drugs that help people, why do you need to sell them as if they were used cars? It seems counterproductive, particularly when the most pernicious memes all involve your lack of ability to produce useful drugs and your desire to squeeze money from the drugs anyway.
    2) I assume that the marketing people (and their bosses) don’t understand that trust and integrity aren’t infinite resources, that they are very quickly exhausted, and that they are very hard to regain once lost. Once people can’t trust you, it’s much easier to demonize you, because you’ve traded in much of your (good) humanity for cash, and what’s left is the humanity we’d prefer not to acknowledge. Do they think their lack of integrity will help them to sell drugs, or do they not think they’ll be in the business for long and so don’t care about conscience or consequences?

  4. Hap says:

    You also have to wonder what the “authors” were thinking. If you knew you didn’t write it, and that you were being used to endorse advertising copy, what would make you think that putting your name on the article was a good idea? Did they really need that extra entry on their CVs that badly to give up their integrity for it? Or did were they trying to subtly advertise the availability of their souls for sale? (I would have recommended the back sections of the local free paper, if the latter were the case.)

  5. Liza says:

    Is it still considered ghostwriting if an undergraduate student does most of the literature review (Pubmed searches) and writes the first draft with little guidance but is not listed as an author?
    Perhaps this is part of why the small jump to being paid for someone else’s employee’s work is not too large for some academics to take?

  6. Curt Fischer says:

    Perusing through the 80 pages of documents that the NYT and PLoSMedicine have posted, I found that at least in an initial draft of the “Bachmann” article, Tong Shongguan, Steve Parker, and Nicole Cooper – at least some of whom were ghostwriters – were called out in Acknowledgements and thanked for their “editorial assistance”.
    Later on, the sole author on the byline of the review (Gloria Bachmann), says in email correspondence with Tong Shangguan that she has “reviewed the entire article” and that it is the “best article [she] has come across on this topic”.
    At first, I was pretty scandalized by seeing all this stuff. Obviously, the failure to disclose Wyeth’s involvement in this operation is a big problem. But assume for the sake of argument that the academic author of the article did not precisely know that Wyeth was invovled. (It is not very likely that this was the case, but just assume…)
    Given that assumption, let’s focus on the eventual “author’s” ethical behavior. How different is her level of input into the article relative to the PIs of some big academic labs, who have their students or post-docs write review articles? I can say from experience that all PIs I have ever worked with had no problem listing the key contributors to invited review articles as authors. But I doubt that practice is universal in all corners of academia.
    But is it really qualitatively different than the behavior of a big-shot academic PI who takes *exclusive* credit for a review article that was prepared jointly by him and a few of his underlings? Or, does the ethical lapse here rise to the level of plagiarism?
    I can’t really resolve the right ethical category for this incident. A lot depends also on the issue I have neglected – how much the “author” knew about the financial involvement of Wyeth. But that issue aside, what’s the right ethical analogy here? What do other people think?

  7. Anonymous says:

    You write it, your a co-author, simple.
    List the ghost writers as authors and acknowledge the funding source.
    How hard is that?

  8. Hap says:

    I assumed the lead author knew of Wyeth’s involvement/funding and the ghostwriting. If that’s incorrect, then I’m sorry. If she didn’t know of Wyeth’s financial involvement, I would figure that her sins were less egregious than that of the PI who claims exclusive credit for a review authored by his/her group – the PI would have his position as leverage to make sure that the actual authorship is revealed (or if so, the revelation would be far most costly to the hidden author than to him/her) – he’s stealing and intimidating, while the author of the work in question would be claiming credit (that she hadn’t earned) without even stealing it. Her home institution might be unhappy (that their reputation might be besmirched by their faculty’s behavior), but she’s taking credit (and likely blame) for the article, so the repossession isn’t free of cost, and is given without intimidation.
    If the author didn’t know of Wyeth’s funding, the reprobation should more rest on Wyeth for coming up with this convoluted and dishonest scenario than with the PI, though she deserves discredit for putting her name on an article she didn’t write or fund. If she knew of Wyeth’s funding, the blame should be more evenly distributed.

  9. Curt Fischer says:

    @Hap in #8:
    Good analysis of the situation, Hap. The point about the leverage a PI has over his underlings was especially good. I agree with your characterization of the PI “stealing” and the author of the work in question as taking what was given.
    But academic integrity supposedly involves more than respect for intellectual property rights.
    Did we have plagiarism here? Is plagiarism happening under either or both of our scenarios? (One being the hypothetical PI-underling-academia scenario and the other being the really-happened-Wyeth-ghostwriter scenario.) I have a hard time seeing how one scenario could be labeled plagiarism and the other being excluded.
    As a quick check on what other people think, I’ve checked out the Faculty-Student Honor Code of the University of Medicine and Dentistry of New Jersey, where Bachmann is affiliated. It says:
    The principles of truthfulness, fairness, respect for others, trust, and responsibility and a personal commitment to maintaining these high standards and values constitute the fundamental ideal we all must strive to attain. Accordingly, SHRP faculty and students have the following responsibilities: To be truthful in all academic and professional matters, and to always honestly represent their work and that of others […]
    EXAMPLES OF VIOLATIONS OF ACADEMIC INTEGRITY AND OF STANDARDS OF BEHAVIOR
    CHEATING occurs when an individual misrepresents his/her mastery of the subject matter or assists another to do the same. Instances of cheating include, but are not limited to:
    1. Copying another’s work and submitting it as one’s own on an examination, paper or other assignment […]

    So it looks like Bachmann’s own employer is saying that her behavior is academically dishonest. But it can be easy to read any meaning you want into codes like this. What actually professional norms are is another question.

  10. Hap says:

    I don’t think it’s plagiarism because the rights to the work were essentially willingly transferred – the ghostwriters are paid for their lack of credit essentially. The PI in this case would be dishonest in the lack of acknowledgement of the source of “her” words. (I assume plagiarism to be where someone’s work is unwilling copied without attribution.)
    The charge of cheating is closer to accurate – because one is getting someone else’s work without noting their contribution, and receiving professional credit for it (and the transfer can happen with their complicity). The only problem there is I figured that cheating required a much more stringent arena of behavior, but maybe that’s not right.
    However you slice it, the PI has plenty to answer for, and Wyeth still more yet. Dishonesty is still wrong, whatever classification it’s under.
    (Adventures in Ethics and Science would probably be a good place to find analysis, when Dr. Free-Ride analyzes it. There hasn’t been a post in a week or so.)

  11. trrll says:

    I assume plagiarism to be where someone’s work is unwilling copied without attribution.

    Plagiarism refers solely to misrepresenting somebody else’s work as your own. It has nothing at all to do with the rights to the material, or whether the original author is willing. If the rights were transferred, it may be legal, but it is still plagiarism

  12. Lu says:

    >11. trrll
    >If the rights were transferred, it may be legal
    Authorship is not transferable, it’s inalienable. Whoever did the work is an author and this may not be changed.
    Copyright, however, as a right to distribute etc, can be transferred.

  13. Anonymous says:

    Gives us all a bad name an makes it harder for real scientists in industry to publish their work.
    Absolutely! Whenever marketing people have tried to pull one of these schemes with my data (and shopping a ghostwritten paper to some “Key Opinion Leader” is routine, despite how shocked, shocked! everyone is whenever the occasional company gets busted) I always explain to them that a) I write my own papers, b) I get first or last authorship on them and c) I have a more impressive CV (in quality, if not in quantity) than whatever bottom-feeding KOL they’re trying to suck up to.

  14. Eskimo says:

    One thing that puzzles me about this practice:
    the bigshot whose name would be valued by pharmaceutical companies is precisely the person whose CV shouldn’t need padding with articles he or she didn’t write.

  15. pharmagossip says:

    For the KOLs it’s easy money for no work.
    For the Pharma cos it’s a way of getting their messages (and ad claims) into the literature.
    Pimps and prostitutes!

  16. Addi Faerber says:

    I’m less and less surprised by these stories. Physicians (it’s never laboratory scientists is it?) are trained to delegate every possible aspect of their research.The study coordinator goes thro the IRB. The study nurses see the patients. The data manager compiles the cases. The statistician takes the results and perform the stats. Why shouldn’t these docs also delegate the writing? There is incentive for docs to delegate and incentive for niche workers to find new areas to specialize.

  17. BenHemmens says:

    OK: full disclosure: I’m a self-employed science writer and translator.
    I would stay clear of a ghostwriting job like this if I possibly could. I’d make an impossibly expensive offer, I’d be all booked out for weeks and I’d do without an income for a month or two. And I can’t, am simply constitutionally unable to, write anything without forming my own damn opinion about the state of the field, and my clients get warned in writing if I think they are saying something questionable. That, at least in the odd little central European country where I operate, is part of the duty of translators, who after all are, legally, a consulting profession.
    On the other hand, you don’t know what actual use a client is going to make of your texts. You can hit them with all kinds of clauses in your terms and conditions, forbidding them to use it for any other than the purpose explicitly recorded at time of ordering, but actually controlling what they do with it? No chance. OK: if you find yourself writing a review article you have a decent idea what’s going down. But if the guy says – I’m paying you to put my slant on the stuff in words, and it goes like this – you record your objections and you write/translate like he wants. That’s crap, but no professional writer or translator can avoid doing some crappy hack work.
    The real bad guys in this scenario are not so much the contracted writers, but the integrity-free academic **um who put their name to something they haven’t written or properly supervised the writing of. Because every last one of them has more income security than the people doing the writing, who likely earn their dough one job at a time. What a writer could be facing when turning down something like this is that of the two smallish outposts of Big Pharma in Smalltown, your guy is going to say: you’re toast as far as we’re concerned, and we’ll tell our pals down the road, too. What the academic could be facing is a slightly less good performance review at the end of next year.
    I’d refuse a job like this every time. And fortunately I’ve never yet come up against anyone making unethical requests. But there’s a lot more at stake for me, materially, than for anyone – even a fixed-term employee – at any university.
    Which all boils down to: we have to take a long, hard look at how academic science careers are organized, and whether the kind of selective pressures people are subjected to on their way to that tenure-track position encourage uncompromising integrity over double standards, or the other way around. In many different countries. I’d have to say, I don’t think the last 20 years – which is how long I’ve been involved – have been particularly great in that respect.

  18. Jonadab says:

    That’s highly unethical.
    I have enough of a problem with ghostwriting where fiction is concerned. Indeed, it bothers me when a famous novelist who can’t come up with any new material puts his name on along *with* the actual author’s (previously unknown) name, for the sole purpose of helping the book sell better (and taking a cut of the profits in exchange). I don’t mind *actual* collaborative works, you understand (Niven, for instance, has been involved with a significant amount of real collaborative writing), but I don’t feel it’s right to put somebody’s name on the thing who hasn’t had a significant role in writing it. It’s dishonest. The readership is being deceived into believing that they’re going to be reading work by a certain author, when in fact this is not the case at all. That’s wrong.
    If we’re talking about non-fiction (let alone scientific papers), that raises altogether more serious ethical issues.

  19. Ben Hemmens says:

    Jonadab: I don’t care who wrote it, also long as it’s clear that the person who is listed as the (main, senior) author takes full responsibility for the content.
    A prof. delegates the writing to a postdoc. – no problem. An industry guy hires an outside writer- also fine. But the buck stops with the guy doing the ordering. If the story turns out to be guff, it’s him (or her) who should feel it the most.

  20. S Silverstein says:

    Has Ghostwriting infected the “experts” With tainted knowledge, creating a vector for further spread and mutation of the scientific knowledge base?
    Regarding Bachmann’s paper – er, make that Casper the friendly ghost’s paper from DesignRight, the Wyeth-hired medical writing company – “The Importance of Treating Vasomotor Symptoms”, here is another dilemma posed by ghostwriting:
    How many of the cited references in Bachmann’s article were themselves ghostwritten and potentially biased, or otherwise influenced by drug companies? ow many such articles are out there?
    Bachmann’s own “expert opinions” about these specific medical matters may be based upon false or misleading information she’s read in other journals over the years, the percentage of which are genuine vs. ghostwritten or industry-influenced being an unknown.
    While I believe Bachmann is most likely rationalizing away the unethical nature of attribution (without fair and justifying contribution), perhaps fueled by additional motives of academic portfolio building and perhaps pecuniary gain, it is possible she is being genuine about agreeing with the “science” in the paper.
    However, her agreement may be predicated upon her own tainted expertise — tainted by reading ghostwritten or industry-influenced articles in her area of specialty.
    Will we ever be able to peel back all the layers of the ghostwriting onion to get to the core of impartial and objective scientific articles related to drugs and medical devices? Perhaps not, but the practice must stop going forward.
    Tainted literature creates tainted scientific knowledge, the carriers of which may then further taint the knowledge base (with the best of intentions and with firm belief in the fairness and accuracy of their activities, of course).
    Such are the systemic risks of ghostwriting.

  21. BenHemmens says:

    @S Silverstein:
    even non-ghostwritten, honest-to-god peer-reviewed, govt. funded research is full of chinese whispers (no offence to the chinese intended – does anyone know a non-racial alternative?).
    whole fields and sub-fields keep themselves alive by means of their participants citing and reviewing each other.
    science is full of pompous old farts just making things up as far back as galileo – i strongly recommend koestler’s “the sleepwalkers” for an eye-opener on that undeservedly revered gentleman…
    for an optimistic take on the mess, just read popper.

  22. Anon says:

    BenHemmens wrote:
    “Jonadab: I don’t care who wrote it, also long as it’s clear that the person who is listed as the (main, senior) author takes full responsibility for the content.”
    By that logic, should rich academics be allowed to buy papers that give them a publication track record and better chance at tenure than poor ones, as long as they “take responsibility for content” (which entails little risk since the ones who are held liable are usually the doctors who end up killing people by following the faulty science of the academics)?
    Just askin’.

  23. BenHemmens says:

    “should rich academics be allowed to buy papers that…”
    a quick aside to begin with: some academics are so rich that they found their own private research institute and win a nobel prize. see peter mitchell. or simply build the best intruments of their age and collect data no-one else has (tycho de brahe). or hire more minions, erm, postdocs (a prof. near you).
    i think you’re a) mixing up original research, where it is actually required to report exactly where the physical work was done, insofar as it was not done in the labs of the named authors, with review articles (here we were talking about review articles). i don’t see any problem with farming out the spadework of literature searching, or of writing the article, as long as it’s properly supervised. i don’t see any problem with having some experimental work done in a lab of “big pharma”, as long as it’s correctly declared.
    and b) you left out the word “full” before responsibility. what i mean by full responsibility is that the person appearing as senior author has to stand over the reporting of the facts and interpretations in the review article with their reputation and in cases of deliberate misrepresentation of the state of the field, their job, and, in case of damage to third parties resulting therefrom, with their personal fortune.
    I hope that’s enough for you.

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