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Elisabeth Pain

The Ethical Conflicts of a Medical Writing Career

This week’s PLoS Medicine offers a rare personal account of the ethical conflicts that can come with a medical writing career. The account was provided by Linda Logdberg, who worked as a medical writer for medical communications companies for 11 years, performing writing jobs contracted by pharmaceutical, biomedical, and medical device companies. She left the medical writing industry in 2006 and is now a high school science teacher at Fernbank Science Center in Atlanta, Georgia. 
In ‘Being the Ghost in the Machine: A Medical Ghostwriter’s Personal View‘, Logdberg explains why and how she went into medical writing, the factors that kept her in the business, and the ethical concerns that finally forced her out.

Logdberg is a former scientific researcher who, over the course of her research career, grew increasingly disheartened about job prospects and other things. Ironically, she moved from research into medical writing as a result of an authorship dispute: a “colleague” expected postdocs to draft grant proposals that would be submitted in his name. She resigned and took a job as a medical writer. At first, Logdberg found her medical writing work interesting and valuable, and the flexible working schedule and good income were pluses.
But Logdberg became increasingly concerned about ghostwriting, “a small, but real, part of my duties,” she writes. Other common practices, such as doublespeak, became increasingly intolerable to her. “Clients admonished us to always distinguish between ‘adverse effects’ (for competitors’ products: Drug X could have caused the heart attack) and adverse events (our product: some patients taking Drug X just happened to have a heart attack),” Logdberg writes. She left after challenging the therapeutic value of a drug being supported by a manuscript she was revising. 
“Ethical concerns about medical ghostwriting have been directed primarily at ‘guest’ authors and the pharmaceutical companies that pay them,” Logdberg writes. But “One voice that is largely missing is that of the ghostwriters themselves who, after all, create the documents that are in the ethical and legal crosshairs. Without them, one could argue, there can be no fraud, because it is they who create the fraudulent product.”
Rather than banning the profession, Logdberg suggests taking medical writers outside of medical communications agencies and into academia — at arm’s length from industry and in close contact with the researchers. 
In addition to authorship issues, this approach would help solve another problem, Logdberg argues: “the underemployment of [those academics who go on to become] medical writers, who, possessing academic training and experience without opportunities to use them, are ‘all dressed up’ intellectually ‘with no place to go’,” Logdberg writes. “All too often, people like me find themselves unemployed or in science-related positions such as teaching that offer little hope of advancement in a job market that has not added new jobs in biomedicine in 20 years despite a doubling in the number of PhDs.”
must-read for anyone considering a career in medical writing. Also of interest is another perspective on ghostwriting and other industry unethical publication practices, in the same journal, which we have blogged about here.