I’ve met a ghost. Not the kind who haunt old Victorian mansions, moaning, pacing hallways, slamming doors, but a family man with an ordinary day job.
He works as medical writer, and in the last seven
years, he has authored an impressive set of articles found in top scientific
journals. You won’t recognize his name, because he is unacknowledged for his
contributions.
He is known as a “ghostwriter,” a figure despised by
medical journal editors who wish to see him “exorcised” from the literature.
Because they leave few traces, little is known about
ghostwriters. Luckily, I had the
privilege of interviewing one who agreed to speak freely about ghostwriting on
condition of anonymity. For All Hallows’ Eve, we present you with an Interview
with a Ghost.
1.
Q: Can you briefly describe what you do as a
medical ghostwriter?
2.
A: I work as part of a publishing team
consisting of: 1) the supporting pharmaceutical company, 2) the true authors of
the study, 3) reference support staff, and 4) graphic support staff, if I’m
lucky. In a perfect world, this team would work together to produce a readable,
accurate account of the study in question, its results, and a critical review
of how those results may (or may not) change the standard of care. In reality,
authors are required to publish their findings, and the pharmaceutical company
is paying for the study, so they are looking to me to produce a manuscript that will
help make the company’s drug the new top dog.
3.
Q: What led you to medical writing?
4.
A: When I was a graduate student, I had no idea
there was anything else for a PhD in biochemistry and molecular biology to do
other than an industry lab, a government lab, or staying in academia. My first
position, a publications manager for a medical communications company, just
sort of fell in my lap.
5.
Q: What do medical writers charge for their
work?
6.
A: Experienced medical writers will typically
charge between $100 and $150/hr or about $3,000 to $4,000 per assignment.
7.
Q: In cases where you are not listed as an
author, are you listed as a contributor in the acknowledgments section of a
journal?
8.
A: Some clients feel it is in their best
interest to present me as an author, but the pharmaceutical company will often
shut them down, since I am not a thought-leader in that field. Sometimes I am
added to the acknowledgments; most often I am not mentioned at all, which
technically makes me a ghost.
9.
Q: In what journals have
articles that you’ve ghostwritten appeared?
10.
A: My work appears in
almost every medical field, from the New England Journal of Medicine, to the
Journal of Clinical Oncology, Oncology, PLoS Medicine, American Journal of
Psychiatry, Cardiology, and supplements to most of these journals as well. I
have also authored a number of online continuing medical education (CME)
sessions, various symposia presented at medical conferences, as well as
posters, abstracts, and those pamphlets you see at your doctor’s office
discussing treatment for a disease or how to self-medicate.
11.
Q: Are there any tell-tale signs of a
ghostwritten article? Can you detect it in other papers?
12.
A: Ghostwriting is easy to detect if you know the primary
author, or witnessed that individual present at a conference. When someone
isn’t clear, or jumps around a lot, or can’t speak the language, yet has a
publication in the NEJM, you can bet there was a ghost involved. Very
prolific clinical researchers – especially those actively seeing patients and
running their own clinics – are also likely to be working with ghosts.
13.
Q: Studies of the prevalence of ghost and
honorary authorship in medical journals [1], and Cochrane reviews [2] report
that about one in 10 articles include ghost authors. Both of these studies were
based on author self-reports. How accurate do you think these estimates are?
14.
A: I think that figure is a little low. You have
to remember that authorship is key to success and survival for most
researchers.
15.
Q: Litigation against
Merck regarding Vioxx revealed that academics
were routinely recruited and paid to put their names on articles they had
little (if any) involvement in producing, for the explicit purpose of creating
credibility for the study [3]. [FrancisFordCoppola. HarveyWeinstein.
StevenSoderbergh.] Is this a
common practice?
16.
A: In my experience, the pharmaceutical company
would pay a communications/marketing company to write the manuscript, who would
then go out and find academics who would be willing to become the “authors” of
the manuscript and paid an honorarium. I’ve worked with some authors who do
absolutely nothing on the manuscript, requiring an additional ghostwriter to be
hired, and still demand an honorarium for their time. These academics are
willing to enter into this relationship because of the importance of authorship
to their careers. You can’t entirely blame the pharma company. Universities encourage
academics to play this game.
17.
Q: Do you believe that you add value to medical
publishing, or are you merely a hired hand for work that others refuse to do or
do badly?
18.
A: Short answer is “yes.” I believe I provide a
service to those who need assistance presenting their findings to the
scientific community. If you have a great study but present it badly you won’t be seeing
it anytime soon in NEJM. Until we do away with
authorship requirements for promotion and tenure all together, we will continue
to need the skills of individuals, like myself, if these studies are to be
published at all.
19.
Q: Have you attempted to influence an editor to accept a
manuscript?
20.
A: I personally have not. Besides being morally
wrong in my view, it is extremely difficult to get in touch with journal
editors, which makes the submission process such a joy. Yes, that was sarcasm.
21.
Q: Have there been cases where your sponsor
wanted you to make conclusions that were not supported by the data? How did you
deal with these instances?
22.
A: Yes, I have. Every manuscript includes some marketing
spin and controlling how much spin is the trick. Sometimes
the abstract — often written by someone else — comes to a different conclusion
than the main manuscript or relies on different data. The easiest way to deal
with the issue [of unsupported conclusions] is to use the data.
23.
Q: Are you a member of a professional society
for science writers? Does that society have any guidelines for ghostwriting?
24.
A: I have been a member of the American Medical
Writers Association from time to time. They do have a series of guidelines
and a code of ethics and they do suggest that medical communicators be
recognized for their contributions.
25.
Q: How do you claim credit for articles that you
have ghostwritten for which you are not acknowledged? What does your CV or
resume look like?
26.
A: My CV consists of the various positions I’ve
held through the years, and I do have a portfolio of projects that I have
worked on. Most of my new business comes from former clients. If you stop
hearing from a company that you have a long working relationship with, it may
be due to some issue they had with your last project.
27.
Q: Do you trust the medical literature? Or, now
that you have a view on how the system really works, does it give you pause
when you read the literature?
28.
A: Every manuscript uses some marketing gimmick or spin in order
to enhance the weight of the data. I remember when I was a graduate
student, we were taught to look at our data with a critical eye. When a figure
from a scientific lab has extra bands or markings that are not even mentioned
in the text, it throws the whole manuscript in question for me. I can’t stop
questioning the literature, especially in the higher tier journals, where there
is a lot of “I’ll wash your back if you wash mine,” mentality. Don’t get me
wrong, I love science, I just know how the game is played, and it leaves a bad
taste in my mouth.
29.
Q: Some have proposed
that we need to rid the medical literature of ghostwriters; others argue that
we merely need to make their identity and contributions known [4]. What is your
opinion?
30.
A: Either journals
should establish agreed-upon rules for what defines an “author” or do away with
authorship altogether. I believe that everyone who worked on the paper should
be mentioned in the Contributors section.
31.
Q: Can you see your reflection in a mirror?
32.
A: Well, since I’m nocturnal, there is never
enough light for me to see anything in a mirror. I can walk through walls,
though.
33.
Q: What do you think of garlic?
34.
A: I love it.
Remember, I’m not a vampire.
35.
Q: What are you dressing up for Halloween?
36.
A: A medical researcher. Or the fifth dentist
(4 out of 5 dentists agree . . . ).
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