Medical journal examines ghostwriting

Canada's top medical journal, the Canadian Medical Association Journal, takes a look today at the risks involved with ghostwriting, following up on the case of McGill researcher Barbara Sherwin.

The Toronto Star last month revealed that Sherwin was listed as the sole author on a 2000 article on hormone replacement therapy, without revealing that she had been helped by ghostwriting firm DesignWrite. The firm had been hired by drug company Wyeth to promote its HRT products. She also worked with the company three years later, though she denies she used any of its contribution in the 2003 article.

In its article today, the CMAJ says the revelations were the tip of the iceberg.

Somewhere between 50% and 100% of articles on drugs that appear in journals are ghostwritten,” says Dr. David Healy, a psychiatrist at the University of Cardiff in Wales, United Kingdom, and a critic of the drug industry's influence on physicians’ drug prescribing habits.

Healy says that ghostwriting “crept up on” the medical profession and became so common by the mid-90s that even senior researchers came to accept it as an ethical practice. Other critics of the practice agree, claiming that many researchers will put their name on a document as primary author even if they just edited it — or only read it and made no changes.

“If you have people like me who say they can’t do this, the pharmaceutical industry can easily go elsewhere and find a person who will,” says Healy.

Ghostwriting has been able to spread, the article says, because all three groups involved -- drug companies, academics and medical journals -- benefit.

Transparency advocates say ghostwriting has become commonplace because it provides substantial benefits to three parties: drug companies, researchers and medical journals. By managing the publication of articles about their products, it is easier for drug companies to spread positive results and bury negative results. This often provides a big boost to drug sales. Having the name of a “key opinion leader” on a study is even better, ghostwriting critics say, because it gives the study an air of independence and respectability.

Many academics show little reluctance in lending their names to articles someone else wrote because it pads their resumes, which tends to help them bring in more money on the lecture circuit, says Arthur Schafer, director of the Centre for Professional and Applied Ethics at the University of Manitoba in Winnipeg.

“They sold their credentials for false credit and money,” says Schafer.

As for medical journals, they benefit by gaining access to papers on the latest clinical trials for new drug products. Some even accuse medical journals of pandering to the pharmaceutical industry, including turning a blind eye to ghostwriting, so they can publish clinical trial results.

 The article quotes critics calling for more transparency in who writes journal articles and details of their contributions, but does not say what CMAJ will do. As the CMAJ notes, ghostwriting will be a major topic at a meeting of journal editors next weekend in Vancouver.