Ghostwriting the R.I.P.

This viewpoint piece was inspired by the recent PLoS Medicine Debate - What Should be Done to Tackle Ghostwriting in the Medical Literature?

Ghostwriting is not the disease, it is a symptom. If one were to ameliorate this specific indicator, the pathogen would rear its ugly head elsewhere in medical publishing. In other words, if one wants to limit the negative impact ghostwriting has on academia and industry, the underlying problem must be addressed.

And the practice of ghostwriting is almost as sinister as its label. It involves an individual (or corporation) contributing to a scientific paper without being credited. Now this may seem like the individual was shortchanged, but it is the reader who suffers in the end. Often, the purpose of this technique is to obfuscate where the controlling interest behind a body of work lies and to hide the ulterior motives.

The reason ghostwriting is so deleterious to the trustworthiness of medical science lies in the fact that it successfully circumvents established protocols intended to maintain a transparent lens between the reader and the author. These directives include requiring all authors to declare any conflicts of interest, and because these ghostwriters are not authors, their motives are not disclosed.

Because ghostwriting is a hidden practice, the true prevalence is difficult to report, and even if numbers were available they would most likely suffer from undercoverage. Although the link between pharmaceutical industry and medical academia may be difficult to ascertain, that between industry and government is a matter of numbers. According to the Center of Public Integrity, PhRMA (Pharmaceutical Research & Manufacturers of America) spent $22.7 million on lobbying in 2007 alone. And each individual pharmaceutical corporation spent millions more on their own as well.

In other words, the ghostwriting issue extends well beyond the academic definition of authorship or concerns over academic transparency. The problem is simply the rash on a measles sufferer or the runny nose of a person with the common cold -- a symptom of a much deeper and more important problem. It is for this reason that scientists must endeavor to extricate themselves from the ubiquitous reaches of industrial and pecuniary interests. When medical researchers recognize the problem and act with integrity on it, public trust in both academia and industry may one day be restored. However, if the underlying cause is ignored, the only activity left for legitimate medical research may very well be inscribing its own tombstone.

Nathan