“The British Medical Journal, which printed the team’s conclusions, also published its own investigation, showing that Roche had hired ghost writers to author some of the articles involving Tamiflu, and that those writers had said they were under pressure to highlight positive messages about the drug. Roche responded that hiring such writers was common industry practice at the time of the articles, and it rejected the idea that they had been pressured to write positively about the drug.”

On and on it goes; and if it weren’t for tenacious people like Peter Doshi, academic ghostwriting would be even more pernicious than it is.

This blog has long covered the scandal of ghosted professors. It will continue to do so.

Spinal Tap

The University of Wisconsin has endured the taptaptap of bad news about one of its faculty for years, and for years it has closed its ears to it.

It’s our old friend Thomas Zdeblick, object of a federal investigation into his remarkably lucrative relationship with Medtronic.

Investigators … found that two papers Zdeblick co-authored were among 11 in which Medtronic employees, including those in the company’s marketing department, were secretly involved in drafting and editing, a practice known as ghostwriting.

Both papers were published in the Journal of Spinal Disorders & Techniques where Zdeblick has served as editor-in-chief since 2002. That role was the subject of a 2009 Journal Sentinel/MedPage Today investigation that found the journal frequently published favorable articles about Medtronic products under Zdeblick’s watch. The story noted that Zdeblick’s financial relationship with Medtronic was not disclosed by the journal.

Many more gory details here. The picture the investigation draws is one of rampant conflict of interest destructive of patient health and research integrity. An Emory professor to whom Medtronic gave $25.5 million protests that the money had absolutely no effect on the articles he wrote about its products.

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The Zdeblick scandal jumps to Reuters. Perhaps now, with the release of the Senate’s definitive report, this story will get the attention it deserves. The University of Wisconsin will no more respond to it than Donna Shalala’s University of Miami will face up to what it has in Charles Nemeroff. It will take international coverage of practices at schools like Wisconsin for the conflict of interest that corrupts academic medicine in the United States to change.

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Two of the featured Medtronic beneficiaries are at the University of Louisville.

More Toasted, More Ghosted.

Remember this handy phrase when allegations of ghostwriting swirl around high-profile medical school professors, politicians, and pundits. As a rule, the more prominent and celebrated and busy you are, the more likely some of your writing’s being done by other people.

That’s the allegation here, against Fareed Zakaria, who is already dealing with having plagiarized another writer.

THE GHOSTS OF GLAXO

It’s eerie. Walk the corridors of your medical school and behind the doors marked Keller, Feinberg, Strober, Wagner, flit The Ghosts of Glaxo, professors who, in life, treated disease, and now, in death, ghost.

They ghost for Glaxo, a power so great it just paid the United States government penalties of three billion dollars.

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Glaxo’s ghost-hunters know the haunts; they know which universities are ghost towns where wraiths who put their names on research they don’t conduct and articles they don’t write loom.

In the gloom Glaxo’s Gorgyrae of the underground coax the ghosts out with the sorts of treats ghosts like and the ghosts emerge in a shimmer, scripting their signature with glamorous flicks of the air upon the pages of alchemical antidepressant articles.

These hidden precincts within the American medical school are our university royalty, and what Bagehot said so long ago about the British royalty applies word for word here:

Above all things our royalty is to be reverenced, and if you begin to poke about it you cannot reverence it… Its mystery is its life. We must not let in daylight upon magic

Some are calling for universities to discipline their ghosts. Let them be! We are their (experimental) subjects, and our reverence for their mystery must remain.

“The University of Pennsylvania has concluded that the chairman of its psychiatry department and a colleague let their names be listed among the authors reviewing a medicine in a journal article that was actually written by …

… the drug’s manufacturer.”

Yikes!

“No punitive action” will be taken.

Whew!

Wouldn’t want to disrupt the ghostwriting-for-pharma flow.

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UPDATE: A reader notes: “The poster boy for conflict of interest in psychiatry, Charles Nemeroff, was first author on the article in question.”

Nemeroff! Always Nemeroff! Your name from hence immortal life shall have.

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Why no punitive action? Because at the time Dwight L. Evans and Laszlo Gyulai put their name on a paper on which they did no work, there were no written rules at U Penn saying you shouldn’t put your name on a paper on which you did no work. A bioethics professor comments: “[S]tudents in grade school are taught the basic ethics of plagiarism.”

Remember: These are the sophisticated experts in whose hands you are placing your mental health.

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Droll comment thread at CHE:

This reminds me of the Seinfeld episode in which George was being fired by his boss for having sex with the cleaning lady on his desk. George’s paraphrased response: “Was that wrong? I gotta tell you, if I knew that wasn’t allowed here, I never would have done it.”

‘As Ginsberg says, “faculty members who plagiarize must do so at their own expense.”’

Charming post by UD‘s buddy Carl Elliott on the burgeoning culture of ghosting (which has a tendency to shade into plagiarism) in the American university bureaucracy.

The trend is getting pretty embarrassing. On more than one occasion, UD has felt that various officials of her own university would lend more dignity to important events if they read their speeches beforehand, so that we didn’t have to watch them struggle through new words and phrases.

But there’s something Carl overlooks in his review of ghosted speeches and columns by university administrators and faculty, and that’s credit. If Carl had agreed (he’s notoriously burdened by conscience) “to lend my name to an article which the public relations office would ghostwrite, but which would be published under my byline,” he’d have been able to list this publication, and many others (he was asked to underwrite a series) in his annual report to the dean, on his cv, etc. Med school professors do this all the time – they take credit for research articles written by other people in and around their labs. Which is why high-profile faculty members of this sort will list, I don’t know, 7,000 publications on their cvs. An entire industry of ghosted books, ghosted articles, and ghosted speeches written by pharma-paid copywriters, public relations people, and grad students, churns away for these people.

One growth area in an otherwise…

… dreadful legal market will surely involve suing university researchers who allow their names to be used on articles ghostwritten by pharma. When people are harmed by the drugs falsely represented in these articles, and when the government pays for the falsely represented drugs, there should be legal recourse. More and more scholars are elaborating on what those forms of recourse could be.

We might well see, for instance, law professors at a university teaching their students how to sue medical school professors at the same university. The law professors would explain that while it’s immoral to allow other people to do your research and your writing for you, and then to take credit for it, it’s illegal to be involved in forms of misrepresentation that harm people. It’s called fraud.

Short and sweet.

But don’t institutions expect their faculty … members to publish ethically and in the best interest of patients?

Apparently not.

“I don’t wish to go any farther …

with it.”

The legal system may have other ideas.

Ghost Counter Ghost

A reader writes, in response to Jonathan Leo’s essay about ghostwriting (go here for a link to the original essay):

Oh dear. That article is not very well researched, is it? They mention the European Medical Writers Association (EMWA) as sanctioning the practice of thanking writers for “editorial assistance”. I take it they haven’t actually read EMWA’s guidelines on the subject, since they have totally misrepresented EMWA’s position, and also fail to cite EMWA’s guidelines in their references list.

Here’s what the EMWA guidelines actually say about “editorial assistance”:

“Vague acknowledgements of the medical writer’s role, such as ‘providing editorial assistance’ should be avoided as they are open to a wide variety of interpretations.”

Anyone who wants to read EMWA’s guidelines can find them here:

http://www.emwa.org/Mum/EMWAguidelines.pdf

Leo et al also use a rather idiosyncratic definition of ghostwriting. Most people would consider a ghostwriter to be someone who is not acknowledged, not someone whose role is transparently declared. Whether medical writers should be listed as authors is a legitimate matter for debate, but the debate is not helped by writing such an emotive and badly researched article.

(Conflict of interest declaration: I was one of the authors of EMWA’s guidelines)

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Jonathan Leo responds:

Scientific Papers with Unnamed Authors = Ghostwriting

We are happy that Adam has responded to our article as it gives us a chance to clarify a couple of issues, and to highlight one of the major points in our essay. Namely, that some groups in academic medicine are trying to find ways to allow the presence of unnamed authors to be involved with scientific papers – a practice which most people would call “ghostwriting.”

In his posting Adam says that we misrepresented the EMWA stance on the appropriateness of thanking editorial assistants and he cites the EMWA guidelines. However, when we mentioned the idea that the EMWA condones the practice of mentioning editorial assistants as a way around ghostwriting we did not have the 2005 EMWA guidelines in mind, but instead had Adam’s 2007 editorial in mind where he does sanction this practice. We should have been clearer in our essay about this. We did assume that when he wrote his editorial that he was speaking in behalf of the EMWA. If he was not, then we apologize.

Adam’s 2007 Editorial

The story behind his editorial starts back in 2006 when Charles Nemeroff and his colleagues published a paper in the journal Neuropsychopharmacology. Their review article concluded that a useful treatment for depression was a vagus nerve stimulator manufactured by Cybertronics. The journal Science discussed charges that the article in question was ghostwritten because one of the main authors of the paper, Sally Laden, was not mentioned in the byline. Laden was also paid by Cybertronics. Adam’s subsequent editorial was very critical of the Science article and took the same dismissive tone with Science that he has taken with our paper. He has also taken this dismissive tone in the comments section of the BMJ and PLoS Medicine. In his editorial he never argued about the facts behind the Vagus nerve paper, Laden’s role, or who her employer was. The major point of his editorial was that the paper should not be labeled as ghostwritten because Sally Laden was mentioned in the acknowledgement section, and this is why we mentioned the EMWA. In his defense of Laden’s role he says:

“In fact, Ms Laden’s role, and the fact that the authors maintained final control over the content, were reported in the Acknowledgements section in these words [3]: ‘We thank Sally Laden for editorial support in developing early drafts of this manuscript. We maintained complete control over the direction and content of the paper. Preparation of this report was supported by an unrestricted grant from Cyberonics, Inc.’”

And just last year in a discussion about the most famous ghostwritten paper of all time, Study 329, Adam again used the “editorial assistance excuse.” In his words, “It’s also not accurate to describe this as a ghostwritten article, as I see that Sally Laden was acknowledged in the published version.” Yet, in this article, Laden was simply acknowledged for her editorial assistance. Our take is that Sally Laden should have been listed in the author byline of both the Nemeroff paper and Study 329. This is not really a very profound, or earth-shattering idea, nor do we think it solves the major problems in medicine with undeclared conflicts of interest. It just seems to be simple common sense.

EMWA Guidelines

We are glad that Adam has brought up the guidelines and we are happy to address those here. At one point in the EMWA guidelines they say, “The involvement of medical writers and their source of funding should be acknowledged. Identifying the writer, either as an author or contributor or in the acknowledgements section.” To us this seems to suggest that EMWA believes that mentioning editorial assistance in the acknowledgment section is considered acceptable. Later in the document, they do say, “Vague acknowledgements of the medical writer’s role, such as ‘providing editorial assistance’ should be avoided as they are open to a wide variety of interpretations” but it is important to point out that the EWMA is still trying to find a way to have unnamed authors on papers. Instead of using the term “editorial assistance” they are simply proposing another term. In their words: “We suggest wording such as ‘We thank Dr Jane Doe who provided medical writing services on behalf of XYZ Pharmaceuticals Ltd’.” However simply changing the term of “editorial assistance” to “medical writer” is just another way to keep deserving authors off the byline.

The acknowledgement section is traditionally seen as a spot to mention people who don’t rise to the level of “author” – for instance, colleagues who looked at the paper and made comments, a grammar guru who tweaked the composition, or Mom and Dad who provided the necessary motivation. The EWMA seems to be doing their best to figure out a way to include deserving authors in the acknowledgement section – something we have previously referred to as “an academic sleight of hand.” It is not that we are against the term “editorial assistance,” it is that we are against leaving a deserving author out of the byline. Keeping them in the acknowledgement section but calling them something else is just a way to sanction ghostwriting. What we should have said in our paper is that simply mentioning authors in the acknowledgement section as editorial assistants or medical writers or any other term is not a solution.

Legitimizing Ghosts

At the end of Adam’s posting he says that whether medical writers should be listed as authors is a legitimate debate, but why should this be considered a legitimate debate? If academic medicine allows papers to have unnamed authors, as Adam is saying, then they are sanction ghostwriting. Shouldn’t the ICJME just require that writers of papers be listed as authors? We did point out that we think ICJME has a loophole that can allow ghostwriting, but we don’t think their intention is to condone the use of unnamed authors, and we don’t think they are debating whether this should be allowed.

The Twilight Zone

This is a very weird discussion. It seems to us that we are the ones calling for increased recognition for a group of very bright and skillful people. Rather than be hidden in the shadows we think that their skills and intelligence should be given the credit they deserve by rising to the level of authors. Medical writers do provide a very valuable service and there is no reason they should not be used but why not list them as authors? Sally Laden is surely one of the brightest and most prolific people in the scientific literature yet a pub med search would not reveal this. Yet, for our efforts, this group’s spokesperson attacks us on the basis that his group is not deserving of this credit. Welcome to the world of academic medicine. Adam has taken on the task of attacking anyone in the medical literature who suggests that writers should be called authors. But he seems to be leading his organization down a path that we are not sure his constituency wants to follow. If he is not careful his organization is going to become the EMGWA -The European Medical Ghost Writers Association.

And speaking of industry-compromised medical school professors…

UD‘s friend Jonathan Leo has a new article out about the pharma-sponsored ghostwriting of seemingly neutral scientific articles. It’s a model of lucidity, first defining “ghostwriting,” then clarifying all the ways in which it’s a deceptive and destructive practice, and finally proposing new rules for the submission of medical research papers.

The article appears in a subscription-only journal; but here are some excepts.

Transparent and honest authorship would seem to be a bare minimum standard for professors publishing medical research.

Indeed, imagine how your colleagues in any other field would respond if they found out that you didn’t write the articles listed under your name on your cv… That the articles were in fact written by a ghostwriting firm being paid by a corporation – the way, for instance, the makers of Paxil are accused of paying a firm $120,000 to ghostwrite a book representing itself as objective but in fact constituting an extended advertisement for Paxil. “Ghostwriting,” Leo points out, “is performed by writers who have undisclosed conflict-of-interest and are paid well by pharmaceutical companies to ensure that the manuscripts contain the chosen marketing messages.” Only in the American medical school would discovering this deception occasion no response.

While the average reader likely interprets ‘editorial assistance’ as help with grammar or improvements to the overall readability of the article, in reality such ‘assistants’ make major contributions to papers, and would commonsensically be considered as co-authors.

It’s common in corporate ghostwritten articles not to mention the ghostwriter(s) at all, or to hide a thank you in a small note at the end of the piece. And, as Leo points out, it’s just as common to characterize their contribution as purely ‘editorial assistance,’ when it’s often far more substantive than that.

A few journals have instituted ghostwriting-resistant policies, among them Neurology:

[Its editors] require that any paid medical writer be included in the author byline accompanied by full disclosure.

The Scandal of Ghosted Professors

Carolyn Beeler, at WHYY, makes explicit the problem with medical school professors who allow their work to be ghostwritten by the pharmaceutical industry:

“A medical writer might create a shell of the article that says this is the primary outcome measure, this is the population measure that’s going to be included in the study, and then create dummy tables for the results,” [Harvard's John] Abramson said. “That is perfectly legitimate.”

The problem is when that veers into ghostwriting. Medical writers paid by drug companies have control over the data analysis and writing, not the academic whose name adds legitimacy at the top of the study, Abramson said.

“Then there’s a serious problem, because then what’s happening is that the commercial sponsor of the study is using a facade of science,” Abramson said.

Massachusetts psychiatrist Dr. Danny Carlat said ghostwriting might hold a special allure for companies marketing drugs to psychiatrists because there is a vast array of drugs that are of similar effectiveness.

“In a field like that, where there’s so much competition, ghostwriting becomes a very important part of the marketing machinery of any company,” Carlat said. “You want to convince psychiatrists who are reading these studies that your drug has some kind of advantage, however slight, over the competitor’s drug.”

And the allure for professors who hand their intellectual integrity over to marketing agencies?

Well, sometimes they get a cut, of course. Money’s always nice.

And it’s a quick and dirty addition to your cv. Nice raise and promotion work, if you can get it.

“[G]hostwriting practices violate well-established academic standards. Academic authors who sign their name to ghostwritten publications pad their CVs and gain scientific credibility through publishing in journals. But if our students do this, and we find out, we sanction them. They could, in fact, be expelled for violating authorship rules.”

Trudo Lemmens talks to Paul Thacker about med school professors who put their names on ghostwritten, industry-sponsored scientific articles.

Quick recap…

… on ghost-written professors:

Why do academics serve as authors on scientific articles they did not write, using research they did not perform? Because they are rewarded, both by their universities and by their colleagues for how much they publish and for its prominence.

Ghosts of the University

The Sydney Morning Herald quotes the vice-chancellor of Macquarie University on acquisitive, amoral universities.

Among his complaints:

… [M]edical researchers lend their names to articles written by drug companies to boost sales. Ghost writing has benefited researchers by giving them additional publications to add to their resumes..

The problem, which has alarmed medical editors in the US, arises when ”publications are the coin of the realm in university scientific careers…”


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He says a university should produce people “who understand the world and their place in it, who can speak coherently, who know what a poem is and who can tell a symphony from a jingle.”

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