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.

Where the Simulacrum Ends is a University Diaries Category. It appears at the bottom of this post.

But the simulacrum never ends. The constant, ubiquitous appearance of artifacts that present themselves as the intellectual or creative work of one person, but are in fact the work of a hired ghost (like the ghost complaining in this post’s title), helps create the white-noisy, bogus, unreal feel of the postmodern world.

Our most thoughtful writers – unspectral ones, like Don DeLillo – evoke this very contemporary sense that everything is engineered, even nature. In Don DeLillo’s novel, The Names, a young man enters an airplane:

The crew is Japanese, the security Japanese… He hears Tamil, Hindi, and begins curiously to feel a sense of apartness, something in the smell of the place, the amplified voice in the distance. It doesn’t feel like earth. And then aboard, even softer seats. He will feel the systems running power through the aircraft, running light, running air. To the edge of the stratosphere, world hum, the sudden night. Even the night seems engineered, Japanese…

When even your evenings are engineered, the fact of ghostwritten cookbooks, scientific articles written by ghosts in the employ of the pharmaceutical companies promoting the drugs under discussion in the article, or, most recently, grades and comments on university students’ papers written by ghostwriters in India paid by American professors, ceases to excite comment… The occasional ghost-confessional will appear in the New York Times, telling us how demoralizing, disembodying, strange, it feels to be a career ghost (Yet who wrote/edited/exaggerated the ghost’s confession?)…

Alas, poor ghost! But pity as well the strange disembodiment of the ghosted, for they too must feel the erosion of their reality as their pantomimed self pops out at them everywhere.

And pity their dupes.

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.

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.

… can the ghostwriters on our universities’ medical faculties be far behind?

Background here.

UD‘s buddy Bill Gleason reminds us that the business of pharmaceutical companies paying professors to write books – or to put their names on books written by ghost-writing companies – continues to thrive. (Pharma also has professors put their names on articles largely or entirely written by the same ghost-writing companies.) Like all ghostly things, this one leads a fitful existence; occasionally there’s a reported sighting. But you can’t be sure you’ve seen a ghost until you get documentation, and in this case, people have been trying to get documentation out of the American Psychiatric Association, which published the book…

On May 4, there’ll be a day-long workshop, at the University of Toronto, on the ethics of ghostwriting. David Healy will be there, along with other academics who’ve been willing to go up against powerful and rich vested interests, inside the university and out.

Financial Times:

A long-delayed academic paper analysing use of multiple sclerosis drugs failed to disclose all of the authors who worked on it, sparking fresh concerns over the practice of “ghost writing” in medical journals.

Karen Facey, a researcher, was commissioned in September 2007 to prepare a paper for the British Medical Journal on the government-backed “risk sharing scheme” for MS treatment and commented on subsequent drafts, but was not cited either as an author or a contributor in the final version published last December.

The issue has come to light at a time of growing efforts by medical journals to clamp down on “ghost writing”, the process by which medical writers prepare draft papers often on behalf of pharmaceutical companies, and then find academics willing to lend credibility by adding their names to the work…

“Plus,” said UD to Mr UD at lunch just now (they had leftover Chinese food plus an egg and cheese omelet), “there are ghost letters.”

“Ghosted scientific articles, and ghosted letters?”

“Listen to this:

[Jenny] White and colleague Lisa Bero, PhD, [both] of the University of California San Francisco, found 24 articles that were produced as a result of grants that Parke-Davis gave to [ghostwriting firm] Medical Education Systems in 1996 and 1997 to draft articles and letters to the editor regarding gabapentin [Neurontin] for publication in peer reviewed journals.

So they ghostwrite articles, and they ghostwrite letters in response to the articles they themselves have ghostwritten.”

“So… say a letter to the editor criticizing a ghostwritten article that the corporate ghost who’s written the original article then ghosts a response to is itself ghostwritten,” mused Mr UD. “If you catch my drift. Then you have significant research debate in high-level journals carried on exclusively by ghosts.”

“Ghost vs. Ghost, as Mad Magazine would say… But wait. Say the entire debate is carried on by the same ghost, in order to make the thing look more legit. Like, you know how corporate-generated, pretend-grassroots campaigns feature letters with on-purpose writing mistakes to make them look real? So maybe here you’re getting a vast fake controversy about the Neurontin results — all of it generated by one ghost, back and forth, back and forth with himself — here indignant, there defensive, here threatening to sue, there threatening to cancel his subscription… ”

“Fun!”

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(UD thanks Pharma Marketing Blog
for the image.)

“These articles contributed to widespread prescription of hormones to women who did not need them, but who were put at risk of blood clots, breast cancer, and other adverse effects,” said Adriane Fugh-Berman, associate professor of physiology and biophysics at Georgetown University Medical Center, a pharmaceutical industry critic.

Adriane’s pissed because Wyeth, maker of the often unnecessary and sometimes dangerous hormones in question, wrote five articles, which reached hundreds of thousands of doctors, praising its own hormones.

Great hormones, if I do say so myself…

I mean, of course Wyeth didn’t reveal in the articles that it was praising its own hormones. That’d be nuts. People would dismiss the findings as advertising rather than science. Nor did the professors of medicine Wyeth paid to put their names on the articles reveal that they didn’t write a word of them. That’d be nuts too. Their reputations as scientists of integrity would go up in smoke.

These are polite people, these ghosts, and, like Gloria Bachmann, another Wyeth ghost, they went out of their way to thank the ghostwriting firm Wyeth paid to write the articles the ghosts didn’t write. (To clarify: The distinction here is between ghosts, who simply float about, and ghostwriters, who put the ghosts’ names on things the ghostwriters have written.)

Leon Speroff, one of the ghosts, wrote the following to his ghostwriters about the article he got paid to pretend he wrote:

“You did a super job of writing this paper – succinct and makes the points very well.”

Leon’s mother taught him to say thank you when he got a gift.

Leon’s mother forgot to tell him not to steal.

James Stein, a [University of Wisconsin] cardiologist, said he was approached twice in the last week to put his name on educational material for different drug companies. He said he turned down both offers because, “frankly, it’s plagiarism.”

“If an undergraduate did this, he would be expelled,” Stein said.

When a drug company puts a doctor’s name on an article that actually was written by a professional writer, it is able to present a more biased and promotional version of an issue as though it were coming from an independent source, Stein and others say.

The company’s ultimate goal is to sell more drugs, said Steven Miles, a physician and professor at the Center for Bioethics at the University of Minnesota Medical School.

“These ghostwritten articles are advertising masquerading as scientific reviews,” he said. “It’s dishonest.”

Forgot to tell him not to lie too.

Never too late to learn. Maybe Speroff is reading this.

A Canadian academic was puzzled:

I  recently looked at the c.v. of a distinguished professor of medicine and saw that he had authored (most usually had co-authored) about 800 articles in peer-reviewed journals, an average of nearly 30 per year over his career. His publication rate has accelerated over the years, reaching 40 articles per year in the past decade. How can a scientist author and publish 40 articles in a year? Year after year? In my fields (Science and Technology Studies, Philosophy, Sociology), five peer-reviewed articles in a year is a lot, and most researchers would be happy to write one truly good article each year.

Rather than conclude the obvious — these guys are fucking geniuses — and go back to his low-paid slow-lane job, Sergio Sismondo decided to investigate.

Turns out they’re not writing the articles!

…[D]rug companies and their agents produce a significant percentage of the manuscripts on major current drugs. These manuscripts are then “authored” by academic researchers, whose contribution ranges from having supplied some of the patients for a clinical trial, to editing the manuscript, to simply signing off on the final draft. The companies then submit these manuscripts to medical journals, where they fare quite well and are published. The published articles contribute to accepted scientific opinions, but the circumstances of their production remain largely invisible. When the articles are useful, the marketing departments of the drug companies involved will buy thousands of reprints, which sales representatives (reps) can give to physicians. I call this whole process the “ghost management” of pharmaceutical research and publication.

[Ghost authors] are unlikely to make major contributions to the analysis or writing of an article. They are shown well-crafted manuscripts that have been reviewed by many scientists, writers, and marketers. They are not given access to the data. They are asked their views on very specific points. They are given short deadlines. Thus, authors of industry manuscripts are largely sidelined from the process of analyzing, writing, and publishing research.

About half of what you read about the drug you’re thinking of taking was written by a public relations firm.

[I]t appears that roughly 40 per cent of medical journal articles on major in-patent drugs are parts of individual publication plans on the drugs… [P]harmaceutical companies have complete control over roughly half of all clinical trial data…

A philosopher, Sismundo grapples with the ethics of simulacral science:

The pharmaceutical industry … has developed a [new] form of plagiarism, involving only willing participants. Moreover, it has created new reasons for concern: the hiding of interests that drive research and publication and the possible harm to patients that this may create. When sales reps bring reprints of articles to the offices of physicians, prescribing nurses, hospital staff in charge of formularies, and other drug gatekeepers, those articles may look like independent confirmation of the reps’ pitches. Plagiarizing [ghost authors] lend their good names to the pitches.

On the up side, there’s the rich abundance of scientific output with which, as modern consumers, we are blessed:

Another much-discussed issue in the ethics of publishing is over-publication. We are buried in masses of literature, making it difficult to find what is valuable. Publication hides as much as it reveals. Every year, library budgets increase at well above the overall rate of inflation. This is caused in part by publishers increasing the prices of journals, and in part by the increasing number of journals. The ghost management of pharmaceutical research and publication plays a role within the medical sciences, as industry planners calculate how many new articles bearing key messages they need to affect perceptions and sway those who prescribe drugs.

In his year-end review of bogus research, Gary Marcus notes endemic cheating in scientific studies and lists six ways to fix the problem. Each approach makes sense – do something about publish or perish, establish an ethical code, encourage insiders to police the work in their field…

But for some reason, Marcus omits the biggest problem of all: pharma. The staggering financial incentives for colluding with corporations and their ghost writers make an incentive like tenure look paltry.

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UD thanks Dirk.

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UPDATE: And don’t forget this problem.

They can agree to have seemingly unbiased articles about – I dunno – the safety of OxyContin go out under their name, even though Sackler-funded ghostwriters would have written the articles.

For doing nothing but agreeing to Purdue’s use of their name, these professors could earn (before the whole Oxy thing collapsed) tens of thousands of dollars, and thereby make their own small contribution to millions of addictions and deaths.

There are plenty of examples like this. An economist earns big bucks by letting a corporation use her name on an article touting … let’s see … the superiority of coal over other forms of energy. The safety of dangerous anti-depressants. This or that hormone.

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There are other ways for professors to trade their reputations for money, and a prof at GW may have availed himself of one of these. Nothing’s been proven, but two affiliated scholars at the Program on Extremism he runs have already resigned in protest against Lorenzo Vidino having reportedly received thousands of dollars for designating certain people terrorists, or terrorist-connected. The money came from rich oil states engaged in convoluted reputational battles with other such states.

Vidino, a dual citizen of Italy and the U.S., argues that even the most moderate Islamist organizations in the West can tilt Muslims toward separatism and violence. [M]any Muslims [think] that he simply dresse[s] up bigotry in academic language. Georgetown University’s Bridge Initiative, which studies Islamophobia, has described Vidino as someone who “promotes conspiracy theories about the Muslim Brotherhood” and “is connected to numerous anti-Muslim think tanks.” In 2020, the Austrian Interior Ministry cited a report by Vidino as a basis for carrying out raids on dozens of citizens or organizations suspected of having links to the Muslim Brotherhood. No one targeted in the raids has been arrested, much less convicted of any wrongdoing. An Austrian appellate court ruled the raids unlawful.

UD would love to know if he’s declaring this money on his end of year GW Academic Review form.

SOS has been reading up, this morning, on the just-sanctioned oligarch Oleg Deripaska, and she found these extremely instructive sentences in a 2018 NYT article, so pay attention.

Unlike Mr. Deripaska, Lord Barker had a largely spotless reputation. His only minor brushes with scandal came in 2006, when he left his wife to live with a male interior decorator, and in 2012, while serving as energy minister, when he made the tabloids for using a microwave at Parliament to warm a cushion for his pet dachshund, Otto.

LOLOL. Do you see what the two extremely clever writers who produced these two sentences did? Do you see why the ghost of Lady Bracknell shines bright out of these two sentences? I mean, read it out loud, using her upperest of upper class British accents. Go on!

First, their set-up, and it’s vintage Oscar Wilde, as in

The General was essentially a man of peace …

Then … Bada bing bada boom: … except in his domestic life.

So here we begin with another insipid cliche: spotless reputation… Though that sly largely tells you Bracknell waits panting in the wings. Largely, essentially – insert a seemingly innocuous adverb in front of your cliche and let fly.

That short first sentence, in other words, is the set-up. The second, much longer sentence, will launch us into the realm of absurdity… Or not launch, really – launch suggests an instant liftoff, whereas the trick actually involves sort of the opposite of a liftoff… a kind of sly gradual fizzling out is more like it… an operation whereby the sentence, instead of gaining steam and significance (writers are typically instructed to put their most significant material toward the end of their sentences, to work up to it — in part so that the reader is led to want to read further), delightfully self-deflates, leaving us in a terrain so beyond-trivial, so astoundingly non-serious, so insanely petty, so infinitesimally small, as to …

I mean, ask yourself: Why didn’t they write dog? Why did they belabor, bedeck, and bedew the sentence with breed and name? With warm? With pet? Have the writers not read Politics and the English Language?

Of course they have. But I don’t pay a fortune to subscribe to the New York Times in order to march solemnly through a stern-faced rendition of what is in fact a farcical story featuring sleazy twisted self-regarding idiots – I want a sense, as I read, that, along with the obligatory surface rendition of events, the writers grasp the sick world that set the events in motion. The writers correctly pinpointed the dachshund detail as a … sly … opening to that world, and they went with it.

The only thing SOS thinks could have improved this writing would have been if Lord Barker had inadvertently put the dachshund rather than the cushion in the microwave, in the same way Miss Prism inadvertently put the baby rather than the manuscript in the handbag. Alas, real life seldom cooperates to this extent.

Though it is certainly true that we got more than we might have expected in the name Lord Barker. Here life lent the whole thing a very Richard Brinsley Sheridan touch. Nice.

After referring to his institution as the University of California in this year’s commencement speech, the president of the University of South Carolina plagiarized, verbatim, a paragraph about personal ethics.

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How do you achieve this outcome?

Let’s put aside things like a drop of the hard stuff. Without that it seems pretty unaccountable, no?

Here’s what UD figures, FWIW:

Like many busy people, the president of the University of South Carolina has a squad of speechwriters. Here perhaps are the two things that went wrong:

1. He mentioned to one of them that he liked this one quotation a lot, and it seemed real pertinent, so could the ghostwriter work it in. Sure, boss. Only the ghostwriter (who may have been a student) stuck it in without attribution.
2. I’m gonna go with an overly obliging spellcheck on the California thingie. Student’s typing the speech real fast and misses the fact that after she puts down the letters University of Ca the app figures she means California and helpfully fills that in for her. As to why the president went ahead and read California – that’s an easy one, eh? He’s never seen a word of the speech before delivering it, and he’s on automatic pilot, paying very little attention to what he’s saying, thinking mainly about the reception right after the speech… … …

Again, the same texts are predicated of differing subjects, which [M.V.] Dougherty said calls “into question the intelligibility of the texts manufactured by the two plagiarizing ghostwriters. Have they each produced coherent works of Catholic teaching, or are the plagiarizing documents simply theological word-salads?”

UD can’t wait for Adrian Vermeule’s and Edmund Waldstein’s Catholic state (see details here). UD calls it a cathophate, since it is something of a Catholic parallel to the caliphate some radical Muslims work toward.

In anticipation of that glorious day when the Catholic church is the state, UD has been reading the Catholic press.

The Catholic News Agency is a good source on the sort of discourse we can anticipate from our priest-rulers. Here is one article in that outlet about high-level Catholic preachment.

Many priests plagiarize or employ ghostwriters, or plagiarize and employ ghostwriters. The ghostwriters may themselves plagiarize. And since – again – many priests apparently plagiarize – a lot – the plagiarizers may well be plagiarizing from plagiarizers. The final product, preached by very busy important priest-rulers who use ghostwriters, may therefore be a plagiarized plagiarized ghostwritten statement of Truth to us, their subjects, from the authorities.

It is rather like the mysterious trinity, with Father being the King standing above us mouthing words he pretends to have written — words that tell us the truths we must believe and be ruled by; Son being the plagiarist who feeds stolen words to the words-mouthing Father; and Holy Ghostwriter being the ancient obscure force of originary plagiarism.