Well, for once there is a controversy and I don’t have an opinion. Generally I have opinions even where there is no controversy, so this kind of sets me back.
The issue is ghostwriting in medicine.
Ghostwriting is the practice whereby a writer produces an article or book for which another person takes credit. That much we can all agree on. However, there is some “stretch” in the definition. While some people think ghostwriters are out writing whatever they feel like and then tacking somebody’s name on it, there are some nuances to the profession. I’ve been a ghost for years, and I can tell you that the business works a little differently.
In all of my cases of medical ghostwriting, the author(s) approach me with content. It may not be organized content or even complete content, but they always have an idea, some data, some facts, and a wide range of key points. I may have to extract this content from PowerPoint presentations, notes on legal pads, audio CDs of meetings, or telephone interviews, but the authors present me with the content. It then becomes my job to organize it and package it in a way that makes it publishable.
Some authors want me to do some of the research but that’s generally for backgroud material. For instance, if the article is on heart disease, they may want me to get some general statistics on the incidence and prevalence of heart disease or what heart attacks cost the American healthcare system, etc. I often get a free hand to develop that content but the authors see it before anyone else does and they must approve it.
Ghostwriting has become controversial in medicine in the past several years. The fear is that big drug companies or other medical companies hire people like me to write articles or books and then just get a willing doctor to sign his or her name to it. There is also speculation that big companies might even conspire with me to write something favorable about a product and I, being a writer, will use my talents to help deceive the medical profession.
The routine practice today is that ghosts are disclosed in the paper, that is, they come out of the closet in the fine print where the authors admit they had “editorial support” from a particular person or company. That disclosure goes in the same place where doctors or other medical people must disclose financial deals they have with medical companies. The doctor who writes about Wonder Drug XYZ must now disclose (albeit in tiny print) that he is a paid consultant to the XYZ Company.
So far, medical writers are staying pretty mum about the controversy or just avoiding ghosting. But let’s look at both sides.
On the one hand, as a ghostwriter, I am totally dependent on my author’s content. I lack the expertise, desire, and energy to delve deeply into the statistical design of their studies or weig all of the medical evidence that might surround conclusions they have drawn. In other words, if they tell me 80% of people taking this drug get rid of their acne, then that’s what I write. If the doctor is trying to hoodwink the public, then I am his accomplice. I facilitate his being able to publish without being a safeguard as to the accuracy of his report.
It also would seem that doctors ought to be able to publish their own papers. A man or woman capable of graduating from medical school and practicing as a physician really ought to be able to write an article. And even if the article has a few bumps in it, medical journals all retain the services of editors and proofreaders to help iron out the articles into publishable form. So the inclusion of a professional writer in the mix does seem a little suspicious.
Last but not least, ghostwriters mean that authors take credit for what they have not done. At the very least, that makes them a tiny bit deceptive, doesn’t it? The new use of disclosures helps remedy that situation a bit. Ideally, the author of the paper has actually read the paper and feels confident he or she can stand behind the content. However, in my experience, many “authors” are very quick to rush anything publishable to the journals and I’m not entirely certain some of these authors have even read their papers much less truly analyzed them.
So that’s why ghosting is bad. But ghosting is good in that most physicians, particularly the kind who do medical research, are insanely busy individuals who have a lot of valuable information to share and not a whole lot of time to write it. Writing is a difficult chore for some people and it requires professional expertise. Just as you might get a professional mechanic to fix your car (even though you drive it around town), why not get a professional writer to fix your ideas into an article?
I used to think ghosting was an acceptable practice because, well, it was an acceptable practice. Everyone did it. It was (and is) widely done and most people in the medical field knew it. It’s just like celebrity biograpies (you don’t think those celebs write their own books?) or celebrity perfumes. People often attach their name to products they don’t totally create from the ground up.
So what do I think about medical ghostwriting? I think if that if the ghostwriter does not provide content, if the author(s) are diligent about “owning” the content and being sure they can stand behind it, and the ghostwriting is disclosed, it’s OK.
Any opinions?
