Ghostwriting – how does academic medicine justify it?

We’re always interested at PLoS Medicine in different perspectives on the ghostwriting problem. Following considerable news coverage of our recent Stern and Lemmens paper on legal liability for ghostwriting, another article, this one by Jonathan Leo and colleagues (who have previously written for us on the lack of ghostwriting policies in major US medical schools), has appeared in Society. In it they offer some explanations for why ghostwriting is “allowed” in academic medicine.

The parts I found most intriguing were their examples of how academic medicine is complicit. We all know that in the “publish or perish” environment of medical academia publications are currency, which must help explain why many academic guest authors receive no monetary payment at all for their unethical and dishonest collusion with pharma that allows them to take (academic) credit for papers they didn’t write.

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

Apparently not. One particular example cited by Leo and colleagues, involving the widely-prescribed Paxil (paroxetine; an SSRI antidepressant), jumped out at me: they describe allegations that an American Psychiatric Press (APP) textbook called “Recognition and Treatment of Psychiatric Disorders,” ostensibly authored by leading psychiatrists Charles Nemeroff and Alan Schatzberg, was actually ghostwritten by writers employed by the manufacturer of Paxil, GlaxoSmithKline, who paid the writing firm US$120,000.  An earlier draft of the text written by the paid medical writers is on the website of the US-based Project on Government Oversight.

What’s astonishing is not that the institutions and publishers deny the involvement of GSK-paid ghostwriters (they don’t), but that they accept and justify the ghostwriting because the authors “signed off on the final copy.” Leo and colleagues quote James Scully, Medical Director for the American Psychiatric Association: “The book was reviewed for any potential bias (among other things) by eight independent reviewers, and there was no undue influence on the content from industry or any other outside source.” The psychiatrist Daniel Carlat, in his New York Times blog last year, on the other hand, called the textbook “an advertisement for Paxil.”

That medical academia finds these types of arrangements acceptable is, I think, at the heart of the problem of ghostwriting. And for anyone who has been a student or trainee in medical academia─subject to strict codes of conduct prohibiting plagiarism etc.─this apparent double-standard will strike as more than a little ironic. Clearly we need to address this double-standard. I love the analogy Leo and colleagues draw, so I quote from their article directly:

A college professor determines one of his graduate students handed in a paper largely written by someone else. After being confronted, the student acknowledges that indeed someone else wrote the paper. The student then says, “I approved the final copy, and had eight classmates look over the paper and they all vouch for its unbiased conclusions.”