Transparency Is the Solution to the Medical-Journal 'Ghostwriting' Controversy

The media, scholars, researchers and curious individuals are primed to jump to conclusions when they learn that a medical journal article’s contributors include employees of a pharmaceutical company or hired “ghostwriters.” Our society has been conditioned to be skeptical for good reason. The abuse of “words” for profit as opposed to the common good can be unabashed or shadowy, an exposé away from further poisoning the receptiveness of those needing clear information.

Four years ago, in the wake of the Vioxx case, media attention swarmed to flush out ghostwriting in medical journal articles. It was a juicy, irresistible story for the media, exposing “secret” deals between pharmaceutical companies and opinion-leading physicians and researchers, who would sign off on an article written by a medical education company that would play up benefits and play down questions about a pharmaceutical product.

In reality, most key individuals who agreed to be an author were usually heavily involved in the editing and final product (and usually asked to participate because their known position was in agreement with what the article’s summations would likely conclude). That reality was not as salacious as when the system was abused.

Flash forward from 2005 to 2009 to yet another flurry of attention to ghostwritten articles for medical journals. While the impact on specific companies identified with this practice will be for them to look manipulative and anti-consumer, it also throws a harsh light on medical journals themselves—still going on four years after such a public lashing!—and threatens the credibility of any journal article about a product from a pharmaceutical company.

Nevertheless, it is folly to abandon the idea of professionally augmented communication (i.e., ghostwriting) because of past misuse. Instead, we must continue to focus on the future of medicine, of pharmaceuticals, and to employ all methods of scholarly communication of crucial medical issues in ways that the credibility and importance are clearly and unequivocally communicated. Someone who knows the subject MUST write about it. Lack of skill in research leads to product failure. Likewise, lack of skill in writing leads to communication failure.

Articles based on pharmaceutical company research must be part of the knowledge base. Medical journal articles sponsored by drug companies are a legitimate part of communicating to physicians. Physicians and others must care about the accuracy and relevance of the article, not who assisted in the writing.

Drug companies seek ghostwriting services in part because some researchers are not skilled writers. Additionally, when several sources combine to produce an article, an overarching writer is crucial to ensure clarity and flow. To be blunt: there is NOTHING wrong with ghostwriting as long as it is made clear at the beginning of the article who wrote the material, who contributed to the material and who endorses the content. The lead author must play a significant role in the final article, putting their credibility on the line for it. However having someone else write early drafts or polish scientific language into something more easily understood should be just as acceptable in medical journals as for writing of speeches for politicians or executives or the myriad of nearly anonymous Capitol Hill staffers involved in writing significant pieces of legislation.

What is needed is unabashed transparency—the significant difference between 2005 and 2009.

PhRMA has issued guidelines to take the invisible apparition out of ghostwriting. Since an integral part of any drug’s development and commercialization program has been the “publication plan,” transparency and credibility must be the mantra. If PhRMA members do not lead, others will institute their vision of disclosure—notably legislation introduced by Senator Chuck Grassley detailing guidelines. It’s simple: lead or lose.

Most medical journals plan to apply additional scrutiny to authorship. Pharmaceutical companies can help them with robust disclosures, even into the minutiae of researchers. Then the journal editors can decide who to cite. There is nothing wrong with getting help from medical writers, provided they and their source of funds are clearly acknowledged. What would be wrong is NOT to engage medical writers, since they have both the knowledge of the subject and the skill to communicate clearly and effectively

Today, with websites and blogs, full and fuller disclosure is easy and easier. For example, the process for research may not be spelled out in a short op-ed or presentation paper—but those interested can be directed to fuller detail on websites. Likewise, the writing process can follow a similar pattern—clear disclosure immediately, greater detail available elsewhere. It is time to shift from being reactive and negative to proactive and positive.

Communication is a must for understanding. Understanding is a must for better health. PC

ABOUT THE AUTHOR

> Don Hannaford is Senior Vice President and Chair of the Public Affairs Practice at Levick Strategic Communications, a Washington, DC, firm specializing in high-profile crisis communications, public affairs, financial and regulatory communications. Previously, Don was Managing Director of the New York office of Zeno Group, and before that, the Washington, DC, office of Manning, Selvage and Lee. He has broad experience in managing communications strategies for national and multinational pharmaceutical manufacturers, healthcare organizations and others. He has a BA dual degree from the University of Pennsylvania.