Medical ghostwriting is difficult to investigate, for the actors involved in conducting, analyzing, writing, marketing and managing a piece of research are unacknowledged in the final manuscript.
What little is known about ghostwriting is based on anonymous surveys, interviews, and the occasional deposition of a disgruntled whistle-blower. In the event of a lawsuit, when companies are forced to reveal internal documents, we may view the underbelly of this spectral industry, which is thought to be involved behind much of the influential medical literature.
Sergio Sismondo, a philosopher and sociologist at Queens University in Canada, used a different approach to understand medical ghostwriting. Given the propensity for industries to organize, Sismondo simply attended one of their conferences.
In his 2009 article, “Ghosts in the Machine: Publication Planning in the Medical Sciences,” Sismondo documented an annual meeting of the International Society for Medical Publication Professionals (ISMPP) to explore the workings and relationships among different interest groups. The result revealed a complex network of actors including industry sponsors, contract research organizations (CROs), medical communication companies, STM publishers, journal editors, and academics.
And they don’t always work together harmoniously, Sismondo reported. Industry scientists are often antagonistic toward writers and marketers for misreporting their results to create spin. One presenter — an STM publisher — believed that its own journal editors, and the authorship policies they created, were ultimately doing harm to medical publishing:
We spend a lot of time trying to re-educate our journal editors. . . . We’re saying you have to change your instructions for authors. You have to reflect the changing mood of the times. And yet we still get journal editors who say ‘This journal frowns on ghostwriting’ or something similar. ‘This journal will not accept papers that have writing support.’ And actually what we’re trying to say to them is, ‘Fine, you may have that view but what you’re actually doing is driving it underground. It’s far better to be transparent and get this out into the open.
This is not a picture of a finely tuned machine, but an industry composed of various parts with different values, goals, and agendas. Even within specific groups, there may be some ambivalence toward ghostwriting. For instance, journal editors clearly benefit from clear and concise manuscripts crafted by professional writers but also demand adherence to strict authorship criteria, which precluded their listing as authors.
As for academic authors, publication planners view key opinion leaders (KOLs) as little more than indispensable louses:
Although they are recognized as crucial, KOL authors are often portrayed as lazy and greedy. As depicted by planners, they typically make few substantial contributions to the manuscripts they author, are slow to respond, and miss deadlines. They expect prominence in authorship order, and sometimes demand money for their contribution.
To their defense, Sismondo writes, these academic authors are typically provided with only a penultimate version of the article shortly before it is whisked off for journal submission. From the perspective of a publications planner, an academic is viewed more of as a check box on a prepared list of required steps than a true intellectual collaborator.
Sismondo avoids the familiar narrative of painting the issues too simply, as a crisis in scholarly communication, with its heroes and villains and simple solutions. Nor does he see everyone on equal moral grounds, pointing out serious conflicts of interest, such as when a CRO or academic publisher owns and operates a professional medical communications company.
Stepping back and reflecting on the medical publishing industry, Sismondo is philosophical.
Authorship in the medical sciences has lost its romantic notion of the auteur and has returned us to an earlier version of the scientific author, as the one who speaks with authority. This is the age of Robert Boyle and his air pump, where scores of assistants and technicians performed the necessary functions of science and yet remained hidden from the scholarly record.
And yet there is one difference. The academic “author” has been marginalized in the process, sought only for the authority of his name and no longer for his knowledge or expertise. When operated in this way, medical science is reduced to a form of marketing, which draws its authority from traditional academic science.
Given the investments and payoffs from this new model of corporate science, don’t expect change anytime soon. For the applied biomedical sciences, this has become the new normal.