Starving tumors.

Essay " What is the purpose of publications?…[The] purpose of data is to support, directly or indirectly, the marketing of our product. " [1] There are many reports of medical journal articles being researched and written by or on behalf of pharmaceutical companies, and then published under the name of academics who had played little role earlier in the research and writing process [2–14]. In extreme cases, drug companies pay for trials by contract research organizations (CROs), analyze the data in-house, have professionals write manuscripts, ask academics to serve as authors of those manuscripts, and pay communication companies to shepherd them through publication in the best journals. The resulting articles affect the conclusions found in the medical literature, and are used in promoting drugs to doctors. For example, as reported in The New York Times [4], an Annals of Internal Medicine article on Merck's " Advantage " trial of Vioxx omitted some trial participants' deaths. Distancing himself from the Annals article, fi rst author Jeffrey Lisse said in an interview that " Merck designed the trial, paid for the trial, ran the trial…Merck came to me after the study was completed and said, 'We want your help to work on the paper.' The initial paper was written at Merck, and then it was sent to me for editing " [4]. Such incidents have provoked many commentaries about ghost writing in the medical press. This article enlarges the focus from ghost writing to the more general ghost management of medical research and publishing: when pharmaceutical companies and their agents control or shape multiple steps in the research, analysis, writing, and publication of articles. Such articles are " ghostly " because signs of their actual production are largely invisible— academic authors whose names appear at the tops of ghost-managed articles give corporate research a veneer of independence and credibility. They are " managed " because those companies shape the eventual message conveyed by the article or by a suite of articles. As discussed below, a substantial percentage of medical journal articles (in addition to meeting presentations and other forms of publication, which are not the focus here) are ghost managed, allowing the pharmaceutical industry considerable infl uence on medical research, and making that research a vehicle for marketing. Ghost writing and honorary authorship are not in and of themselves scientifi c problems, though they become so when they shape science to meet …