Why Does Academic Medicine Allow Ghostwriting? A Prescription for Reform

A book, paper, or speech that involves an author who is not given credit is considered ghostwritten, at least according to most dictionary definitions. This straightforward and seemingly commonsense definition has yet to be accepted within academic medicine. Over the past 15 years, the academic medical community has quietly tolerated the presence of ghostwriters in the medical literature, a practice that no other segment of the university community has allowed. A medical research paper containing a subtle endorsement for a medication carries more weight with clinicians and patients if the pharmaceutical company that wrote the paper is not mentioned in the authorship byline, especially if it lists prominent university professors from prestigious institutions. The practice of ghostwriting is neither rare nor harmless. Alleged ghost authors haunt the clinical trial literature of virtually all the recent blockbuster drugs, including medicines like Vioxx, Avandia, Paxil, Zoloft, Zyprexa, hormonereplacement therapy, and Fen-phen. As the makers of these drugs are embroiled in product liability lawsuits from their product’s tendency to cause harm, the involvement of ghostwriters in the production of scientific evidence to support their use has raised eyebrows. Recently, a public dialogue on ghostwriting has emerged, with public advocacy organizations and some medical journal editors, practicing physicians and bioethicists voicing their perspectives and calling for reform. As this dialogue continues, we have noted a critically important issue often overlooked by many of those involved: When exactly should a scientific paper be considered ghostwritten? Medicine aside, most people who hear the term “ghostwriter” think of a paid writer who authors an article, book, or speech without credit. While discussions of ghostwriting have some complexities, it seems there is one, and only one, criterion to determine whether a scientific paper has been ghostwritten: If a person who should have been listed as an author was left off the byline, then the paper has been ghostwritten.