There is a fascinating process playing out in academic medicine right now. The general public is understandably concerned that much of the medical literature has not been written by the named authors – what most people would call ghostwriting. In response to these concerns, rather than ban the practice, it appears that several groups within academic medicine are simply trying to change the commonly accepted definition of ghostwriting so that medical papers can still have unnamed authors but not be considered ghostwritten. In other words, rather than ban the practice, change the definition so that the practice can continue. For anyone who is naïve about how medical papers are published, the recent letter by Dr. Jay Amsterdam relating to the ghostwriting charges at the University of Pennsylvania is required reading.
When accusations about ghostwriting are raised, one can count on new and novel defenses appearing in the media. One of the more common defenses that we see is: The Byline Doesn’t Matter Excuse. The thinking goes that as long as deserving authors are mentioned in the acknowledgement section then the paper wasn’t ghostwritten. The proponents of this theory usually use the ICMJE guidelines to support their argument. This narrow explanation is not satisfactory because the idea of appropriate authorship credit certainly predates the existence of ICMJE.
According, to the ICMJE guidelines, as long as an major contributor doesn’t sign off on the final copy of the paper they can opt out of being called an author. Someone who writes 90% of the paper can simply refrain from standing by the whole paper. In numerous articles we have tried to point out the ICMJE guidelines have a loophole in their guidelines that lets this practice continue. We are not alone in this observation as several ghostwriters have pointed out that the loophole lets them stay off the byline. The guidelines appear to be written to address honorary authorship rather than ghostwriting.
As a start, academic medicine should refocus the debate on the rights of the readers. Why should a reader have to question the byline? Why not give the medical writer the credit they deserve and call them an author so that the reader knows who wrote the paper? It seems like such a simple proposition.
Personally we think that a paper whose byline omits the author of the first draft should be considered ghostwritten, even if the paper thanks them for editorial assistance. This was the case for Study 329 and most people consider it to be ghostwritten. And while we have tried to point out that allowing authors to be mentioned in the acknowledgement section does not seem like a practice that academic medicine should allow, clearly our argument is not being heard. Our critics (including some medical writers who co-author these articles) keep falling back on the “ICMJE says it’s acceptable” excuse, and the debate falls into an argument about the semantics of the term “ghostwriting.” Recently, both the MPIP, which is a group of medical journal editors, and the University of PA appear to have sided with the idea that omitting corporate authors from the byline and mentioning them in the acknowledgment section is acceptable. We have discussed the University of Pennsyalvania case in a recent paper titled: Medical Ghostwriting: A University-Sanctioned Sleight of Hand?
So, instead of beating our heads against the wall about arguments over the definition of ghostwriting, and getting nowhere, we propose a more straightforward definition which more accurately describes what is going on. Let’s call it: “Unbylined Corporate Authorship” (UCA). Can everybody agree with this more descriptive and more straightforward term?
Granted, we think it will be hard for academic medicine to declare that it approves of the practice of publishing papers with unnamed coprorate authors on the byline but that is exactly what is happening.
Additional Note: Last week we were guest bloggers on Ed Silverman’s blog, www.pharmalot.com. In our blog posting at Pharmalot we went into more detail about ghostwriting. Also of interest on that posting, are the subsequent comments, many of which were written by medical writers.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
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