Ethical Editing – Ghostwriting is an unhealthy practice

Image: SciELO.

The term Ghostwriter is defined as a professional writer who is employed to write works for which he will receive no official credit but will instead remain anonymous. This has been a very common practice since time immemorial when secretaries and scribes used to write speeches and letters for their country’s leaders, or the pupils of a particular teacher would complete their master’s work under his direction and sometimes after his death. Even today, it is customary for presidents to give public speeches which have been written by someone else, or for ghostwriters to respond to letters written to citizens in the name of the president. They may even be contracted to write their “autobiographies”. Ghostwriting also frequently occurs in the world of journalism, in the production of comics, and some encyclicals have even been written for Popes by ghostwriters.

What is wrong with this ? Nothing. But….in the world of academic studies in general and the field of research in particular, ghostwriting is also considered to be a form of plagiarism, unethical behavior which could even go as far as to cause health problems for the population, with corresponding legal repercussions. Let’s investigate this further.

The ghostwriter is a resource frequently used by university students who must present a piece of written work to enable them to graduate, a Masters and even a post-graduate thesis, and for this they contract professional writers who do the work for them. As a result of this practice, “paper writing factories” have come into existence which levy a charge to write all kinds of academic works. These have sprung up by the dozen over the last ten years, offering their services on-line. The basic services offer previously written essays at affordable prices, but a “personalized” writing service is also offered at a higher price, which frequently ranges from US$10 to US$50 per page.

The problem is even more critical when we get into the field of academic research and that of publications which appear in peer-reviewed journals. The ghostwriter is encountered most frequently in health sciences journals, and marginally so in other research disciplines. But how frequently does ghostwriting occur or how extensive is it? To get an idea of this, we carried out some research using Google Scholar (our enquiries were carried out on 10/11/2013).

For our first enquiry we searched for the general term ghostwriting and obtained 9,570 results. As many of the results related to journalism in general or to the publishing industry, we reduced the scope of the enquiry by limiting our search query by using the terms “research” or “academic”, excluding the sub-set “-students”, only searching for items published in 2013, and excluding citations and patents. We finally obtained a result of 199 published articles, almost all of them relating to the field of biomedicine. Almost 200 articles produced in only 10 months of this year, not an insignificant number!

Ghostwriting can constitute serious unethical behavior and could also be a form of plagiarism

It may come as a surprise that ghostwriting can be thought of as a form of plagiarism, but this is how it is defined in dictionaries. People and institutions also have the same opinion when referring to the matter.

For example, The Dictionary of the Royal Spanish Academy (Diccionario de la Real Academia Española – DRAE) gives as the first meaning of “plagiar”

plagiar

(From the Latin “plagiare”)

1 tr. To copy in their entirety, the works of others, passing them off as one’s own.

Likewise, in English, The Merriam-Webster online dictionary defines plagiarism as

to steal and pass off (the ideas or words of another) as one’s own to use (another’s production) without crediting the source

Dr. Francis Collins, director of the National Institutes of Health (NIH) considers that ghostwriting could in some cases be treated as a case of plagiarism. This viewpoint is expressed at least twice in a report produced by the US Senate and commented upon later in this document, and again in an article which appeared recently in the journal Bioethics. Lastly, in a work published on the  iThenticate blog, a company which specializes in offering plagiarism detection services, it states that

Based on these definitions, the concept of ghostwriting at its base level is plagiarism. After all, the whole point of ghostwriting is to hide credit from the real author and instead recognize another source. However, there are several factors based on different methods of ghostwriting that make the subject not black and white.  (2011)

In other words, the ghostwriter can be both acceptable and unacceptable.

Technology has fostered global research and global health, but has also allowed deception to take place on a global scale. Journal editors have not made significant advances in the use of technology or in formulating appropriate policies to identify dishonesty, or combat it.

In the case of a doctoral thesis produced by a ghostwriter, the candidate fraudulently presents the work of another as his own. This action is defrauding both the institution which awarded the degree as well as future employers for whom the possession of a PhD is a requirement for the job.

Ghostwriters are also used on some occasions by academics and active researchers who contract with researchers who are unemployed, underemployed or occupying lowly positions to write articles and books without recognition of their role as author. This practice is not limited to medical researchers, although they constitute the majority of cases. We must make it clear that ghostwriters are not the same thing as professional medical writers. It can happen that a group of researchers may contract a professional writer to edit a document based on original research data, but it is the researchers who continue to maintain control of the written work by blocking marketing messages that are favorable to companies or products.

The use of  the ghostwriter in medical journals causes ethical and legal problems. This concern is due to the fact that pharmaceutical companies and the industries which produce medical technology may frequently distort the results produced by clinical trials. They may also not be impartial. These articles prepared by medical writers hired by the industries are then given to certain “invited authors” who put their name to them in return for payment. The articles are then usually sent to commercial journals with a high impact factor, and for this reason it is more attractive to invited researchers to put their name to them because of the boost that these articles will give to their own careers.

This behavior creates obvious conflicts of interest, distorts medical evidence, affects consumers by their bias towards certain drugs which has, as its objective, the approval of the drugs by health officials for inclusion in the Formularies used by health institutions, in many cases with preference to generic drugs. These fraudulent works that encourage dishonesty do become possible risks in serving the poorest of patients, since emerging markets use the research published in developed countries to produce advanced therapies.

But what of the medical responsibilities of these companies when faced with a lawsuit? In court, lawyers paid by these companies will present those studies as scientific evidence to contradict independent research that questions the effectiveness of these drugs. In other words, a pharmaceutical company pays a ghostwriter to write an article in support of a drug, which then gets published in a major journal with a high Impact Factor. Then, if there is a lawsuit which goes to court, the lawyers present those articles as scientific evidence, thus closing the case.

And what do those high Impact Factor journals do, and what do the reviewers do? In general, the ghostwriter is not detected by the reviewers, since the evidence emerges often years later and only in cases that end up in court. That is, the ghostwriter is not easy to detect and because of this is labelled “ghost”.

So, how prevalent is ghostwriting, and what kind of journals lend themselves to this practice, making it a matter of concern?

A recent investigation by the US Senate into scandals related to ghostwriters has shown that this is a common practice in many schools of medicine at renowned universities such as Stanford, Harvard, McGill, Mount Sinai Medical Center, Yale and so on. Also this investigation shows how dozens of the most prestigious medical journals were involved in the approval of pharmaceutical products that are distributed globally, such as Avandia, Tylenol and hormonal therapies for menopause.

The following studies should be noted:

• A New York Times study in 2010 found a level of ghostwriting in the world’s principal medical journals (JAMA, Lancet, PLoS Medicine, New England Journal of Medicine) of between 4.6% and 10.9% of articles published.
• A paper published by PLoS Medicine showed that only 13 of the top 50 US medical journals have clear policies against ghostwriting.
• Close to 50% of the publications on drugs used in psychiatry that are still under patent were written by ghostwriters.

PLoS Medicine has requested a future ban on papers submitted by invited authors, indicating that there should be a formal retraction if it is discovered in the future that an article was written by an unknown ghostwriter, and that the institutions should be notified of the author’s misconduct.

Institutional Positions

AMWA. American Medical Writers Association

This is the leading institution in the world for training professional medical writers  and considers them to be of fundamental importance in medical research. Its code of ethics establishes a position against ghostwriting.

EMWA. The European Medical Writers Association

Like the AMWA, EMWA discourages the use of the term “ghostwriter” to describe professional medical writers since the term implies that the participation of these writers has something hidden  about it and recommends that the participation of professional medical writers should always be transparent. However, it promotes the use of professional writers because of the skills that they have developed in scholarly communication which allow for an improvement in the level of the publications. EMWA states that the contribution of medical writers and their funding sources should be made explicit, and if the contribution of the writer does not meet the journal’s authorship criteria, it should be placed in the acknowledgements.

ICMJE. International Committee of Medical Journal Editors (known as the Vancouver Group).

It establishes definitive requirements for authorship in journal articles, trying to discourage unethical practices, giving guidelines to journal editors on how to indicate the contribution made by each author of an article.

WAME. World Association of Medical Editors.

WAME considers ghostwriting dishonest and unacceptable. Ghostwriters are generally paid by companies with commercial interests in the particular subject. Professional medical writers can write papers without being listed as authors provided their role is recognized according to the guidelines established by the AMWA.

When editors detect papers produced by ghostwriters, their actions must address both the authors and their commercial partners, if they are involved. Various actions are possible:

• publish a warning that states that the paper has been written by a ghostwriter together with the names of the responsible companies and the authors of the paper.
• inform academic institutions of the authors and the commercial companies involved.
• inform the media and government organizations.
• inform the WAME forum.

Considerations

Although very early on these practices were condemned as unacceptable and unethical, the recommendations have not been widely implemented by academic institutions and journal editors for various reasons that are understandable yet unacceptable. There are many editors that do not implement this policy because the companies that hire and pay ghostwriters are the same ones that advertise in their journals and have contracts for the distribution of reprints, and we are talking here of many of the world’s leading commercial journals.

Research institutes, generally universities, have not taken direct action, since in many cases it implicates accomplished researchers who hold positions of power and who attract grants for their universities and, moreover, going against ghostwriting could open up a Pandora’s box for everyone, academic institutions and publishers. Professional associations are also slow to react against their own members by virtue of their own corporate vision that obliges them to defend their professions.

And what about the journals published under the SciELO Program? The official site states that there are currently 351 journals in Health Sciences, to which a good portion of the 109 journals in Biological Sciences could be added. It would be very important that, at the level of the SciELO Program in general, right down to the individual journal, that a firm and proactive position be taken. The concept of “conflict of interest” is too vague to define with precision the problem of ghostwriters in the health sciences.

Ghostwriting is unhealthy. Thus the title of this post.

Acknowledgements

I would like to thank Dr. Tomás Baiget, director of “El profesional de la información”¹ (EPI) for his assistance in reviewing the original text of this article. Any errors that remain are my sole responsibility.

Note

¹ El profesional de la información – http://elprofesionaldelainformacion.com

References

AMWA ethics FAQs. American medical writers association. Available from: <http://www.amwa.org/amwa_ethics_faqs>.

European medical writers association. Ghostwriting Positioning Statement. Available from: <http://www.emwa.org/Home/Ghostwriting-Positioning-Statement.html>.

Frequently Asked Questions About Medical Ghostwriting. The Project on Government Oversight (POGO). 2011. Available from: <http://www.pogo.org/pogo-files/alerts/public-health/ph-iis-20110620.html#what%20is%20corporate-funded%20medical%20ghostwriting>.

Ghostwriting in medical literature. Minority staff report. 2010. Available from: <http://www.grassley.senate.gov/about/upload/Senator-Grassley-Report.pdf >.

International committee of medical journal editors. Uniform Requirements for Manuscripts Submitted to Biomedical Journals:Ethical Considerations in the Conduct and Reporting of Research: Authorship and Contributorship. 2009. Available from: <http://www.icmje.org/ethical_1author.htm​l>.

iThenticate. Can Ghostwriting Be Considered Plagiarism? Available from: <http://www.ithenticate.com/plagiarism-detection-blog/bid/64034/Can-Ghostwriting-Be-Considered-Plagiarism>.

Merriam-Webster Dictionary. Plagiarize. Available from: <http://www.merriam-webster.com/dictionary/plagiarizing?show=0&t=1313540495>.

POGO Project on government oversight. Frequently asked questions about medical ghostwriting. Is ghostwriting a type of plagiarism? Available from: <http://www.pogo.org/our-work/articles/2011/ph-iis-20110620.html> 

Real Academia Española. Plagiar. Available from: <http://lema.rae.es/drae/?val=plagiar>.

STERN, S., and LEMMENS, T. Legal Remedies for Medical Ghostwriting: Imposing Fraud Liability on Guest Authors of Ghostwritten Articles. PLOS Medicine. 2011. Available from: <http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001070>.

The New York Times. Ghostwriting Is Called Rife in Medical Journals. September 10, 2009. Available from: <http://www.nytimes.com/2009/09/11/business/11ghost.html?_r=0>.

TOBENNA, D.A. Profits and plagiarism: the case of medical ghostwriting. Bioethics. 2010, vol. 24, nº 6, pp. 267-272. Available from: <http://onlinelibrary.wiley.com/doi/10.1111/biot.2010.24.issue-6/issuetoc>.

Wikipedia. Escritor fantasma. Available from: <http://es.wikipedia.org/wiki/Escritor_fantasma>.

Word association of medical editors. Ghost writing initiated by commercial companies. Available from: <http://www.wame.org/resources/policies#ghost >.

External links

iThenticate – http://www.ithenticate.com/

Top grade paperscom: http://www.topgradepapers.com/

About Ernesto Spinak

Collaborator on the SciELO program, a Systems Engineer with a Bachelor’s degree in Library Science, and a Diploma of Advanced Studies from the Universitat Oberta de Catalunya (Barcelona, Spain) and a Master’s in “Sociedad de la Información” (Information Society) from the same university. Currently has a consulting company that provides services in information projects  to 14 government institutions and universities in Uruguay.

Translated from the original in Spanish by Nicholas Cop Consulting.