{"id":33758,"date":"2013-03-02T11:57:49","date_gmt":"2013-03-02T16:57:49","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=33758"},"modified":"2013-03-02T16:01:56","modified_gmt":"2013-03-02T21:01:56","slug":"ghost-specialty","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2013\/03\/02\/ghost-specialty\/","title":{"rendered":"ghost-specialty…"},"content":{"rendered":"
In closely reading many of the Clinical Trials of the psychoactive drugs in the last thirty years, I found that the majority put varying levels of spin on the data. I didn’t expect that. I had spent my medical life believing that the Journal editing process and peer review process was a system that wouldn’t allow that. I was wrong as rain – wronger than I could have ever imagined. <\/div>\n

Subsequently, I learned about things like ghost-writing, guest authoring, data manipulation techniques – something like an epidemic of corruption in our medical literature. When I first started to see these examples, I thought they were isolated incidents, but began to realize that deceit seems to have been the rule rather than the exception. So when people began to lobby for reform: funding declarations, conflict of interest statements, acknowledgement of authors, data transparency; it hardly seemed like there was any question that such measures were necessary, yet they have been heavily resisted. <\/p>\n

One argument has been "what’s so wrong with editorial assistance?" Doctors are lousy writers. Ghost-writers produce much more readable articles. But ghost-writing is so much more than grammar and style, as this article makes clear. From my point of view, ghost-writing’s wrongness is self evident, but I think this article fleshes out the "why" of it in a compelling way: <\/div>\n
\n
Medical Ghostwriting and Informed Consent<\/a>
by Almassi B.<\/sup>
Bioethics.<\/font><\/strong> 2013 . doi: 10.1111\/bioe.12017. [Epub ahead of print]<\/div>\n

<\/p>\n

Ghostwriting in its various forms has received critical scrutiny from medical ethicists, journal editors, and science studies scholars trying to explain where ghostwriting goes wrong and ascertain how to counter it. Recent analyses have characterized ghostwriting as plagiarism or fraud, and have urged that it be deterred through stricter compliance with journal submission requirements, conflict of interest disclosures, author-institutional censure, legal remedies, and journals’ refusal to publish commercially sponsored articles. As a supplement to such efforts, this paper offers a critical assessment of medical ghostwriting as contrary to good patient care, on the grounds that it contradicts established general principles guiding clinical ethics. Specifically, I argue that ghostwriting undermines trust relationships between authors and their readers, and between these readers and their trusting patients, and in so doing contradicts the duty of respect for patient autonomy by obstructing informed consent. For this reason, complicity in ghostwriting practices should be understood as a violation of the professional ethical duties of physicians and other healthcare workers.<\/strong><\/sup><\/div>\n<\/blockquote>\n
Here are a few quotes along the way and the author’s conclusion: <\/div>\n
\n
Recent analyses characterize ghostwriting as plagiarism or fraud, and have urged that it be deterred through stricter compliance with journal submission requirements, thorough disclosure of conflicts of interest, author-institutional censure, legal remedies, and medical journals’ voluntary refusal to publish commercially sponsored articles. As a supplement to such efforts, I offer a critical assessment of medical ghostwriting as fundamentally contrary to quality patient care. While ghostwriting is a problem for research ethics, I argue here that it also contradicts established moral principles guiding clinical ethics. Specifically, medical ghostwriting contradicts respect for patient autonomy by impeding facilitation of patients’ informed consent, and as such should be understood as a violation of physicians’ professional ethical responsibilities.<\/strong><\/sup><\/div>\n
<\/div>\n
We may be especially but not exclusively concerned about authorship misattributions in journal publication. A former long-time drug company sales representative, Kimberly Elliott testifies that key opinion leaders can be handsomely financially compensated for giving lectures ‘largely based on slides supplied by the company’ – we might call this ghost lecturing. What Sismondo characterizes as ghost management includes corporate sponsors’ involvement throughout all phases of development and marketing, including but not confined to medical writers’ penned research and review articles made available for doctors’ ostensible authorship.<\/strong><\/sup><\/div>\n
<\/div>\n
… as described in The Observer<\/a> in 2003:<\/strong><\/sup><\/div>\n
    \n
    Dr. David Healy, of the University of Wales, was doing research on the possible dangers of antidepressants, when a drug manufacturer’s representative emailed him with an offer of help. The email, seen by The Observer, said: ‘In order to reduce your workload to a minimum, we have had our ghostwriter produce a first draft based on your published work. I attach it here.’<\/strong><\/sup> The article was a 12-page review paper ready to be presented at a forthcoming conference. Healy’s name appeared as the sole author, even though he had never seen a single word of it before. But he was unhappy with the glowing review of the drug in question, so he suggested some changes. The company replied, saying he had missed some ‘commercially important’ points. In the end, the ghostwritten paper appeared at the conference and in a psychiatric journal in its original form – under another doctor’s name.<\/strong><\/sup><\/div>\n<\/ul>\n
    <\/div>\n
    I have suggested that critics of medical ghostwriting as an ethically and evidentially troubling aspect of contemporary commercialized research would do well to draw on the recognized professional bioethical duty of respect for patient autonomy, and specifically of the facilitation of patients’ informed consent. I have argued that ghostwriting obstructs informed consent by misleading (i) physicians and other medical professionals reading the research in published ghostwritten form, and (ii) these readers’ patients, themselves epistemically and medically dependent on their caregivers’ reliance on the testimony of ghostwritten research. I have argued that ghostwriting undermines critical assessment of the credibility of published medical research as expert testimony because of its authorial misattribution, and so encumbers physicians and other healthcare professionals assisting patients becoming to be sufficiently and accurately informed of their treatment options, benefits, risks, and other such considerations. Thus ghostwriting doubly undermines trust and the informed consent built upon it. Physicians have a compelling professional ethical duty, then, not to participate in ghostwriting, which should be clearly framed in medical education as contrary to trustworthy medical research and quality clinical care.<\/strong><\/sup><\/div>\n

    <\/p>\n

    This is not to imply that professional medical writers have no place in medicine. Far from it: developing, acquiring, and publishing research can be a collaborative enterprise to which specialists bring their varied complementary strengths to the collective process. Writing and skill in scientific communication more broadly need not be disregarded as valuable specialized communicative contributions. A driving force behind commercial ghostwriting in medicine is to obscure the evidential weight of these varied intellectual contributions: making use of the value of authorship as an evidential indicator of research credibility while treating it as interchangeable and disconnected from research veracity. Authorship becomes a peculiar free-floating thing, able to be gifted and traded as long as these exchanges remain hidden. By recognizing transparency in one’s specific scholarly contributions to medical research as a requirement of medical ethics, as a matter of one’s duty of respect for patient autonomy, medical professionals can undercut this corrosion of authorship and so maintain trustworthy mechanisms of research publication.<\/strong><\/sup><\/div>\n<\/blockquote>\n
    My own take on this story has to do with the covenant between the sick and those who are entrusted with their care at any level. A medical researcher is no different from the primary care physician, obligated by the same ethic and responsibilities. Neither the marketing department at a pharmaceutical company nor the medical ghost-writer shares that obligation. In fact, often the task is the opposite – to make the drug look better than it is, safer than it really is.<\/div>\n

    If Martin Keller himself had written up Paxil Study 329, would he have concluded that Paxil was a safe and effective treatment for adolescent depression? I can’t know the answer, but my guess is that it would’ve been a lot harder for him to do that than it was for him to sign on to Sally Laden’s ghost-written version. Sally’s covenant was with the sales force of GlaxoSmithKline, not the patients who would be taking the drug – and that shows throughout the paper. In the David Healy example above, the real author was writing for the pharmaceutical company – not Dr. Healy.<\/p>\n

    In the Healy example, this statement is simply a lie, ‘In order to reduce your workload to a minimum, we have had our ghostwriter produce a first draft based on your published work. I attach it here.<\/em>’ It’s an invitation to join in a different kind of covenant – and way too many accepted this kind of offer. Over time, it became something of a norm selecting for an upper echelon heavily populated by compromised pundits. The covenant between organized and academic psychiatry and mentally ill patients has become largely broken. <\/p>\n

    That ghost-management, ghost-lecturing, and ghost-writing have produced a ghost-specialty is self evident. The only real issue is what happens now? It is hardly likely that the current denizens of organized and academic psychiatry will be able to re-establish a rational covenant with the mentally ill among us…  <\/div>\n","protected":false},"excerpt":{"rendered":"

    In closely reading many of the Clinical Trials of the psychoactive drugs in the last thirty years, I found that the majority put varying levels of spin on the data. I didn’t expect that. I had spent my medical life believing that the Journal editing process and peer review process was a system that wouldn’t […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-33758","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/33758","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=33758"}],"version-history":[{"count":34,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/33758\/revisions"}],"predecessor-version":[{"id":33793,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/33758\/revisions\/33793"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=33758"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=33758"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=33758"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}