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Ghostwriters and ghostbusters: drugmakers routinely hire writers to prepare 'research papers' touting their products for publication in prestigious medical journals, and some physicians are happy to sign their names to them - for a fee. The practice raises serious questions about the integrity of medical literature.

Article Excerpt
In the early 1990s, Troyan Brennan, a physician and lawyer at Harvard University, received a generous offer: $2,500 just to sign his name to an article that was already written and slated to be submitted to a prestigious medical journal. Immediately suspecting that a drug company was behind the deal, Brennan--who is endowed with a stubborn sense of ethics--declined the offer. He then wrote his own article, exposing the ghostwriting scam and naming the company behind it.

Brennan sent me his article when I was the editor of the New England Journal of Medicine (NEJM), and we published it right away. (1) It was one of the first to expose the practice of medical ghostwriting by pharmaceutical companies.

What is ghostwriting? In the medical context, a nonphysician writer pens a manuscript that is published under the name of a "guest" physician--a doctor who, in most cases, has been paid to lend his or her name to the article. Both the ghostwriter and the physician are at fault: The doctor gets credit (and money) for work he or she didn't do, and the pharmaceutical company can promote the drug under a mantle of scientific respectability. Both threaten the integrity of science.

A doctor who goes along with this practice violates a fundamental publishing principle--that people should publish only their own work. The practice also represents a financial conflict of interest. (2) And to the extent that the ghostwriters simply parrot the drug company's merchandising messages, they are complicit in producing biased medical information.

For all these reasons, ghostwriting damages the authenticity of medical literature and can lead to the spread of misinformation among doctors, inappropriate uses of drugs, and needlessly expensive medical care. Ghostwritten articles have promoted off-label use of some drugs; downplayed the risks of drugs for obesity, arthritis, and psychiatric disorders; and exaggerated the benefits of other drugs. (3)

Generally, two types of articles are ghostwritten: reports of clinical trials and reviews of previously published medical literature.

Many clinical research trials are funded by industry. When testing a new drug, for example, a pharmaceutical company will hire a researcher as the "principal investigator" and then engage other physicians--anywhere from dozens to hundreds--from all over the country or the world to conduct tests of its new drug. The company collects and...

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