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In this next module I'm going to talk about the issues of ghost writing and
guest authorship. So this has been a hot topic in the last
three, four years, it's been covered in a number of articles in the New York Times.
And it has had some pretty profound influence, on the medical literature.
So I want to spend some time talking about it.
I'm mostly going to be talking about the medical literature here, this has been a
major problem in the medical literature. I'm not sure to the extent at which it, it
occurs in other scientific disciplines, but certainly for the medical literature
it's been a huge issue of late. So what are we talking about here?
So what are ghost authors? So a ghost author is somebody that a, a
company would hire. A professional writer who a company would
hire to draft a manuscript. At the end of the day though they would
not be listed as an author on the manuscript.
Hence the term ghost authorship. So the company goes out and hires
somebody. And it's, you know, I, I, I'm certainly.
Have nothing against professional writers getting involved in the manuscript writing
process, I think that can often be a very good thing.
The problem is in the lack of transparency.
That who, the person drafting the manuscript is paid by a drug company is
probably given the message that they're suppose to be putting across by the drug
company. And yet there's no transparency on that,
on the final draft. It comes across often times, some of these
articles are then given a guest or honorary authorship, which I'll talk about
in a minute, to make it look like an academic wrote that.
And so there is all sorts of problems there.
The related, type of authorship is this guest authorship or sometimes called an
honorary author. And this happens when a company writes a
manuscript, drafts a manuscript, does all the data analysis, kind of makes all the
conclusions on their own. After the draft is ready, they contact
somebody who is at an academic institution,
Usually in a kind of a prestigious university.
And say, hey, we'd love to make you an author on, on this paper.
You know, you remember, you kind of helped us a little bit with the study designing
way back when? Well now we want to make you first author
on the paper. And this happens, and I'm gonna show you
how well documented this is, and Authors, you know academic researchers lend their
name. As an author, you're often a first author,
And it's a, it's a benefit for sort of *** tat, *** for tat relationship.
The, So it's a benefit for academic researcher.
Because, often times these drug company studies are major clinical trials that get
published in major journals. So there they boost the academic
researcher's academic resume for things like promotion.
They also help the drug company, because if you kind of, try to minimize the
involvement of the drug company, and make it look like somebody at a prestigious
independent academic institution was the person responsible for the article,
That bolsters some credibility to the pe-, to the paper, some sense of the there's an
independent person involved. So,
Obviously, that is misleading. So people have tried to figure out, how
often does this occur? It's kind of a well known thing that this
has occurred for, for a while, of a long time in the medical literature.
People have been aware of it, and it's just kind of been done.
It's been getting a lot more press attention lately.
Because of the fact that there's been some major drug trials and some, some court
trials involving drug companies, where there's been a lot of internal documents
that have been opened for viewing because of these court trials.
And some interesting things have been found there and so, I think there's just a
heightened awareness of this issue. So, how often does it occur?
In the latest study in British Medical Journal in 2011, some researchers sent an
anonymous survey to the corresponding authors of articles from top medical
journals. So these are things like the Annals of
Internal Medicine, JAMA, New England Journal of Medicine.
And they asked them to report in an anonymous survey how often guest or
honorary authorship occurred and how often ghost writing occurred.
And so they found that 17.6% of those corresponding authors reported the
occurrence honorary or guest authorship and 7.6% reported the occurrence of ghost
authors. So it's happening in some of these papers
may have overlapped. So it's happening though in about,
You know, right? Somewhere around twenty percent or so of
papers. So that's a fairly high percentage,
And these, again, are the top medical journals.
So this really quite pervasive. So just to give you an example of, of this
as a case study, there was a paper published in JAMA in 2008.
The researchers had access to a, a whole bunch of internal company documents from
Merck because Merck was being sued due to the drug Vioxx which, was pulled off
shelves when it was learned to increase the risk of heart attack.
So the researchers went through a whole bunch of court documents.
They found about 250 court documents that were relevant to this issue of authorship,
and they looked at these company e-mails and company internal documents that were
related to either publishing clinical trials papers or review papers.
And what they found was really quite interesting and, and, and shocking.
So I'm just going to quote the, the summary that the, the authors wrote in the
JAMA paper. So they reviewed 24 clinical trials papers
and, and they said this is what they found.
Documents were found describing Merck employees working either independently or
in collaboration with medical publishing companies to prepare manuscripts, and
subsequently, subsequently recruiting external academically affiliated
investigators to be authors. So this is this whole problem of using
honorary or guest authors. Recruited authors were frequently placed
in the first and second positions of the authorship list.
So again, people knew that this was occurring but when we had all these
documents, then you could really kind of track exactly how prevalent and how
systematic this was at a company like Merck.
An just to give you an idea. This is one of the emails that was
published in this article. It's from an internal company email where
they're writing to a potential guest author and asking them if they'd like to
be an author. And it kinda just shows you how blatant
this is. So the company writes to the potential
guest author, I would like to invite you to be an author on the abstract and
manuscript for this study." We are currently preparing both for submission
before the end of this year. So obviously, the company is already
preparing these things. And now, after the fact, they're asking
for this person to be an author in the study.
Could you please let me know if you would be interested in authorship on both the
abstract and manuscript. One of the two planned type publications
or none. So it's, like, well, authorship is just
this, you know, thing that the company has to give out in the, the researcher can
choose whether or not they wanna be an author on any of these things.
So, you can see really that this is truly a guest authorship.
In making your decision, you may want to take into consideration that the results
of this study were negative at first glance.
So they're saying hey, you know, to the researcher,
You know, you may not want to be on this study because it came up negative.
Well, obviously that's not the reason somebody should be an author on a study or
not. Obviously this researcher was not heavily
involved in the analysis and the writing of this paper.
So this is a clear case of guest authorship and they turned up a number of,
you know, very, Emails like this which made it very
obvious what was going on. I, even more interesting, when they look
at the review papers. Now review papers aren't based on any, you
know, new data. So, what was happening with the review
papers is that people that were in marketing and Merck we kind of coming up
with a marketing strategy. They were then contracting with medical
publishing companies who would go strike the manuscripts.
Obviously those publishing companies, those professional writers, weren't gonna
be put as the authors on that manuscript. And then they would go to an external
academic person and ask them to be the author.
So, this is a real case where a review article may present a particular opinion
or view or perspective. And so they're.
Basically getting a, an outside academic person who has this, you know, sense of
authority and independence to lend their name to their marketing strategy, and
often, They, these, authors were paid honoraria for their participation so not
only did they, you know, not write the article and they get to put it on their
CV, but they're also being paid to lend their name.
And interestingly only half of these review articles disclosed the, the ties to
Merck. So that's quite insidious.
And you can see that, that could have a profound impact on the medical literature.
Merck could actually, you know, put this whole set of opinions and perspectives out
in the medical literature with it having the, the stamp of, you know, it coming
from an academic institution when it really came from the drug company
marketing people. So you can see how why this has been such
a, a hot issue. I'll refer you to a couple more articles
if you're curious and, and it's a very you know, fascinating topic.
If you're curious to read more there's been a whole bunch of articles in the New
York Times about this. And I'll.
Just quote you from one more from one these articles to again to show this
wasn't just Merck. So in another case with Wyeth being sued
over hormone replacement therapy. Another whole set of court documents came
out. And so the New York Times and Plath
Medicine got together and kind of went through these documents and, and here's
the summary. The court documents provided detailed
paper trail, showing how Wyeth contracted with a medical communications company to
outline articles, draft them, and then solicit top physicians to sign their
names, Even though many of the doctors
contributed little or no writing. The document suggests that the practice
went well beyond the case of Wyeth and hormone therapy involving numerous drugs
from other pharmaceutical companies. So this is really, was a really widespread
thing for drug companies. And again, now journal editors are
becoming much more aware of it. So, it's likely that this practice will
change, But as that British Medical Journal
article showed, it's still fairly pervasive in the literature.
At least in the medical literature. The proceeding program is copyrighted by
the board of trustees of the Leland Stanford Junior University.
Please visit us at med.stanford.edu.