Better strategies to tackle ghostwriting in the medical literature are the subject of a debate by leading authors in next week's issue of the open-access journal PLoS Medicine. Ghostwriting is scientific misconduct, argues Peter Gøtzsche, Director of the Nordic Cochrane Centre, Copenhagen, Denmark, because it is dishonest and often does not allow for proper accountability of the role of authors and study sponsors in the publication process.
"Court cases that allowed access to industry files have shown that ghost and guest authorship are common," says Dr. Gøtzsche, citing a recent example involving the anti-inflammatory drug rofecoxib (Vioxx) in the Journal of the American Medical Association (JAMA).
But Jerome Kassirer, former editor-in-chief of the New England Journal of Medicine, disagrees. He states that while ghostwriting "debases the fundamental tenets of the medical profession" and can jeopardize patient care, we still do not have enough evidence of its existence. "We must be careful not to impose excessive regulations to solve problems that may not be threatening," argues Dr. Kassirer.
A third perspective on ghostwriting comes from an international group of professional medical writers who argue that so long as their contribution to publication is explicitly disclosed, "the communication expertise and health care knowledge" of professional medical writers can be an untapped resource to help researchers publish and disseminate their research. They propose a new checklist for authors using medical writers that can be included with manuscript submission and encourages appropriate disclosure of writing assistance.
One of the problems in tackling ghostwriting, says Dr. Gøtzsche, is that "the involved parties have a common interest in secrecy, and junior researchers can ruin their careers if they reveal that the professor did not write the papers that bear his or her name." The implications of ghostwriting are considerable: "ghostwriting threatens the validity of our medical knowledge, and in doing so it jeopardizes patient care," says Dr. Kassirer.
Ghostwriting occurs when someone makes substantial contributions to a manuscript without attribution or disclosure. It often occurs simultaneously with "guest authorship" (sometimes called honorary or gift authorship), where authorship is given even though the contributions of the named authors are minor or nonexistent.
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