Back then it became evident that a particularly pernicious type of ghost-writing was much more prevalent than anyone seemed to realize.
This sort of ghost-writing has several important elements.
- Commissioned by Those With Vested Interests - The writing is commissioned by an organization with a vested, usually commercial interest, e.g., a pharmaceutical company.
- Directed to Support Vested Interests - The ghost-writer, perhaps a free-lancing medical writer or employee of a medical communication company, writes an article meant to support that organization's interest, often by setting the stage for the organization's new products. For example, a pharmaceutical company about to market a new drug may commission articles that makes the condition for which the drug is used seem particularly common or important, or which emphasizes the negative aspects of current treatments.
- Fronted by an "Expert" - Finally, an expert, often a well-known academic, agrees to become the article's ostensible first author.
Another article in the journal Perspectives in Biology and Medicine's 2007 "medicine and industry" issue addressed the importance of this sort of ghost-writing. [Moffatt B, Elliott C. Ghost marketing: pharmaceutical companies and ghostwritten journal articles. Perspectives Biol Medicine 2007; 50: 18-31.] It made two important assertions.
Ghost-Writing Is Common
Moffatt and Elliott concluded that ghost-writing practice is common, perhaps accounting for as many as 10% of journal articles. Moreover, stealth marketing campaigns that emphasize ghost-writing may create a bolus of articles that may be enough to dominate the literature on particular topics. Moffatt and Elliott summarized some of the known campaigns, including those sponsored by Pfizer Inc to support Zoloft, by Wyeth to support Fen-Phen, and by Parke-Davis (later merged into Pfizer Inc) to support Neurontin. It is particularly worrisome that the clinical literature on a particular topic may be dominated by the products of organized stealth marketing efforts.
Ghost-Writing Is Wrong
The arguments are strong and straight-forward.
First of all, and most importantly, it is harmful to the public health. Although relatively little is known about the details of corporate ghostwriting, the glimpses that we get of it through anonymous surveys and lawsuits suggest that the reason pharmaceutical companies go through the trouble and expense of shaping medical opinion about the safety and efficacy of their products is that it is highly profitable. Marketing campaigns seek to influence the prescribing practices of doctors. Ghostwritten articles may mislead doctors about the actual risks and benefits associated with medical treatments. Medical misinformation of this sort has the risk of harming a large number of people. The potential for harm is amplified by the fact that ghostwritten articles usually bear the name of a highly respected researcher who appears to have no financial stake in the issue at hand.Furthermore, Moffatt and Elliott argue that ghost-writing undermines science.
Second, ghostwritten journal articles always contain undisclosed conflicts of interest. The failure to disclose conflicts occurs on many levels. The "named author" fails to disclose that he or she has received payment for agreeing to publish the paper under his or her name. The MECC fails to disclose that it has received a substantial amount of money to prepare the article and find a 'named author.' And the sponsoring company fails to disclose that it has a direct financial stake in the drug or product in question.
Ghostwritten articles are useful as marketing tools precisely because they appear to come from a disinterested source. In fact, the entire program of ghostwriting is designed to give articles written by people with a direct financial interest in promoting a product the appearance of disinterestedness.
The harm done by ghostwriting is compounded by the fact that the system of scientific communication is a key aspect of scientific objectivity. One approach to scientific objectivity holds that sc