Full Disclosure: Bring Health Writers Out of the Ghostwriting Shadows

If the consequences for pharma-sponsored ghostwriting are steep – lawsuits, public embarrassment, retractions, under-bus-throwing – the temptations are also very real. It's hard to argue with a steady and, in some cases, very nice payment for your writing.

Linda Logdberg knows this temptation well. At a conference on the Ethics of Ghost Authorship in Biomedical Research at the University of Toronto in May 2011, the biologist and freelance writer told the audience about her experiences as a ghostwriter. She then wrote a piece for PLoS Medicine: Being the Ghost in the Machine: A Medical Ghostwriter's Personal View, which was one of the original inspirations for this Full Disclosure series.

Logdberg had a PhD in biology but was having trouble finding a tenure track position in academia. She found that there were a lot of things to like about working for a medical communications company:

First, I believed that I was helping people: sick people need drugs, and physicians need to know about those drugs to prescribe them appropriately. Second, I had young children and valued the flexibility of working at home, which most med-ed companies offered at least part of the time. Third, the work was interesting: I interacted with top researchers and was assured of an ease of access that I never would have had as an assistant professor. Fourth, the money was good. Really good, especially compared with the typical assistant professor salary. And perhaps most important in the longer run-it was fun. Traveling, eating in high-end restaurants, wearing fashionable clothes, and rushing to meet important deadlines-what's not to like?

There was so much to like that Logdberg worked as a medical writer for 11 years and was involved in many different projects for small companies and large. But, as she writes, the work also began to make her feel uneasy.

In addition, the ethical issues began to tap me on the shoulder: perhaps the most memorable example of this was a contraceptive product that caused severe, unpredictable vaginal bleeding in some women. My job was to draft a monograph that would profile the product's benefits, one of which, according to the client, was that although the bleeding could be severe, it was at least something that women could anticipate. In other words-the bad news is that a meteorite will strike you, but the good news is-a meteorite will strike you!

And a meteorite is bound to strike ghostwriters, too, if they find ways to fudge those side-effect facts while sneaking marketing messages into the medical literature. Logdberg has some very interesting advice on how to remedy the situation and create more work for health writers in the bargain. (I assume none of you object to that.)

She cites a piece by Richard Monastersky from the Chronicle of Higher Education in 2007 that showed that the "number of tenured and tenure-track scientists in biomedicine has not increased in the past two decades even as the number of doctorates granted has nearly doubled." What are all of these PhDs supposed to do with their degrees? Why wouldn't they ghostwrite, if only to pay back their student loans?

So Logdberg proposes a shift in the money flow. Right now, pharmaceutical companies hire medical education companies, which hire ghostwriters. She thinks that pharmaceutical companies should pay the universities and research centers directly as part of the grant for the academic work. The professor gets some money, and the school gets some money for a staff of writers who work with the professors to help make sense out of the science:

The pharmaceutical company's role would be limited to factchecking the document and clarifying issues about dosage, adverse events, postmarketing developments, etc., and the final product would be submitted for peer review by the researcher personally. The incentive for the pharmaceutical company would be to educate and inform physicians and researchers, pure and simple. Drug promotion would still occur, but would be in the hands of advertising agencies.

One of the most intriguing things about this approach is that it gives the research center some skin in the game because, as Logdberg writes, "the academic institution that employed the researcher-author would have a stake in ensuring the paper's accuracy as well as in exposing conflicts of interest."

For this to work, the schools would have to institute some rigorous training for the writers themselves, including significant ethics training to help spot some of the trickier ethical dilemmas. The school would have more control over the outcome. As it is now, academics are working independently and yet listing their school's name as the author affiliation in the journal articles – and not the pharmaceutical company or device maker. With Logdberg's plan, the schools could demand some specific requirements from the pharmaceutical company as part of the condition of the grant.

One of those conditions should be something along the lines of what Dr. Mark Kramer proposed in Antidote. He suggested that all authors – academics and medical writers – have their work fully acknowledged and that the listed authors on the article be required to write a companion piece for the journal's editors, "a scholarly critique of the soundness and limitations of the scientific methods that were used to address the central hypotheses of the article and each and every argument made in the discussion sections and conclusion sections."

More work for health writers and PhDs sounds like a great idea, but it should also be paired with better oversight into what pharmaceutical companies and academics are producing for medical journals.

Have your own solution to the problem of pharma-sponsored ghostwriting? Share it in the comments below, send it to askantidote@gmail.com or send me a note on Twitter @wheisel.

Photo credit: iStockphoto

Related Posts:

Full Disclosure: Health Writers Take Big Risks When Ghostwriting