Author: Sergio Sismondo
Position: Associate Professor
Institution: Queen's University, Canada
E-mail: sismondo@queensu.ca
Submitted Date: February 10, 2009
Published Date: February 11, 2009
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

There are two very different reasons to be concerned about ghostwriting. One is that we want authorship to be fairly apportioned. The other is that we do not want the interests of ghostwriters' sponsors to bias the medical literature. Of these, the second is by far the more important.

Actually, attention to the second of these reasons suggests that ghostwriting is a misleading term. A company statistician who does the analysis for a paper on a trial may introduce bias into the analysis just as easily as a writer. A company's publication plan that places positive results in major journals and buries negative results similarly introduces bias. For reasons like this, I prefer to worry about the "ghost management" of research and publication.1

Although hard data is scarce, we know a tremendous amount about the ghost management of at least pharmaceutical research. Samples indicate that approximately 40% of the medical literature on blockbuster drugs is managed by pharmaceutical companies through publication plans.1,2,3 Almost all of that will involve some measure of ghostwriting.4

Publication planning is in the open. I attended one meeting of publication planners and saw them openly discussing the return on investment of medical journal articles, openly discussing how to publish the most articles from a single study, openly discussing whether authors should be allowed access to data!4 Scattered through the program were editors and publishers of some of the very most prestigious medical journals. Some of these editors and publishers took the opportunity to promote their journals to the audience. They were not trying to avoid ghostwritten articles, but to attract them.

Thus, the problem of bias connected to ghostwriting is a real one. Following Gøtzsche's lead, we should address it head on.5 We should not be distracted by forms of ghostwriting — the junior academic or science writer exploited or hired by the senior researcher — that merely pose problems of fairness. The integrity of medical literature as a whole is at stake.

1. Sismondo S (2007) Ghost management: How much of the medical literature is shaped behind the scenes by the pharmaceutical industry? PLoS Med 4(9): e286. doi:10.1371/journal.pmed.0040286

2. Healy D, Cattell D (2003) Interface between authorship, industry and science in the domain of therapeutics. Br J Psychiatry 183: 22-27.

3. Ross JS, Hill KP, Egilman DS et al. Documents From Rofecoxib Litigation
Related to Rofecoxib: A Case Study of Industry Guest Authorship and Ghostwriting in Publications. JAMA 299(15): 1800-12.

4. Sismondo S (2009) Ghosts in the Machine: Publication Planning in the Medical Sciences. Soc Stud Sci 39: forthcoming.

5. Gøtzsche PC, Kassirer JP, Woolley KL, Wager E, Jacobs A, et al. (2009) What Should Be Done To Tackle Ghostwriting in the Medical Literature? PLoS Med 6(2): e1000023 doi:10.1371/journal.pmed.1000023