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Neurology Journals: How They Hope to Discourage ‘Ghostwriting’


doi: 10.1097/01.NT.0000333581.80468.43

Drug companies frequently conceal their efforts to use journals as a marketing tool by persuading respected academic researchers to claim authorship of an article actually written by a medical ghostwriter paid by the company to put the drug under study in the best possible light.

That claim, made by Joseph S. Ross, MD, of the Mount Sinai School of Medicine, and colleagues, in an April 10 paper in the Journal of the American Medical Association (JAMA), elicited letters and editorials decrying the practice. The article used court documents from litigation involving rofecoxib (Vioxx) to show that Merck routinely hired ghostwriters to prepare manuscripts for publication, and then attributed authorship to respected academic researchers who did not always disclose the financial compensation they received from the company.

Merck withdrew rofecoxib from the market in 2004 because of evidence that it contributed to heart attacks. The company agreed to a $4.85 billion settlement in a class-action suit involving thousands of former rofecoxib patients or their families.

In interviews with Neurology Today, several leading neurology editors spoke about the challenges of identifying ghostwritten papers and blocking their publication.

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The “perfect solution” to this problem, according to John H. Noseworthy, MD, editor in chief of Neurology, might be to reject any submission written by a ghostwriter, “and maybe that's where we'll be in the near future.”

But that might merely drive the problem further underground, he added.

Instead, Neurology will demand an accounting of each author's contribution to a paper, and promote all contributors to full authorship. That way, ghostwriters and the scientists will appear together in each paper's byline, “and you'll see that the science writer was paid by the company,” Dr. Noseworthy said.

“Basically we're saying that if the first draft was written by a commercial writer, then that person is an author and you have to tell us that. Anyone who tries to hide authorship will be in violation of our policy, and if we become aware of that there will be consequences.”

Although the policy does not prohibit ghostwriting, it may curb the practice, Dr. Noseworthy believes.

“If you have an academic reputation and we force you to say this paper with your name on it has been written in part with help of a commercial writer, you'll pay close attention to the paper, or else you'll say I want to write the draft myself,” he said. “I think it will force the behavior we want. Most self-respecting academics don't want their name on a paper written by a commercial writer.”



The consequences for violating the policy will be determined on a case-by-case basis by the editorial board, Dr. Noseworthy said, but they could include sanctions on future submissions to Neurology. “The consequences could be mild, moderate, or severe depending on the level of violation,” he said.



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This policy also will help avoid problems pertaining to copyright, said Patricia K. Baskin, MS, managing editor of Neurology.

“The lead author and all other known authors must assign copyright to us, allowing us to sell reprints and to charge for reuse of the material,” she said. “However, an author does not have the right to assign copyright if the paper has actually been written by a professional medical writer hired by a pharmaceutical company but not identified as an author. The company might argue later that they still own the materials because the authors did not have the right to assign the copyright.”

Under Neurology's new authorship agreement, the editor could choose to deny future publishing privileges for a specific period to authors who deceived the journal by signing a copyright transfer agreement for an article actually written primarily by a ghostwriter. The editor also could sanction authors for failing to credit a ghostwriter who had made a substantial intellectual contribution.

“The new authorship agreement will provide transparency to the fact that certain writers are working for a drug company,” Baskin said. “That will give the readers a chance to decide about their credibility.”

Murray Sagsveen, general counsel of the AAN, agreed with Baskin. “We must eliminate ghostwriting for at least two reasons,” he said. “One, journal articles should include the names and disclosures of all contributors to manuscripts and published articles so that peer reviewers and readers can better evaluate the work, and two, all authors must be identified in order to appropriately transfer copyright ownership to the journal. Concealing the identity of contributors to manuscripts and published articles is, in my opinion, an unethical and fraudulent practice.”

Other neurology journals also seek to identify ghostwriters. The Journal of Neuroscience, for example, published by the Society for Neuroscience, defines an “author” as anyone who makes a substantial intellectual contribution to the article. It also opposes “honorary” or “guest” authorship.

And Roger N. Rosenberg, MD, editor of the Archives of Neurology, said he studies each submission for evidence of ghostwriting.

“Clinical trial papers should be written by the authors who did the work,” he said. “And they should always disclose any financial support to the author by the sponsor.”

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Several neurology editors share strategies for discouraging ghostwriting by industry writers.

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• DeAngelis CD, Fontanarosa PB. Impugning the integrity of medical science: The adverse effects of industry influence. JAMA 2008;299 (15):1833–1835.
    • Ross JS, Hill KP, Krumholz H, et al. Guest authorship and ghostwriting in publications related to rofecoxib: A case study of industry documents from rofecoxib litigation. JAMA 2008;299(15):1800–1812.
      ©2008 American Academy of Neurology