What IS Medical Ghostwriting? Don’t throw the Baby out with the Bathwater.

Published September 1, 2009 in the Op-Ed section of the Montreal Gazette

By Kate Johnson

Barbara Sherwin  and McGill University’s unfortunate tangle with pharmaceutical ghostwriting could deal a serious blow to the publication of sound, ethical research worldwide if the reaction is to throw the baby out with the bathwater.

As medical ethicist Margaret Somerville, also of McGill, has already pointed out, Sherwin’s mistake could have been made by any number of well-intentioned, busy researchers.

The “publish or perish” panic in medical academia has many brilliant researchers scrambling to churn out enough papers to justify their jobs. John Eden, another well-known researcher implicated in this ghostwriting scandal, recently admitted this to Seattle blogger William Heisel.

As a medical editor, I help researchers with their writing –  enabling them to communicate the results of their studies to the wider medical community.

This is not ghostwriting.

But in their haste to distance themselves from this ghostwriting exposé of the pharmaceutical industry, medical schools and academic journals may intimidate researchers from seeking the appropriate help of professional writers and editors.

In doing so they risk losing a great deal of valuable research done by brilliant investigators who can’t write.

Commenting on the ghostwriting scandal to reporter Jason Magder, Dr. Paul C. Hébert, Editor-in-Chief of the Canadian Medical Association Journal  hit the nail on the head when he said “doctors are generally not very good writers”.

I see many first drafts that confirm this observation. But between the lines, buried under mixed metaphors and sloppy grammar, is always a diamond in the rough – a nugget of valuable medical information that the rest of the world needs to know. Like a good meal, there’s much to be said for presentation.

On the other hand, there are also many doctors who know how to write well, but just don’t have the time. Having interviewed Dr. Sherwin several times over the past 15 years, I would guess she would be in this category. As an internationally recognized authority in her field, she expresses herself articulately, eloquently and philosophically – which is why she is consulted so frequently by her colleagues and the media.

Margaret Somerville fits into this same category. She describes her own near brush with a ghostwriter when she was approached by a medical publisher to write a paper: “I replied that I didn’t have time to write such an article. The publisher said that they could help….It never occurred to me that accepting that offer would be unethical – and I’m an ethicist,” she wrote. The publisher’s version was unacceptable, so in the end she wrote the piece herself. But if the publisher’s article had been acceptable to her, “I would not, at that time have thought it unethical to publish it,” she writes. “I thought of this offer as equivalent to having a research assistant, which is a universal practice in academia.”

People like Somerville and Sherwin – and many, many others – have a wealth of information and experience that the medical community and public can benefit from, but they struggle to find the time to write. After all, they were not trained as writers. Wouldn’t their expertise and energy be more valuable in the lab or clinic?

Many important studies gather years of dust because researchers can’t face the mammoth job of writing them up. Medical research would move ten times faster, cures and treatments would be uncovered at twice the pace, if only the papers would get written, edited, submitted and published more quickly.

Assistance from professional medical writers is accepted and encouraged by many journals because it saves journal staff the time, frustration and even money involved with reviewing sloppy pieces.

“We value the contributions of medical editors and technical writers who play key roles in helping translate complex medical terms into simpler concepts,” Dr. Hébert, of the Canadian Medical Association Journal told me this week, when I asked him to clarify his concerns about the ghostwriting scandal.

But in the wake of this exposé, medical journals like the CMAJ are being forced to examine their position on authorship, and of course to publicly condemn ghostwriting.

Clearly, this is a public debate that is long overdue, but before we reject ghostwriting forthright it’s important that there is a clear definition of what it is.

Professional writers hired by companies to promote the benefits and downplay the risks of a product are ghostwriters. Professional writers who work with researchers to help them focus their thoughts and communicate their scientific findings are not.

In his medical ethics blog, and in the Toronto Star reporter Stuart Laidlaw suggests that medical ghostwriting  “operates a lot like the essay-writing firms that tempt students to pay someone else to write their term papers”. While students get expelled for plagiarism, professors get promoted.

Editing, on the other hand, is a grey area. At a basic level it involves crossing t’s and dotting i’s…checking spelling and punctuation. At a less basic level it becomes structural – moving sentences and paragraphs around – sometimes even suggesting connecting sentences to link ideas and improve flow. But, as any journalist knows, a good editor takes a critical look beyond the superficial – aiming for focus, and conceptual integrity, ensuring the information is presented in context, and that there is a discussion of implications. These are the threads that bring a scientific paper together – they are the concepts that inspired the researcher to undertake the investigation in the first place, but sometimes they get buried in the data and need someone to dig them back out.

Researchers around the world need the assistance of professional writers to facilitate the rapid, efficient communication of their life’s work. Providing them with this kind of academic support would take the shine off what ghostwriters have to offer and restore integrity to medical publications.

I am a member of the American Medical Writers Association. 

Disclosure: As a freelance medical journalist I cover developments in the world of doctors and medicine and write mostly for a physician audience. I also do consulting work as a medical editor, helping researchers prepare their papers for submission to journals. To avoid any conflict of interest between these two things I don’t edit the work of physicians and have confined my editing contracts to the field of nursing.