Today we publish part one of a three-part guest blog series that came to us in an unsolicited submission. But because we’ve followed the two authors’ work, we are pleased to accept and pass along their thoughts. Here is the first of the series by Jonathan Leo, PhD, and Jeffrey Lacasse, Ph.D.

Part One: When Should a Medical Paper be Considered Ghostwritten? Three Easy Steps to Finding Ghost Authors

One of the hidden secrets of the medical literature is that the named authors on a paper’s byline, particularly in the case of clinical trials, are not necessarily the individuals who wrote the paper. It is not uncommon for pharmaceutical companies, or medical product manufacturers, to write their own papers and then find university professors to agree to be the named authors of the paper. The company employees are then invisible to the readers. Presumably, the suggestion that a certain medication or medical product is safe and efficacious will carry more weight if it comes from an unbiased source, often called a Key Opinion Leader (KOL), rather than a company representative. According to Forest Pharmaceutical’s marketing plan for Lexapro, “Bylined articles will allow us to fold Lexapro’s message into articles about depression, anxiety, and comorbidity.” With ghostwritten papers it is hard to know where to draw the line between science and marketing. Because of its secretive nature, the true extent of this practice is unknown. What will probably surprise much of the general public, and many members of the media, is that the medical community has not called for an outright ban on ghostwriting. Rather than forbid the practice outright, some in the medical community seem to be trying to develop policies that will allow papers to be published with invisible authors, but that won’t be labeled as “ghostwritten.”

When should a paper be considered ghostwritten? In any other segment of academia, or even in popular literature, this is a fairly straightforward question, answered by simply examining the byline. If the paper’s byline has an “invisible author” (a ghost), then the paper should be considered ghostwritten. However, when charges of ghostwriting appear about a medical paper there are all sorts of reasons given why the paper should not be considered ghostwritten. The defenses are endlessly creative and include such notions as: the paper was accurate, the “named” authors signed off on the paper, the paper was peer-reviewed, the person who wrote the first draft is thanked in the acknowledgement section, or the list goes on. These defenses are not just espoused by companies but are often put forth by university administrators. It seems slightly paternalistic to tell the readers of a paper that they shouldn’t bother themselves with concerns about who actually wrote the paper, because higher powers have determined that the paper is accurate, or that the “named” authors have signed off on it, or that the “named” authors are good scientists. If the second line of a paper –the byline usually follows the title- is not accurate, why should anyone trust the rest of the paper?

In our view there are three simple steps for finding ghosts. Step one is to examine the internal company documents to see who made significant contributions to the paper. Step two is to open up the published paper and see who is on the byline. Step three is to see if the byline has omitted some of those individuals who made significant contributions. In many cases of ghostwriting there are other issues such as excessive conflicts of interests or the accuracy of the paper, but these are peripheral issues and do not play a role in determining if the paper was ghostwritten. Also immaterial to the ghostwriting charge is whether the named authors deserve to be on the byline. Granted, honorary authorship and ghostwriting often go together but they are not the same thing. The named authors might certainly deserve to be on the byline, but the question about ghostwriting concerns unnamed authors – people who should have been on the byline but are not present. Since in most cases the internal company documents about how a paper was developed are not available, the process of detecting ghosts can only be done a limited basis, and is reserved for those cases when court proceedings or Freedom of Information Act Requests have made the documents publicly available.

In the next two days we will highlight papers whose bylines have invisible authors and would seem to qualify as ghostwritten, yet have been defended by certain segments of the medical community as not being ghostwritten. The logic of this is problematic. One case involves a surgical procedure and one case involves a psychiatric medication. Keep in mind that one does not need to be an expert in spine surgery, or psychotropic drugs, or really much of anything for that matter, to determine if a paper has been ghostwritten.

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Part two: Medtronic’s Infuse spinal fusion surgery product

Part three: Psych drug Paxil – and conclusion

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Jonathan Leo examines the biological basis of mental disorders such as ADHD, schizophrenia, and clinical depression. Rethinking ADHD: From Brain to Culture, a co-edited volume with psychiatrist Sami Timimi, was released by Palgrave Macmillan in 2009.

Jeff Lacasse has published research on barriers to evidence-based mental health practice, including articles on critical thinking in mental health, clinical treatment of children, and psychiatric medications.

Together they have published several articles on the serotonin theory of depression and ADHD. Over the past several years their articles on ghostwriting have appeared in PLoS Medicine, The Chronicle of Higher Education, and Society.

Their research has been covered in popular media outlets such as The Wall Street Journal, Scientific American, Science,The Chronicle of Higher Education, Fortune, Nature, and the Economist.

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