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Article ghostwriting is definitely a pure technical task that needs good knowledge and skills without fail. We are offering SEO friendly articles writing service for many years online. The pharmaceutical company that had sent the article to him preferred their original version, which they said, had important commercial points in it that were missing from Healy's own version. The pharmaceutical company's original version was subsequently published in a journal with the name of another scientist as author.

David Healy's disclosure of the name of this author alerted me to make enquiries when the journal where I worked as managing editor received an article from the author. If a person employed by a commercial enterprise or organisation with an agenda to promote writes the first draft, the potential for bias is increased. But readers have a chance to weigh potential bias in the balance if full information about the document's history and financing is disclosed and if the raw data of original research is available for scrutiny.

As long ago as , David Sharp, former editor of the Lancet , stated that assistance with translation or through an author's editor service of the sort that many universities offer, is entirely legitimate Sharp, In contrast, he considered the practice of a medical writer producing a first draft in which the writer's employer, rather than the named author, has first sight and input should be outlawed. These sentiments were echoed more recently by Special Assistant US Attorney Cathy Young Thomer who considers ghost-writing to be a fraud when the writing precedes the author Jirik, There is some ambivalence among medical writers over writing of the first draft.

The GPP and medical writer association ethics guidelines focus on guidance for medical writers in preparing drafts of documents publishing the results of clinical trials in journals. The need for close consultation between medical writers and authors is emphasised. The guidelines state that authors must determine the content of the articles and the contribution of the writer should be acknowledged. The GPP consider it inappropriate for medical writers to prepare the first drafts of editorials or opinion pieces.

The background commentary to the EMWA guidelines warns that medical writers may qualify for authorship of review articles if they conduct an extensive literature search. These guidelines therefore envisage medical writers preparing review articles, which can be as influential as editorials GPP in , EMWA in Although medical writers are not ghost-writers if they are acknowledged, acknowledgement alone does not satisfy current concerns.

There are three aspects of acknowledgement that need to be considered. One is the information that should be included. The second is the requirement, adopted by some journals, in the ICMJE guidelines that authors obtain permission to acknowledge from all those mentioned in the acknowledgements.

The third is whether the authors had access to raw data. Journals differ widely in the amount of guidance their instructions to authors give on acknowledgements, from giving no guidance — one could suspect that they care little about the subject themselves — to just referring to the ICMJE guidelines or variously requiring authors to give the name, the role and funding source of any person providing writing assistance.

The EMWA guidelines suggest wording that has been endorsed by some journals e. This formula, however, is not so detailed as the one used in a review article in Neuropsychopharmacology Nemeroff et al. We maintained complete control over the direction and content of the paper. Preparation of this report was supported by an unrestricted grant from Cyberonics, Inc. Clearly, a cohesive approach is called for. It would be helpful if guidance could come from a central source, e.

I drew the ICMJE's attention to this need and submitted proposals for consideration at their meeting in April last year that their guidelines on acknowledgement should be amended to require the following information:.

The names of the people who approved the final draft could, for example, include the publication manager in a drug company or communication agency and would be in line with WAME's statement:.

Other parties, including companies-such as marketing, communications and medical education companies who are paid to assist pharmaceutical and medical device companies in disseminating favourable messages about their products — may initiate the sequence of events for which the author is the final and most easily identified participant.

These other participants are also responsible for ghost written manuscripts and addressing their roles should be part of the solution WAME, Disappointingly they had made no changes to their acknowledgement requirements. Some journals, for instance the Lancet , insist on a signed statement from the person giving permission to be named in the acknowledgements section http: This is not without its difficulties. There maybe legitimate reasons why a medical writer does not wish to be acknowledged, not the least being the fact that authors have made changes to the final version that the writer considers inappropriate.

But they may also relate to changes that are unacceptable on ethical grounds. The position on acknowledgement when these problems arise is not clear. The EMWA guidelines recognise that medical writers have a right to withdraw their names in exceptional circumstances but are silent about whether the medical writers should inform the journal of their involvement and subsequent withdrawal Jacobs and Wager, In the reporting of clinical trial results, the problem of ghost-writing goes beyond concealment of the writer and failure of the named authors to approve the final version of the article.

Even authors who approve the final version might not have had access to the raw data but only tables compiled from raw data. They maybe familiar with the raw data generated by their own centre but not that from all other centres spread through several countries. David Healy regards articles that result from the ghost-writing process which do not offer a fair representation of the underlying data as the problem rather than ghost-writing itself.

Pharmaceutical companies consider raw data proprietary and strongly resist all moves to make their data available for public scrutiny. The current move is to force publication of documents that accompany applications to licensing authorities for drug licences. Either the applicants or the authorities would make these documents available upon the grant of the licence. But even more needs to be done towards access to raw data.

This indicates that medical writers encourage authors to disclose their involvement according to the guidelines. Medical writers have also published articles promoting ethical practices e. Dawes, ; Woolley, But guidelines can be a foil, with all those whose writing had never sought to deceive complying, while business carries on as usual for the dishonest sector.

Furthermore, the willingness to comply with guidelines must go beyond that of the medical writer. Employers need to be persuaded. Currently there is little incentive for pharmaceutical companies to stop the practice of ghost-writing. The shame about the well-meant GPP guidelines designed for company sponsors of large clinical trials is that they have been endorsed by only a few pharmaceutical companies even though employees from some other companies helped to develop them.

Furthermore one communications company that agreed to recommend the guidelines to its clients has subsequently been involved in a ghost-writing story Fugh-Berman, This hints that medical writers, who work hard through their medical writers associations EMWA in Europe, AMWA in American, AMWA in Australia and a similar organisation that is being created in India to promote acknowledgement, would themselves be happy to be relieved of their underworld status but their employers prefer to keep them there.

Journals can ask the right questions, which few are doing at the moment. One of the few is the BMJ which questions authors of review articles and editorials about whether they have written the article themselves or it has mainly been written by a medical writer http: Journals can also have an antenna for ghost-writing signs and of course avoid being tempted themselves by the lure of industry patronage.

There has been a proposal to change authorship to contributorship Rennie, By this system the specific contribution made by every person associated with the publication is listed. This should reveal who wrote the paper.

Unfortunately, although the system is recommended by the ICMJE, it has only been implemented by some large journals. Authors get more than an honorarium from selling their name.

They accumulate articles on their CVs without effort, gaining career advancement and a reputation as an opinion leader, which in turn attracts lavish invitations — all expenses paid — to speak at congresses in exotic locations. A suggestion has been made to name and shame authors who plagiarise Chalmers, , which could be extended to authors who fail to acknowledge writers.

But editors might be reluctant to do this. There seems to be a protectionist attitude towards authors who are members of the same community as journal editors, a fear that innocent scientists or physicians may have their careers ruined or an anxiety about defending a libel action.

The WAME policy statement advises editors who discover ghost-written articles to report the incident to the authors' academic institutions and publish a notice that the article was ghost-written along with the names of the responsible companies and submitting authors:. When editors detect ghost written manuscripts, their actions should involve both the submitting authors and commercial participants if they are involved.

Several actions are possible:. The statement was prompted by a WAME Listserve discussion initiated by the editor of the Journal of General Internal Medicine when Adriane Fugh-Berman reported that a manuscript she had been sent by the journal to review was identical to the one she had previously been asked to author Fugh-Berman, The name of the replacement author was never published on the Listserve or elsewhere.

Hence other journal editors have been deprived of the opportunity of caution with this author, who would seem to have little to fear. In a recent article Moffatt and Elliott ask whether the ethical problems presented by ghost-written articles would be solved if medical writers were acknowledged as authors. To be acknowledged as authors, medical writers would of course need to satisfy the current ICMJE authorship provisions as stated above.

They suggest that university institutions police their faculty members. I fear this is likely to be met with issues similar to those mentioned above when asking journal editors to do the task, but more weight might be added by their further suggestion of also placing responsibility with a government institution e. Less certain is that their suggestion of joining ghost-writers and authors in actions taken against pharmaceutical companies such as Motus vs Pfizer would act as a great deterrent.

Such actions are relatively rare and execution for payment of damages and costs is likely to be pursued against the more financially viable defendants. Elise Langdon-Neuner BSc has a background in science, law and biomedical publication.

She was a litigation partner in a London firm of solicitors for a number of years. After moving to Austria she became managing editor of Diabetologia, the largest European diabetes medical journal.

In she launched a new Elsevier journal and managed the journal through its teething years. Currently she is a senior manager at Baxter BioScience in Vienna, where her work includes editing manuscripts prepared by in-house research scientists. She regularly writes articles, conducts workshops and lectures on various aspects of manuscript preparation and biomedical journal editorial policies.

Her main interests are ethics in scientific publication and the future of scientific communication. Elise Langdon-Neuner is a medical writer in a basic research department at a pharmaceutical company editing drafts prepared by researchers. She has also worked as a managing editor for medical journals. She was a member of EMWA's ghost-writing task force whose consultation process resulted in the drafting of EMWA's guidelines on the role of medical writers in developing peer-reviewed publications.

National Center for Biotechnology Information , U. Journal List Mens Sana Monogr v. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Abstract Any assistance an author receives with writing a scientific article that is not acknowledged in the article is described as ghost-writing.

Ghost-writing , Ghost authorship , Author's editor , Acknowledgement , Pharamaceutical industry , Publication ethics. Introduction Medical ghost-writing is a new term, different from the ghost-writing of autobiographies, fiction and political speeches. Concise Oxford Dictionary, Merriam-Webster Dictionary define a ghost-writer as a person employed to write material for another person, who is named as author: The Importance of Authorship Authorship pinpoints an accountable person.

Medical Writing and Concealment Some medical journal editors believe that participation of writers paid by the pharmaceutical industry results in inevitable bias, regardless of whether the writer's role is disclosed Griffin-Sobel, WAME, however, recommends journals make it clear that medical writers can be legitimate contributors: To prevent some instances of ghost authorship, editors should make clear in their journal's information to authors that medical writers can be legitimate contributors and that their roles and affiliations should be described in the manuscript WAME Some medical journals, through their instructions to authors and editorials, have endorsed a valid role for medical writers in medical journal publication.

The first is that authors are embarrassed to admit to having received assistance. This is more likely to apply to authors using author's editors. They ask how authors, who are too busy or whose writing skills are so poor that they need help, can guarantee the quality of their research. There is however more sympathy if English is not the author's first language http: The second reason is ignorance of the need to disclose.

The third is a concern that journals are less willing to accept the article for publication Wilde, This concern is legitimate Griffin-Sobel, But the chances of rejection are greater if a medical writer's involvement is not disclosed but suspected or discovered.

Among others, the American Journal of Medicine has said that they reject papers, which have too much company-speak Larkin, The fourth reason for non-disclosure is to stealthily market drugs. Healy and Cattell summed up the scenario of articles perceived as written by opinion-leaders with minimal company representation and non-declaration of other non-academic inputs increasing the likelihood that the articles will be influential with prescribers and purchasers.

We know that readers are sceptical of articles with declared pharmaceutical industry involvement Chaudhry et al. Examples of Ghost-writing in the Literature Secrecy is always suspect. The Attitude Towards Who Writes the First Draft If a person employed by a commercial enterprise or organisation with an agenda to promote writes the first draft, the potential for bias is increased. Problems with Acknowledgement Although medical writers are not ghost-writers if they are acknowledged, acknowledgement alone does not satisfy current concerns.

I drew the ICMJE's attention to this need and submitted proposals for consideration at their meeting in April last year that their guidelines on acknowledgement should be amended to require the following information: The name of the person who provided writing assistance. If a named author prepared the first draft, the name and funding source of the person who provided writing assistance, if any. Action to Ensure Acknowledgement Guidelines increase awareness. The WAME policy statement advises editors who discover ghost-written articles to report the incident to the authors' academic institutions and publish a notice that the article was ghost-written along with the names of the responsible companies and submitting authors: Several actions are possible: Conclusions Acknowledgement is necessary to exorcise ghosts.

Clear guidance needs to be given on the form of the acknowledgement and an answer should be found for when medical writers are not prepared to give permission for their acknowledgement because unacceptable changes have subsequently been made to their work. All parties concerned need to actively support transparency: The popular press has an important role in raising end consumer and political momentum. Patient groups that will grow with the increase in average age of Western populations could wield more influence in demanding ethics in the dissemination of medical research information.

Questions That This Paper Raises Do medical writers have a legitimate task to perform in compiling data and bringing research to publication? Should accountability be strictly confined to those who genuinely had access to raw data and must they always be authors? Is ghost-writing merely a beacon of the commercialisation of medicine against which patients have no voice? Issues for Further Deliberation The interconnections between authors, journals and the pharmaceutical industry, a major financer of research, are very strong.

Added to which the pharmaceutical industry has a powerful political lobby, especially is the USA. The people who are disadvantaged by unethical dissemination of scientific information are patients and the taxpayer - all of us.

Medical writers, perhaps as a proxy for their employers, rather than academic and physician authors have been the focus of attack for ghost-writing but medical writers do have a task to perform compiling data and bringing research to publication. Their associations encourage ethical practices in this task.

Whether medical writers should be preparing the first drafts of opinion pieces needs careful thought. Authors could still be defined as those who made substantial intellectual as well as research contributions to the work. Authors can only be accountable for the raw data they have had access to. Either raw data needs to be made available for public scrutiny or those who do have access to the raw data must be made personally accountable.

Ghost-writing is a side product of the commercialisation of medicine. Medical writers are earning a living. Pharmaceutical companies have a duty to their shareholders to make a profit and some doctors and scientists are taking advantage of a windfall. Others have commendably resisted the temptation.

Open in a separate window. Conflict of Interest Elise Langdon-Neuner is a medical writer in a basic research department at a pharmaceutical company editing drafts prepared by researchers. The vexed question of authorship:

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