Ghost writers need to be more visibleBMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39104.595463.94 (Published 25 January 2007) Cite this as: BMJ 2007;334:208
What is a medical writer? A medical writer is a professional writer who is hired to write scientific or medical documents, including manuscripts for publication in peer reviewed journals. Most medical writers are employed by drug companies, contract research organisations, or medical communication agencies, but there are also freelance medical writers and consultants.
Currently medical writers contribute extensively to medical journals, mostly as unheralded “ghost writers.” Medical writers also have an important role in medical education, drug development, and drug marketing. Though mostly unseen, unappreciated, and misunderstood, they nevertheless add quite a bit of grease to the wheels of science publishing. It has been claimed that at least 50% of all publications on treatments in the BMJ, Lancet, and New England Journal of Medicine have been written by an unacknowledged ghost writer (BMJ 2004;329:937; 2004;329:1345).
Not surprisingly, given the negativity associated with publications sponsored by the drug industry, the hidden role of the medical writer has attracted much criticism. The preconception that medical writers are all unscrupulous—employed by Machiavellian drug companies to distort and promote scientific data in an unethical manner—is untrue. Most medical writers would welcome more recognition; and in an effort to increase transparency a number of publication guidelines recommend that papers acknowledge medical writers where used. These include the guidelines for good publication practice for pharmaceutical companies that have been endorsed by several pharmaceutical multinationals (Current Medical Research and Opinion 2003;19:149-54; see also the World Association of Medical Editors' guidance on ghost writing at www.wame.org/wamestmt.htm#ghost). My experience is that authors and sponsors are profoundly reluctant to take this simple step—perhaps through embarrassment or ignorance or just to maintain the historical status quo that medical writers are not acknowledged. It seems that any overt association with a sponsored medical writer detracts from the work or from the named authors. Or perhaps it emphasises too strongly a third party who might distort data for their employer?
Unfortunately, data manipulation and publication misconduct do occur in all fields of research (whether industry sponsored or not) and at all levels, from students to professors, and identifying “doctored” papers is a major concern for journal editors. Drug companies are under huge pressure to publish positive results for their drugs, and a great deal of money is spent in planning and preparing a publication programme for a major marketed compound. This commercial pressure fosters data manipulation or, more commonly, data suppression. This is not predetermined but occurs because of the personalities involved in preparing a scientific paper. Professional medical writers should never encourage data manipulation or divergence from the accepted practices of scientific publishing, such as those outlined by the Committee on Publication Ethics (www.publicationethics.org.uk), but I am sure that a minority have, under pressure, contributed to such bad practice. Many medical writers have an academic background and are often in a unique position to understand the economic and personal reasons for data manipulation and misconduct. Clinicians and scientists occasionally “spin” results, pick their publications strategically, and neglect to (or can not) publish negative data. It is impossible to estimate the number of papers that have been manipulated to present an overly positive message.
The drug industry employs medical writers for a number of reasons, such as their speed and specialised knowledge. A publications manager working for a large drug company will be responsible for several publications, with many authors, and will find it convenient to assign medical writers to work with selected academic authors to write papers. It should be stressed that even though the medical writer may have prepared 90% of the paper, he or she does not have a final say on its contents. This is always at the discretion of the authors or sponsor after all data have been reviewed. Horror stories of papers written without authors' consent have emerged (Guardian, http://education.guardian.co.uk, 21 Apr, “Not in my name”), but I have no personal experience of this. Moreover, production of poorly written or erroneous papers is actively discouraged, as the repercussions for the drug and the company involved can be serious. Many publication managers have a marketing background and don't fully understand or embrace the principles of scientific publishing, hence medical writers often act as educators and have to balance the different viewpoints of authors and sponsors.
What can be done to promote better understanding of the role of medical writers? Their contribution to health education is appreciated by some, but the general feeling of circumspection concerning their motives remains. Unfortunately, as most readers of the BMJ and academic scientists will have no or little experience in dealing with medical writers, this circumspection lends support to the conspiracy theorists. I think that positive efforts are needed to bring clinicians, scientists, drug companies, and medical writers into more contact, perhaps through professional societies. In Europe one main professional society, the European Medical Writers Association (www.emwa.org), supports the interests of medical writers, providing comprehensive training programmes and supports ethical writing practices. Other international societies represent science editors and those striving to improve publication ethics. Further cooperative initiatives involving these societies, the drug industry, and academic and medical institutions could significantly improve publication practice. Greater pressure from journals to acknowledge medical writers would also be a positive step, particularly if applied to drug companies.
We should be sending the message that it is not bad practice to use a professional writer (especially for authors whose native language isn't English) and that it is even better to admit doing so. Equally, readers should keep an open mind concerning professional medical writers; they are not a fifth column but are working in a fast moving, modern environment to help disseminate scientific information. Medical writers are here to stay, and their work needs to be embraced and acknowledged to increase the transparency of public information.
It is not bad practice to use a professional writer and even better to admit doing so
KD has been a medical writer for 10 years, working for a research organisation and for medical communication agencies.