Intended for healthcare professionals

Rapid response to:


Ghostwriting: the importance of definition and its place in contemporary drug marketing

BMJ 2016; 354 doi: (Published 30 August 2016) Cite this as: BMJ 2016;354:i4578

Rapid Response:

Re: Ghostwriting: the importance of definition and its place in contemporary drug marketing

I thank Al Weigel of the International Society for Medical Publication Professionals (ISMPP), and Serina Stretton and her colleagues from the Global Society of Publications Professionals (GAPP) for their comments. I have addressed most of their points in an accompanying response, but focus here on their claims about transparency in the commercial publications trade.

Weigel and Stretton both object to my article by emphasizing their trade’s commitment to “transparency”. My analysis shows, however, that modest transparency and small print disclosure, while better than nothing, paradoxically provides an apparatus for subtle misattribution, concealment and spin. My article discusses this as a cultural problem within medicine for which many stakeholders are responsible. It is important not to lay the blame at industry’s door alone. As Stretton rightly points out, it is journals that make authorship rules, and decide how disclosures should be presented to their readers. Table 2 of my article provides some useful suggestions to the editorial community.

More importantly, however, while I applaud Stretton’s and Weigel’s commitment to transparency, I remind them that the publications trade remains unacceptably secretive. Numerous articles are produced for journal publication every year, scientific platforms and publications plans are developed, academics are recruited to participate as authors, trade writers draft manuscripts, and substantial payments pass from corporations to agencies, but little of this activity is in the public domain. Indeed, the process has been characterized as ‘ghost management’ (1).

Commercial secrecy has no place in an open scholarly discourse. Since this literature has been placed within the public academic forum with the goal of informing treatment decisions, readers and their patients have a right to know exactly what commercial considerations were at work in its development, and who was paid by whom to create the material. This right extends not only to current literature, but to published literature with a potential bearing on clinical practice – conservatively, since the turn of the century.

I therefore invite Weigel on behalf of ISMPP’s sponsor companies, and Stretton and her GAPP coauthors on behalf of their own companies, to clarify on this forum what they believe should be transparent, and what should be secret, by responding to the following 5 requests:

1. Will your companies place in the public domain full lists of every journal article they have produced since 2000?

2. Will your companies place in the public domain all the publications plans relating to these articles, including supporting documentation on product positioning, scientific platforms, “educational objectives”, communication points and messages?

3. Will your companies name all academics and medical professionals they have worked with since 2000, including the projects and articles they worked on and the products they worked in connection with?

4. According to the trade definition of ghostwriting, have any GAPP or ISMPP companies, including your own and previous companies you have worked for, ever produced a ghostwritten article? Will you ensure these articles are all now identified, in order to help cleanse the medical literature? Do you also urge writers to bring any such articles to public attention, and will your companies disregard the confidentiality clauses writers have signed with them if they do?

5. Will your companies agree henceforth to place in the public domain:
A. Every publications plan they develop, including all supporting documentation relating to drugs, their scientific platforms and their positioning?
B. All outlines and drafts they developed for every article that secures publication?
C. The names of every academic expert they work with, including the projects they work on and the product being marketed?
D. Full details of intellectual property rights they or their clients hold in respect of research, data, documentation and draft publications?
E. The cash sum typically paid to them by pharmaceutical clients for each type of article and publications plan they develop, such that the public is aware how much money is changing hands in the development of this literature?

There can be no justification for sequestering the machinations of this trade from public view, especially when its output is lodged in open scientific discourse with the goal of influencing patient treatment. In my opinion, if the trade refuses greater transparency, it should be investigated by lawmaker committees – as indeed should the broader culture of commercialism and inadequate transparency within academic medical science and publishing. I await ISMPP and GAPP’s response to these requests for transparency with interest.


1. Sismondo S. Ghost management: how much of the medical literature is shaped behind the scenes by the pharmaceutical industry? PLoS Med. 2007 Sep;4(9):e286.

Competing interests: I am a supporter of innovative pharmaceutical research and have affection for, and friendships within, pharmaceutical corporations and also the marketing and publications trade, whose employees I consider to be ethical and professional. As stated in my article, between 1994 and 2012 most of my income came from consultancy and writing services provided to pharmaceutical corporations, either directly or via marketing agencies. In 2015 I acted as a paid expert witness on behalf of the plaintiffs in a US federal legal action against a drug company.

21 September 2016
Alastair Matheson
Independent consultant
Toronto, Canada