Intended for healthcare professionals

Feature Reporting of research

Ghosts in the machine

BMJ 2011; 343 doi: (Published 06 December 2011) Cite this as: BMJ 2011;343:d7860

Re: Ghosts in the machine

If I tried to make money by deceiving people that a picture that I had painted was the work of some great artist, the law would call it fraud. Yet when pharmaceutical and medical device companies make money by deceiving doctors and patients that their articles were written by medical opinion leaders we call it ghost writing and gift authorship.[1] This double standard is because this form of financial "fraud" is so prevalent amongst the most influential opinion leaders in the profession and so many journals and organisations profit from it that we have institutionalised this dishonesty in which everyone profits except perhaps the patients who may get inappropriate treatment and potentially those who pay for it - in the UK that is usually the tax-payer.

Dr Tony Rickards was a great cardiologist. His memory has been sullied because he was unusually both a “ghost” and a gift author on publications about the MIST Trial. He died in May 2004,[2] before the trial started in November 2004. He was not on the trial design committee: I know because I was. Despite satisfying none of the criteria for authorship of the most highly cited cardiology journal, Circulation, he was listed as an author of the paper.[3] One other member of the trial steering committee and I refused to be authors because of errors in the paper and because the sponsor refused to allow us to see all the data. After persistent pressure from me Circulation eventually published a correction (700 words), data supplement (4 pages) and new version of the paper.[4-6] Before the correction was published the editors of Circulation knew that Dr Rickards had died and did not meet the criteria for authorship. They did not remove his name from the corrected version of the paper. Because Dr Rickards was dead, the sponsors could dispense with the customary payment to eminent gift authors. Circulation published in 2009 a letter responding to correspondence about the MIST paper in which Dr Rickards had moved up to be the fourth author (from fifteenth author on the paper), even though the editors of Circulation knew that he had died 5 years earlier.[7] Dr Rickards was named as an author of a letter he had no part in writing, which responded to correspondence he had not read, about a paper he had not seen or written, which describing research in which he had not participated. If editors ignore their rules on authorship why should anyone else obey the rules?

1. Hendrick R. Ghosts in the machine. BMJ 2011;343:d7860.
2. Caroline Richmond. Obituary: Anthony Francis Rickards. BMJ 2004;329:234.
3. Dowson A, Mullen MJ, Peatfield R, Muir K, Khan AA, Wells C, Lipscombe SL, Rees T, De Giovanni JV, Morrison WL, Hildick-Smith D, Elrington G, Hillis WS, Malik IS, Rickards A. Migraine intervention with STARFlex Technology (MIST) Trial: a prospective, multicenter, double-blind, sham- controlled trial to evaluate the effectiveness of patent foramen ovale closure with STARFlex septal repair implant to resolve refractory migraine headache. Circulation 2008;117:1397-1404.
7. Dowson A, Mullen MJ, Khan AA, Rickards A, Peatfield R, Muir K, et al. Response to letter regarding article “Migraine Interventions with STARFlex Technology (MIST) Trial”. Circulation 2009;119:e194.

Competing interests: My involvement is described in the letter. I have no financial conflicts.

31 January 2012
Peter T Wilmshurst
Consultant Cardiologist
Royal Shrewsbury Hospital
Shrewsbury SY3 8XQ