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Full Disclosure: Health Writers Take Big Risks When Ghostwriting

Full Disclosure: Health Writers Take Big Risks When Ghostwriting

pharma, ghostwriting, william heisel, reporting on health, ethics, journalism, medical writingIn these very tough economic times, it might seem crazy to turn down a paycheck. But what if that paycheck has complicated strings attached?

If you are a health writer for hire, you may find yourself working for a medical communications company that has pharmaceutical companies and device makers as clients. Because the communications firm – and not the drug or device maker – is paying you, you might feel that you have some distance from any ethical dilemmas that might arise. You may write some copy for materials that will train doctors in how to use the device or drug. You may write some direct-to-consumer marketing for a website. Or you may find yourself preparing the building blocks for a submission to an academic journal.

This is where things get tricky.

The difference between what you were doing before and what you are doing with a journal submission hinges on audience expectations. When doctors sign up to take a training sponsored by a drug maker, they know that they are getting a sales pitch. When patients click on an ad for a drug, they know they are getting a sales pitch.

When patients or their doctors or researchers studying a particular disease or treatment read an article in a peer-reviewed journal – signed by an academic research but written by you based on notes from the drug or device maker – they are assuming that the science is solid. They are not expecting marketing messages. This sleight of hand makes the use of ghostwriters attractive to companies. Remember the uproar over Disney advertising on a mock front page of the Los Angeles Times that looked like the real thing? It seemed like Disney and the Times were trying to fool readers.

With ghostwriting in the scientific literature, the stakes are much higher. You can end up in court, like Karen Mittleman. A published author and scientist herself, Mittleman probably never imagined that she would spend so much time as the subject of legal scrutiny. She worked as a ghostwriter-for-hire with DesignWrite, the firm that helped Wyeth on its hormone-therapy product line. In doing so, she became affiliated with the drug company, which was later sued more than 5,000 times. While her name was kept off the list of authors on journal articles that subtly promoted the use of hormone therapy, it is now all over the Drug Industry Document Archive, the repository of documents gathered from lawsuits and Congressional investigations.

Even if you aren't caught up in a lawsuit, the work itself may end up being cause for public embarrassment. Imagine submitting a resume that proudly lists dozens of articles you helped create. Your potential employer Googles one of them and up pops a headline like this: Medical Papers by Ghostwriters Pushed Therapy. Suddenly, you are moved to the bottom of the stack.

And don't think that the pharmaceutical company or your academic "co-author" will protect you. When academics are caught working with ghostwriters, their first instinct seems to be to blame the DesignWrites and Mittlemans of the world. They are portrayed as devious tricksters instead of just contractors doing what their clients requested. As Antidote has noted, when Barbara Sherwin was caught signing her name to a ghostwritten article, she claimed that Karen Mittleman had deliberately befriended her and fooled her into thinking that Mittleman was working for a journal.

Let's assume that all the science in the ghostwritten article is rock solid. It happens to make a company's product look good, but that's just the way the evidence fell. You'll have the satisfaction of knowing that you have contributed in a significant way to the scientific literature, right? Not if your work is retracted. The editors of PLoS Medicine, for example, have called on all journals to yank any paper that was written by a ghostwriter without a proper explanation of the ghostwriter's role. They wrote "if nothing is declared on submission but inappropriate involvement of a medical writer subsequently comes to light, any papers where this breach is substantiated should be immediately retracted and those authors found to have not declared such interest should be banned from any subsequent publication in the journal and their misconduct reported to their institutions."

Whether any journal editors are brave enough to actually start doing this remains to be seen. I searched Retraction Watch – the invaluable online compendium of withdrawn science – and could find only one reference to ghostwriting. It had nothing to do with industry influence.

The bet that most ghostwriters continue to make is that they will avoid trouble. They are building a career in medical communications and, as long as they are getting paid, it doesn't matter if a controversy plays out in blogs, Congressional committees and courtrooms. In my next post, I'll talk about what writers can do to make a safer bet.

Photo credit: striatic via Flickr

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