Universities have been struggling for years with the problem of researchers who let industry-financed ghostwriters draft biased summaries of their work for publication in medical journals.
They're now getting some blunt advice on how to stop it, including from perhaps the most qualified experts: the ghostwriters themselves.
In a pair of articles published Tuesday by PLoS Medicine, two professional medical writers outlined changes that both universities and the journals could make. One suggestion, offered by Linda Logdberg, now contrite about her role in ghostwriting, is straightforward. The universities, she points out, could simply provide their researchers with their own professional writers.
"My recommendation is to take out the middleman," said Ms. Logdberg, a biologist once associated with Columbia University who now teaches science to public-school students in Georgia.
In the other PLoS Medicine article, Alastair Matheson, a professional medical writer who works from both Britain and Canada, suggests that the scientific journals adopt new guidelines to more strictly identify the contributions of their authors.
Ms. Logdberg and Mr. Matheson are offering their ideas at a time of still-mounting legal and political pressure on both universities and the journals to crack down on ghostwriting. Just last month, a University of Pennsylvania psychiatry professor filed a complaint with federal investigators accusing his department chairman and four colleagues of publishing under their names an article that was ghostwritten by employees of a pharmaceutical company and that made unsupported claims for one of its best-selling drugs.
The allegations by Jay D. Amsterdam, a professor of psychiatry at Penn, were promoted by the Project on Government Oversight, an advocacy group, as grounds for the university's president, Amy Gutmann, to be removed by the Obama administration as chair of the Presidential Commission for the Study of Bioethical Issues.
Push to Make Authors Liable
Others are suggesting even harsher tactics. PLoS Medicine published an article last week by two Canadian law experts, Simon Stern and Trudo Lemmens of the University of Toronto, who suggested pursuing legal action against researchers who allow their names to be placed on articles they didn't actually write.
Legal action would be justified because medical-journal articles attesting to the safety or efficacy of a drug or a medical device are often cited as authoritative in court cases, wrote Mr. Stern, an assistant professor of law, and Mr. Lemmens, an associate professor of law and medicine.
Researchers at a series of major American universities, including Brown, Emory, Harvard, Stanford, Tufts, and Yale, have faced allegations in recent years that they've signed their names to medical-journal articles written by others.
Such ghostwriting incidents have included companies promoting medications like Avandia, a diabetes drug, and Vioxx, an arthritis drug, both of which were later found to be associated with elevated risks of heart attack.
The Association of American Medical Colleges has been urging its members to crack down on researchers who allow their names to be placed on articles they didn't actually write. In a 2008 report, it listed ghostwriting among a series of evolving practices through which companies try to influence medical professionals, and it suggested that academic medical centers forbid it entirely.
But Mr. Matheson, in his article in PLoS Medicine, said ghostwriting continues, in part because medical journals don't have clear-enough policies to prevent it. He suggested that the International Committee of Medical Journal Editors, which represents the leading research publications, revise its authorship guidelines so that those who prepare the initial draft of a scientific report, including those working on behalf of a company, are listed as full authors.
A spokesman for the ICMJE, as the editors' group is known, said it would consider Mr. Matheson's suggestions as part of an overall policy review now under way. However, said the spokesman, Michael Berkwits, a physician and an editor at Annals of Internal Medicine, "no ICMJE guidance or standards can fully prevent scientific misconduct or replace the need for critical appraisal by readers of scientific work and its provenance."
Another group of experts, writing last month in the scientific journal Society, made a similar suggestion. The group—Jonathan Leo, a professor of neuroanatomy and associate dean of students at Lincoln Memorial University, in Tennessee; Jeffrey R. Lacasse, an assistant professor of social work at Arizona State University; and Andrea N. Cimino, a graduate student in social work at Arizona State—also suggested that all authors be required to sign a statement pledging that no ghostwriters were involved in their work.
Shifting the Burden to Universities
Ms. Logdberg, meanwhile, suggests that universities simply take away the incentive for ghostwriting. Researchers often need help writing up their findings, and if they had that help available to them on campus, they'd be far less eager to accept offers from companies, she said.
Universities, however, aren't likely to embrace the idea, said Carrie D. Wolinetz, associate vice president for federal relations at the Association of American Universities. Universities already are struggling to cover operating costs from the share of money allocated to them from federal research grants, and they couldn't now be expected to also pay for a new layer of staff writers, Ms. Wolinetz said. "Universities simply couldn't afford this," she said.
Universities nevertheless are taking the matter seriously, Ms. Wolinetz said. Many have toughened their policies governing financial conflicts in recent years, she said, and they're expecting even stricter regulations soon from the National Institutes of Health, the nation's leading provider of money for academic medical research.
Ms. Logdberg, though, suggests the problem may have some roots in university culture itself. She said she drifted into professional ghostwriting after initially working at a company where she wrote summaries of medical journal articles in layman's language for customers such as lawyers and nutritionists. The work slowly grew objectionable to her as some larger companies with public-relations staff later rewrote her material in favor of their products, she said.
"I started out in a place that I thought was quite academically defensible," Ms. Logdberg said. "The immorality to me is not the ghostwriters. It's the physicians or the authors: me drafting something and having someone else sign his name. I'm not the one morally culpable there, to me at least. It's the person who goes ahead and does that without giving me credit."
She mentioned in the PLoS Medicine article that she left her last academic position after being told she was "unacceptably insubordinate" for expressing a reluctance to write anything that someone else later claims as his own. In the interview, she identified the incident as occurring at Helen Hayes Hospital, north of New York City, where doctors are supplied by Columbia University. She left that academic environment, she said, after a doctor asked her to write a grant application that he planned to submit to the National Institutes of Health without her name on it.
Although the expectation seemed standard in the academic culture that surrounded her, Ms. Logdberg said she could not accept it. "I don't want to write even a memo and have someone else sign their name to it," she said.