Medical Ghostwriting: A University–Sanctioned Sleight of Hand?

Aside from academic medicine, when most people hear theterm “ghostwriter” they think of a paid writer who authoreda speech, article, or book without credit. Over the pastdecade, for virtually every blockbuster medication released,there have been allegations that some of the peer-reviewedpapers essential for their commercial success were ghost-written. The most recent case revolves around two professorsof psychiatry at the University of Pennsylvania who wereaccused of involvement with a ghostwritten paper on the useofthebest-sellingantidepressantmedication,Paxil.Followingthecharges,theuniversity conductedaninternalinvestigationand, last week, announced that the professors were innocent.The most important ramification of the UPenn investigation,though, is that instead of indicating a vigilant response toghostwriting, it (perhaps inadvertently) actually sanctionsghostwriting.As we examined the results of the investigation, we werestruck by the fact that the investigative panel seemed toconfuse honorary authorship with ghostwriting. To be sure,both are problems in academia, but there are importantdifferences. Honorary authorship consists of someone beingplaced on the authorship line who did not truly deserve to belisted as an author- often a department head or well-respected senior researcher in the field. As we have recentlyargued, ghostwriting is a simpler issue to ascertain, byasking the straightforward question: Was there a writerwho contributed significantly to the paper, who was notlisted as an author? If the answer is yes, the paper wasghostwritten. This is not just our perspective. In a recentresearch article on ghostwriting, the editors of JAMA de-fined a paper as ghostwritten when, “An individual who wasnot listed as an author made contributions that meritedauthorship,” or “An unnamed individual participated inwriting the article.”TheprimaryconclusionsoftheUniversityofPennsylvaniainvestigation did not result from scrutinizing the paper for aghostwriter, but were instead explanations for why the listedauthorsdeservedtobeonthebyline.Infact,asreportedinthePhiladelphia Inquirer, “Susan Phillips, a spokeswoman forthe medical school, did not respond to a question aboutwhether the medical writing firm wrote the study or editedthe researchers’ writing.” The final statement concludes thatalthough a medical writer (a subcontractor working for themakers of Paxil) helped write the paper, the listed authors“satisfied all authorship criteria and the publication presentedthe research findings accurately. ” Even if the UPenn profes-sor’s deserved to be on the byline, if the byline omitted adeserving author then the paper was ghostwritten.The statement goes on to say that authorship standardshave changed in the last decade, and that in 2001, theauthors were not breaking any rules. However, regardlessof all the other issues involved with this case, this seems tocontradict a statement in Senator Charles Grassley’s 2010report on ghostwriting which stated: “Penn Medicine doesnot use the term ‘ghostwriting’ in its authorship policies, butstated that it has policies against plagiarism and it considersghostwriting to be the equivalent of plagiarism.” But,regardless of UPenn’s past policy, what is of more concernis their new policy, which calls for acknowledging assistance.According to the results of the recent investigation “…current Perelman School of Medicine policy and journalpractice call for acknowledgment of the assistance of amedical writer…..” Thus, the University of Pennsylvania