Who writes the article?
Authors: Andres T. Blei
Journal: Hepatology (2005)

Over the years, I have tried to convey to the readers of this Corner some of the dilemmas that surround the editorial job. At the center of our activity lies the task of examining the written data, an endeavor based on trust: authors of manuscripts certify the veracity of the data at the time of submission, assume responsibility for what has been written and remain accountable for the results. During a recent inquiry, we were startled to learn that a commercially-based enterprise was involved in assisting a well-known hepatologist in the preparation of a review article. Investigation into this incident suggests that this is a more widespread phenomenon. The concept of ghost writing is not novel. A review of the authorship of more than 800 articles published in three U.S. general journals of wide circulation1 revealed an 11% rate of ghost authorship. A dual definition identified the “ghost writer”: first, an individual who was not listed as an author but whose contributions merited authorship (an arguable characterization); second, the participation of an unnamed individual in the writing of the article—a depiction of the problem we are discussing today. HEPATOLOGY is no exception to developments in the wider world of scientific publishing. Ghost writing initiated by commercial companies has become widespread, prompting the World Association of Medical Editors to produce a condemnatory statement on the practice.2 We have witnessed the proliferation of medical education companies that receive fees from the pharmaceutical industry in order to write articles presenting a favorable view of their product. While nothing is inherently wrong with this approach, it differs when the educational company prepares an article, pays an expert to author the manuscript, and after the expert's revisions, submits the article as a scientific contribution. If the purpose of the manuscript is to convince readers of a special interest, this is crass commercialism disguised as academic writing. Two types of articles need to be considered. For original research, investigators may obtain the services of a medical writer to help present their results. Authors avoid conflict by recognizing the role of the writer in the preparation of the manuscript. A review article bears a different responsibility: authorship reflects the expert's scientific or academic proficiency in the subject. Submission of a review article written by a medical education company follows a clear logic. On one hand, the written word is powerful and publication in respected journals lends credence to arguments and claims. On the other hand, editors are supposedly receptive to such papers, as review articles tend to be widely quoted and may attract readers from other disciplines to the journal. But it takes two to tango. Such submissions would not happen without the consent and support of the expert who has lent his or her name to the commercial enterprise. Expertise is an extension of academic recognition that can quickly dissipate when questionable behavior arises. Like modern prophets, editors are asked to remain above the fray and be a voice that can point at what is ethically correct. But the trait does not reflect a holier-than-thou attitude.3 Rather, maintaining the integrity of the publication record is in the ultimate interest of all parties: The reliability of the published word must be protected in order for science and clinical research to advance. Many forces tear at this principle: anxious investigators seeking to be “the first to publish,” reviewers who fail to disclose an academic conflict of interest, and researchers who engage in the practice of double submission. Ghost writing is a new player in a flurry of transgressions. Unlike other sins of publication, ghosts hide and may be difficult to identify. Accordingly, review articles will be examined under a new light. HEPATOLOGY will require confirmation from authors of such articles that no fees have been paid to complete the work.