Systematic review on the primary and secondary reporting of the prevalence of ghostwriting in the medical literature

The "Monsanto papers" and the nature of ghostwriting and related practices in contemporary peer review scientific literature

The Monsanto company - now acquired by Bayer - has been accused of ghostwriting articles within peer review literature, with the goal of using influential names to front its content in defence of the herbicide Roundup. Here, I conduct a detailed analysis of three Monsanto review articles and a five-article journal supplement for which detailed information from company emails is publicly available following litigation over Roundup. All the articles had external, but not Monsanto authors, and ghostly practices including ghost authorship, corporate ghost authorship and ghost management were evident in their development. There was clear evidence of ghostwriting - that is, drafting of the manuscript by non-authors - in only two cases. I found no evidence of undeserving authorship among the external authors. The articles complied with the disclosure requirements of their journals, save for the journal supplement. While crude ghostwriting did occur, much of the literature involved subtler practices through which Monsanto exercised control over content, while the attribution of the articles downplayed the company's role - and correspondingly aggrandized that of the external authors. Such practices are widespread within industry journal literature and are the responsibility of byline authors and journals as well as corporations. I discuss these cultural problems and consider remedies.

Mapping author taxonomies and author criteria: good practices for thinking through complex authorship situations

Authorship criteria can be difficult to apply in complex situations, such as multicenter clinical trials, multidisciplinary research, or manuscripts reporting the results of several studies. Authors may need additional guidance to appropriately credit their colleagues even when using existing accepted author criteria and/or contributor taxonomies to guide their decisions. Definitions and explanations of authorship by various editorial groups such as International Committee of Medical Journal Editors, the Committee on Publication Ethics, the World Association of Medical Editors, and the Council of Science Editors emphasize intellectual input and accountability. Existing contributor taxonomies list additional activities that should be credited, but do not stand in for authorship criteria or confer authorship. The literature was searched for existing guidelines for authors that suggest how to apply accepted authorship criteria to activities listed in contributor taxonomies. No publication was identified that mapped specific authorship criteria to particular contributor taxonomies. Suggestions were developed to assist in differentiating activities that meet author criteria from other contributions outlined in two existing contributor taxonomies.

No room for ambiguity: The concepts of appropriate and inappropriate authorship in scientific publications

Authorship is the currency of an academic career. Scientific publications have significant academic and financial implications. Several standard authorship guidelines exist, and the International Committee of Medical Journal Editors (ICMJE) is the most popular amongst them. There are increasing concerns about the ethics of publications with the rise of inappropriate authorship. The most important reason appears to be a lack of knowledge and awareness of the authorship guidelines and what actions constitute unethical behaviors. There is a need to incorporate standard guidelines in medical curricula and conduct structured training and education programs for researchers across the board. The current perspective describes the significant concepts of appropriate and inappropriate authorship, and the possible measures being formulated to shape the future of authorship.

Authorship: From credit to accountability. Reflections from the Editors' Network

The Editors' Network of the European Society of Cardiology (ESC) provides a dynamic forum for editorial discussions and endorses the recommendations of the International Committee of Medical Journal Editors (ICMJE) to improve the scientific quality of biomedical journals. Authorship confers credit and important academic rewards. Recently, however, the ICMJE emphasized that authorship also requires responsibility and accountability. These issues are now covered by the new (fourth) criterion for authorship. Authors should agree to be accountable and ensure that questions regarding the accuracy and integrity of the entire work will be appropriately addressed. This review discusses the implications of this paradigm shift on authorship requirements with the aim of increasing awareness on good scientific and editorial practices.

Ghostwriting in biomedicine: a review of the published literature

Introduction: The systematic review of biomedical ghostwriting has proven challenging due to problems in consistency and in study design. Moreover, authorship guidelines established by the International Committee of Medical Journal Editors (ICMJE) may have inadvertently created opportunities to potentiate ghostwriting. Given continued interest in ghostwriting by the International Society of Medical Publication Professionals (ISMPP) and other organizations, we undertook an analysis of ghostwriting in the biomedical literature.Methods: We searched PubMed (search terms: ghost writ*, ghostwrit*, ghost writer, ghostwriter, ghostwriting and ghost writing). Results, including abstracts, were reviewed for relevance (relationship to ghostwriting in biomedical journals) to aid in removal of inapplicable work and duplicate publications. After review, we consolidated expert opinions for publication professionals.Results: Overlap was poor across search terms; of 181 unique papers identified, most (112/181) were opinion pieces. An increasing number of papers are using the term "ghostwriting" to describe genetics as well as diverse phenomena of misattributed authorship, including "ghost authorship". Eight primary studies and 1 systematic review of ghostwriting incidence were identified, reporting prevalence ranging from <1% to 91%, in varied settings using differing methods and definitions of ghostwriting. Suggestions for avoiding ghostwriting include early consensus building and better definitions of authorship among manuscript teams.Discussion: The prevalence and definition of ghostwriting remain unclear. Increased transparency and auditable authorship practices that align with specific guidelines may aid in the avoidance of ghostwriting. In addition, MeSH or clearer indexing terms may be helpful to separate usages of ghostwriting in scientific settings (e.g. genetic research) versus biomedical publishing.

Authorship: from credit to accountability : Reflections from the Editors' Network

The Editors' Network of the European Society of Cardiology (ESC) provides a dynamic forum for editorial discussions and endorses the recommendations of the International Committee of Medical Journal Editors (ICMJE) to improve the scientific quality of biomedical journals. Authorship confers credit and important academic rewards. Recently, however, the ICMJE emphasised that authorship also requires responsibility and accountability. These issues are now covered by the new (fourth) criterion for authorship. Authors should agree to be accountable and ensure that questions regarding the accuracy and integrity of the entire work will be appropriately addressed. This review discusses the implications of this paradigm shift on authorship requirements with the aim of increasing awareness of good scientific and editorial practices.

Authorship: from credit to accountability. Reflections from the Editors' Network

The Editors' Network of the European Society of Cardiology provides a dynamic forum for editorial discussions and endorses the recommendations of the International Committee of Medical Journal Editors (ICMJE) to improve the scientific quality of biomedical journals. Authorship confers credit and important academic rewards. Recently, however, the ICMJE emphasized that authorship also requires responsibility and accountability. These issues are now covered by the new (fourth) criterion for authorship. Authors should agree to be accountable and ensure that questions regarding the accuracy and integrity of the entire work will be appropriately addressed. This review discusses the implications of this paradigm shift on authorship requirements with the aim of increasing awareness on good scientific and editorial practices.

Authorship: from credit to accountability. Reflections from the Editors' Network

The Editors' Network of the European Society of Cardiology provides a dynamic forum for editorial discussions and endorses the recommendations of the International Committee of Medical Journal Editors (ICMJE) to improve the scientific quality of biomedical journals. Authorship confers credit and important academic rewards. Recently, however, the ICMJE emphasized that authorship also requires responsibility and accountability. These issues are now covered by the new (fourth) criterion for authorship. Authors should agree to be accountable and ensure that questions regarding the accuracy and integrity of the entire work will be appropriately addressed. This review discusses the implications of this paradigm shift on authorship requirements with the aim of increasing awareness on good scientific and editorial practices.

Authorship: From Credit to Accountability Reflections From the Editors´ Network

The Editors´ Network of the European Society of Cardiology (ESC) provides a dynamic forum for editorial discussions and endorses the recommendations of the International Committee of Medical Journal Editors (ICMJE) to improve the scientific quality of biomedical journals. Authorship confers credit and important academic rewards. Recently, however, the ICMJE emphasized that authorship also requires responsibility and accountability. These issues are now covered by the new (fourth) criterion for authorship. Authors should agree to be accountable and ensure that questions regarding the accuracy and integrity of the entire work will be appropriately addressed. This review discusses the implications of this paradigm shift on authorship requirements with the aim of increasing awareness on good scientific and editorial practices.

Biomedical authors' awareness of publication ethics: an international survey

OBJECTIVE

The extent to which biomedical authors have received training in publication ethics, and their attitudes and opinions about the ethical aspects of specific behaviours, have been understudied. We sought to characterise the knowledge and attitudes of biomedical authors about common issues in publication ethics.

DESIGN

Cross-sectional online survey.

SETTING AND PARTICIPANTS

Corresponding authors of research submissions to 20 journals.

MAIN OUTCOME MEASURES

Perceived level of unethical behaviour (rated 0 to 10) presented in five vignettes containing key variables that were experimentally manipulated on entry to the survey and perceived level of knowledge of seven ethical topics related to publishing (prior publication, author omission, self-plagiarism, honorary authorship, conflicts of interest, image manipulation and plagiarism).

RESULTS

4043/10 582 (38%) researchers responded. Respondents worked in 100 countries and reported varying levels of publishing experience. 67% (n=2700) had received some publication ethics training from a mentor, 41% (n=1677) a partial course, 28% (n=1130) a full course and 55% (n=2206) an online course; only a small proportion rated training received as excellent. There was a full range (0 to 10 points) in ratings of the extent of unethical behaviour within each vignette, illustrating a broad range of opinion about the ethical acceptability of the behaviours evaluated, but these opinions were little altered by the context in which it occurred. Participants reported substantial variability in their perceived knowledge of seven publication ethics topics; one-third perceived their knowledge to be less than 'some knowledge' for the sum of the seven ethical topics and only 9% perceived 'substantial knowledge' of all topics.

CONCLUSIONS

We found a large degree of variability in espoused training and perceived knowledge, and variability in views about how ethical or unethical scenarios were. Ethical standards need to be better articulated and taught to improve consistency of training across institutions and countries.

Ghostwriters in the scientific world

The scientific world is facing a constant problem of ghostwriters. These ghostwriters are often attached to the medical publishing houses and are involved in writing an article for a pharmaceutical company which may, in turn, use the name of an established or a famous scientist as an author to the article. Often, such articles are published in well-known journals and are circulating widely. Many a time the adverse effects are overlooked in such papers. This will result in a corrupt practice of prescribing a drug which is not scientifically useful or may have life-threatening side effects. In this present article, the authors discuss this evil practice of ghostwriting in the context of the present day scientific publishing.

Professional medical writing support and the reporting quality of randomized controlled trial abstracts among high-impact general medical journals

Background: In articles reporting randomized controlled trials, professional medical writing support is associated with increased adherence to Consolidated Standards of Reporting Trials (CONSORT). We set out to determine whether professional medical writing support was also associated with improved adherence to CONSORT for Abstracts.

Methods: Using data from a previously published cross-sectional study of 463 articles reporting randomized controlled trials published between 2011 and 2014 in five top medical journals, we determined the association between professional medical writing support and CONSORT for Abstracts items using a Wilcoxon rank-sum test.

Results: The mean proportion of adherence to CONSORT for Abstracts items reported was similar with and without professional medical writing support (64.3% vs 66.5%, respectively; p=0.30). Professional medical writing support was associated with lower adherence to reporting study setting (relative risk [RR]; 0.40; 95% confidence interval [CI], 0.23–0.70), and higher adherence to disclosing harms/side effects (RR 2.04; 95% CI, 1.37–3.03) and funding source (RR 1.75; 95% CI, 1.18–2.60).

Conclusions: Although professional medical writing support was not associated with increased overall adherence to CONSORT for Abstracts, important aspects were improved with professional medical writing support, including reporting of adverse events and funding source. This study identifies areas to consider for improvement.

The spectre of ghostwriting: eroding public trust in physicians, clinical trial integrity and biomedical authorship

The impact of medical ghostwriting, a violation of authorship ethics, remains unclear within the biomedical literature and among the public, potentially raising concerns about the integrity of the biomedical evidence base. Core texts in authorship and ghostwriting from the clinical literature and the 2010 Senate Minority Report on ghostwriting were reviewed as were uses of the term 'ghostwriting' in contemporary (2009-2011) and more recent (2015-2016) journalistic news coverage originally printed in English. Journalistic coverage oversimplified key concerns about ghostwriting identified by the medical community and the US government. More recent journalistic uses of the term 'ghostwriting' suggest confusion with topics such as financial disclosures or patient monitoring. Pharmaism in the medical literature, an expression of bias against pharmaceutical companies that casts doubt on the credibility of physicians and scientists, may be a source for confusion. The tendency for medical journal editors to discuss ghostwriting in the context of clinical trial transparency or data integrity is another possible source for misinterpretation via oversimplification. Journalistic descriptions of ghostwriting consistently downplay the critical reasoning abilities and competence of practising physicians and deflect attention away from patient concerns and back to pharmaceutical companies. Some uses of the term ghostwriting in news coverage may implicitly undercut belief in the competence of physicians, a troubling trend. Further work is needed to characterise the impact of ghostwriting in the medical literature and to reassure the public that their trust in medical practitioners is well placed.

The Ghost Collaborator

Collaboration is increasingly important for researchers in all disciplines. Universities and funding bodies tend to prefer projects that involve interdisciplinarity, collaboration between different institutions, and international consortiums. Such projects can yield great benefits, but they also pose particular challenges for certain aspects of research integrity, and particularly for awarding credit and authorship. In this article, we describe and analyze the phenomenon of the ghost collaborator, who is initially fully involved and makes a full contribution to a project's design, but then finds him- or herself excluded from meetings and publications.

Good Publication Practice for Communicating Company-Sponsored Medical Research: GPP3

This updated Good Publication Practice (GPP) guideline, known as GPP3, builds on earlier versions and provides recommendations for individuals and organizations that contribute to the publication of research results sponsored or supported by pharmaceutical, medical device, diagnostics, and biotechnology companies. The recommendations are designed to help individuals and organizations maintain ethical and transparent publication practices and comply with legal and regulatory requirements. These recommendations cover publications in peer-reviewed journals and presentations (oral or poster) at scientific congresses. The International Society for Medical Publication Professionals invited more than 3000 professionals worldwide to apply for a position on the steering committee, or as a reviewer, for this guideline. The GPP2 authors reviewed all applications (n = 241) and assembled an 18-member steering committee that represented 7 countries and a diversity of publication professions and institutions. From the 174 selected reviewers, 94 sent comments on the second draft, which steering committee members incorporated after discussion and consensus. The resulting guideline includes new sections (Principles of Good Publication Practice for Company-Sponsored Medical Research, Data Sharing, Studies That Should Be Published, and Plagiarism), expands guidance on the International Committee of Medical Journal Editors' authorship criteria and common authorship issues, improves clarity on appropriate author payment and reimbursement, and expands information on the role of medical writers. By following good publication practices (including GPP3), individuals and organizations will show integrity; accountability; and responsibility for accurate, complete, and transparent reporting in their publications and presentations.

Mythbusting Medical Writing: Goodbye, Ghosts! Hello, Help!

To meet ethical and scientific obligations, authors should submit timely, high-quality manuscripts. Authors, however, can encounter ethical (e.g., authorship designation) and practical (e.g., time and resource limitations) challenges during manuscript preparation. Could professional medical writers-not ghostwriters-help authors address these challenges? This essay summarizes evidence countering three myths that may have hindered authors from considering the use of professional medical writers. Authors with sufficient time, writing expertise, and reporting guideline knowledge may meet their obligations without writing assistance. Unfortunately, not all authors are in this position. Decisions about writing support should be based on evidence, not myths.

Publication practices and standards: recommendations from GSK Vaccines' author survey

BACKGROUND

Evolving standards of good publication practice (GPP) and a survey conducted in 2009 of authors, who were investigators and researchers not employed by the company prompted changes to GSK Vaccines' publication practices. We conducted a follow-up survey in 2012 to assess the company's revised practices and to evaluate understanding of GPP among investigators and researchers who had previously authored at least one publication in collaboration with GSK Vaccines.

METHODS

The 50-question web-based survey addressed authoring practices and transparency of decision-making. Investigators and researchers (n = 1,273) who had authored at least one publication reporting on GSK Vaccines-sponsored human research since 2007, were invited to participate. Responses to 37 closed questions are presented. The remaining 13 questions were open-ended or did not concern publication practices.

RESULTS

A total of 415 external authors (32.6%) responded. International Committee of Medical Journal Editors (ICMJE) authorship criteria were clear to most respondents (78.1%); 7.7% found they were unclear. The majority of participants (86.8%) found GSK Vaccines' authorship questionnaire a suitable tool to assess eligibility for authorship as per the ICMJE criteria. However, only 68.5% felt that the outcome of the questionnaire is communicated appropriately and 58.3% felt well informed on changes in authorship. Nearly two-thirds (62.9%) of respondents felt that having a pharmaceutical company employee as lead author makes manuscript acceptance less likely. Access to relevant data was regarded as sufficient by 78.5% of respondents. Briefing meetings before publication start, publication steering committees and core writing teams were recognized as valuable publication practices. Professional medical writing support was seen as adding value to publication development by 87.7% of participants. Most respondents agreed that manuscript discussions should start early, with 81.7% stating that they were in favor of introducing a formalized 'author agreement' at the publication start.

CONCLUSIONS

GSK Vaccines made changes to its publication practices to ensure improved transparency and better involvement of external authors. The results of this survey suggest that these changes have been effective to a large extent. They confirm the need for effective and timely communication, as well as transparent processes for authorship and decision-making during publication development. The identified gaps in GPP will help to guide further improvements to the company's policies on publication practices.