Corruption in medical science: Ghostwriting

Not so long ago,  I said:
“In my memoirs of deaning, I had written, ‘I would find myself thinking, Now I’ve seen everything; nothing can surprise me anymore, only to experience a novel surprise the next day or the next week’”.
That was in connection with an FDA panel recommending that the purported but unproven anti-cervical-cancer vaccine, which has been reported as responsible for some serious “side” effects including deaths, should be made available to vaccinate young boys to protect them — supposedly, unprovenly — against the less-than-worrying possibility of genital warts. I say “unproven” because the vaccine is only claimed to protect against HPV, the human papilloma virus (and not even all of its strains), and the connection between HPV and cervical cancer or genital warts is purely a matter of association, correlation: no causative relationship has been established. As I find myself repeating ad nauseam, correlation doesn’t prove causation.

So that FDA recommendation surprised even this cynical observer. But almost immediately I found myself gagging over a story (by Paul Basken) in the Chronicle of Higher Education of 18 September 2009, p. A10: “Ghostwriters Haunt the Integrity of Medical Journals — Company-sponsored contributors enhance, without disclosure, university researchers’ papers”.
The story also reveals that “enhance” is a misleading euphemism: the unnamed individuals actually did all the meaningful work.
Dr. Lisa M. Shulman, newly appointed assistant professor of neurology at the University of Miami and serving a fellowship on Capitol Hill “was overworked and under-resourced”. She accepted an offer of help in writing research articles from DesignWrite, a business employed by (among others) the drug company Wyeth. DesignWrite “select[ed] background information on connections between estrogen and Parkinson’s disease, and . . . draft[ed] a proposed summary of the existing data” whereupon Shulman “wrote” “her” article which failed to mention DesignWrite or Wyeth, which happens to sell estrogen pills.

There could hardly be a more obvious case of deceitful publication — excluding, that is, such corporate deceit as Elsevier’s publishing of no fewer than 6 “journals” that were actually “sponsored” by drug companies (“Merck published fake journal”; “Elsevier published 6 fake journals”).

If a student were to do what Dr. Shulman did, it would be labeled unequivocally as plagiarism or fraud, and it would lead at a minimum to failing the relevant course, at worst to suspension or even dismissal from the college. Yet this sort of thing has become so common in “medical science” as to be routine. “A study presented last week . . . found that in The New England Journal of Medicine, at least 11 percent of the articles had ‘ghost’ authors. Another study tracked attempts in the late 1990s by Parke-Davis, now a subsidiary of Pfizer Inc., to get articles published concerning its medication Neurontin. The pharmaceutical company succeeded in placing 11 articles in seven journals, none of which disclosed its role in authorship and only two of which acknowledged its financial support” (Basken, op. cit.).

Those who participated in these deceptive, potentially damaging practices emit “apologies” and “excuses” reminiscent of the words of politicians: use of the passive voice (“mistakes were made”) and failure to acknowledge wrongdoing, calling it mere negligence. Thus Dr. Shulman called her transgressions “an oversight”. She “sees little harm in accepting outside professional help, since she takes full responsibility for the published contents. Her article, she says, is a dispassionate examination of whether estrogen has any connection with Parkinson’s disease. The article opens by stating that ‘increasing evidence’ supports the use of estrogen for guarding against Parkinson’s, although it notes conflicting findings based on variations in age and dosage. ‘There is nothing in my paper that is favorable to Wyeth,’ says Dr. Shulman, who denies that her actions constituted ghostwriting” [emphases added].
Shulman might do well to bear in mind that when you’re in a hole, it’s best to stop digging. Even better, she should find a job she can do without outside help.

Barbara B. Sherwin, a psychology professor at McGill University, lent her name to an article written by a freelance author working for Wyeth: “I made an error in agreeing to have my name attached to that article without having it made clear that others contributed to it”.
NO: her “error” was in not doing the work that the article tried to disseminate.
If Shulman or Sherwin were to have given proper acknowledgment, they would not be able to cite those articles on their vitae as personal accomplishments. Indeed, their names would not appear in the authorship line at all; or if they did, it would be stated clearly in footnotes that their actual contributions were at most editorial.

Another attempt to make black seem white came from Matthew R. Weir, director of nephrology, University of Maryland Medical Center, who tried to minimize the fraud by saying that “such articles typically appear only in lower-tier medical journals, which are recognized as less reliable”. Again it’s not clear how that is supposed to be an excuse. “Dr. Weir has himself been . . . accused in a lawsuit against the drug maker Merck of signing his name to an article that played down the chances that the company’s Vioxx medication might raise the risk of heart attacks. The co-author on the report was a scientist employed by Merck. Dr. Weir says he stands by the data in that article”. It is nowadays common knowledge that VIOXX does indeed raise the risk of heart attacks.

Then there’s the attempted evasion that such “articles don’t mention specific drugs by name, and instead just give a general endorsement of a particular therapeutic approach that happens to align with the medication offered by the company”. Right; just happens to. Would the article ever have been conceived otherwise?

“Rogerio A. Lobo, a professor of obstetrics and gynecology at Columbia University, says DesignWrite contributed work, unattributed, to one of his published papers. But the company’s role was limited to assembling existing research on a subject, providing statistics and charts, and copy editing. He says he substantially changed the final version by cutting out entire sections and eliminating the endorsement of a particular product. ‘I don’t consider that ghostwriting,’ he says. ‘I’m the responsible person, and I stand by it, and I wrote it’” (emphases added; Basken, op. cit.). Thus Lobo admits clearly that his only contribution was editorial or secretarial, not the central and essential work of getting the data.

“Both ghostwriting’s detractors and its alleged participants agree that the difficulty of defining the practice makes it tough to eliminate”.
The only proper characterization of that statement, as of the “apologies”, is BULLSHIT — statements made without regard for their truth. Everyone who contributes to an article must be identified, and best practice has long been that on multi-authored papers the contributions of each individual are spelled out. In that case, the question of ghostwriting cannot even arise. No need to try to define it; just don’t do it. As pointed out by “Steven E. Nissen, chairman of cardiovascular medicine at the Cleveland Clinic . . .  ‘No amount of editing,’ . . . can justify an author’s using an undeclared contributor”.

DesignWrite, a “medical-communications company”, “regards its service as providing a public benefit. ‘We stand behind the accuracy of every article we have been involved in,’ says the company’s president, Michael Platt”.
No surprise there. If the articles are accurate in every detail of their data but failed (happened to fail) to include existing but contrary data, his statement would remain technically correct while misleading in the most important way. Brings to mind the point made by Paul Halmos that lying is sometimes OK, but misleading never is (see p. 168 ff. in To Rise Above Principle: The Memoirs of an Unreconstructed Dean).

Present practices raise “the specter of hidden bias in published papers that favor the effects of the company’s drugs. Doctors rely on such papers when making life-or-death choices about treating their patients” (Basken, op. cit.).
There’s nothing trivial about this, and no lame excuses should be countenanced. Faculty who plagiarize and deceive in this manner should be disciplined even more harshly than students who plagiarize. Students do it often enough through ignorance rather than deliberately, but that cannot be said of these senior miscreants who even seek to justify their misdeeds. These people are a disgrace to the profession of medicine and to the scholarly academic profession.

The larger significance is that “research” nowadays is an activity engaged in by people who don’t belong there. Honest original research is very hard, and the rewards are few, far between, and anything but guaranteed (just ask Peter Duesberg, say). The only good reason for getting into it is because of an overwhelming desire to help gain new knowledge.
Publication should follow work, not precede it. It is preposterous for people like Lobo, Shulman, Sherwin, Weir, to be employed and described as researchers since their primary aim is clearly careerist, to amass publications rather than to advance knowledge. “Preposterous” in the sense Jacques Barzun explained:

That is preposterous which puts the last first and the first last. . . .
Valuing knowledge, we preposterize the idea and say . . .
everybody shall produce written research in order to live,
and it shall be decreed a knowledge explosion.
— Jacques Barzun, The American University (Harper and Row, 1968) 221

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Though there is no mention above of “HIV” or “AIDS”, the connection ought to be obvious enough: The manifold misdeeds of HIV/AIDS “researchers” are part and parcel of an overall corruption of medical “research”. People like Lobo et al., above, are, in the words of Susan Haack, “fake reasoners” who don’t care about the truth-value of what they put their names to; they emit bullshit. Mainstream HIV/AIDS “researchers” are what Haack calls “sham reasoners“, people who seek only to support a pre-existing belief (Susan Haack, “Science, scientism, and anti-science in the age of preposterism“, Skeptical Inquirer 21 #6, November/December 1997).