Everyone agrees that ghostwriting in the medical literature is a bad thing. The question is what can be done to eradicate it.
Professional medical writers’ organisations such as EMWA, AMWA, and ISMPP have done their bit by publishing guidelines and position statements and educating their members about ethical publication practices, and there is some evidence that those efforts are pushing things in the right direction, but it’s clear that they are not going to solve the problem by themselves and that more needs to be done.
So what more can be done?
Well a paper recently published in PLoS Medicine by Bosch et al argues that the best way to deal with it is through legal action. Of the paper’s 3 authors, 1 is a lawyer and another declares an interest in doing consulting work for a law firm, so they would say that, wouldn’t they? It appears to be hard to talk about ghostwriting without conflicts of interest rearing their ugly head.
Now, I don’t want to completely pour scorn on the idea of legal action. It’s an interesting idea, which I suspect could be appropriate in some of the most egregious cases of publication malpractice, and would certainly make people sit up and take notice if it were successful. The deterrent effect of a couple of high profile cases could be quite valuable. Bosch et al suggest that authors of dishonestly written papers could be named as defendants in any legal action relating to harms to patients that result from physicians relying on those papers in their prescribing decisions, and if harms do result in that way, then it’s hard to argue that the authors of the papers aren’t responsible. I wonder if the action could even be extended to the journal that published the paper, although Bosch et al don’t mention that possibility.
However, I think suggesting that legal action is a sensible way forward in the majority of cases is misguided (unless, of course, you’re a lawyer or a consultant to a law firm, in which case I dare say you’ll do very nicely thank you). Legal action is time consuming and extremely expensive, and is going to be completely impracticable as a way of dealing with most unethically written papers.
I know I’ve said this before, but I think it bears repeating: we are never going to get rid of ghostwritten papers unless journal editors start to take the problem seriously (and by taking the problem seriously, I mean actually DOING something about it, not just publishing articles moaning about how terrible the problem is). But as Bosch et al rightly point out, journal editors have not shown a willingness to tackle ghostwriting. And that leaves us with a problem.
I don’t know how we can encourage journal editors to do their bit (although if they did find themselves on the wrong end of a couple of high profile lawsuits involving ghostwritten papers that they published in their journals, I suspect it might focus a few minds), but the question of editorial responsibility is something that’s cropped up in a couple of other contexts recently, and I think it’s worth drawing some parallels.
The first context is my unpleasant experience of finding defamatory material published about my company in the Journal of Bioethical Inquiry. It turned out that, unless I was willing to go down the legal route of suing for libel, which I wasn’t (did I mention that legal action is expensive and impracticable in most cases?), my attempts to have the record corrected were dependent entirely on the good will of the journal editor. If that good will was absent, as it turned out that it was, there was nothing I could do about it as there is simply no mechanism for enforcing ethical behaviour on journal editors who misbehave. Although COPE claim that they investigate complaints against journal editors, their total lack of transparency in their complaint procedure makes it hard to have confidence in the process.
My friend Karen Shashok wrote a detailed article analysing the Journal of Bioethical Inquiry case, in which she argued that a mechanism for making journal editors accountable for their actions is badly needed.
So, if there were a body that was able to hold editors of biomedical journals accountable for their actions, would they be able to take action against journals who publish ghostwritten papers? I don’t know the answer to that, as it’s all a bit hypothetical. But doesn’t it sound like an idea worth pursuing?
It’s also hard to talk about editorial accountability without thinking of the Leveson Inquiry, currently ongoing in the UK. This inquiry is focused on mass media, rather than scientific journals, but perhaps some of the ideas of editorial accountability that will come out of that inquiry could be applicable to journals too?