What are medical journals doing to combat ghostwriting?

I have recently written a 2-part guest blogpost for Pharmaphorum about medical ghostwriting. You can read part 1 here and part 2 here. If you haven't read them, you might want to do so now. I'll go away and have a cup of tea while you do.

OK, are you back? Right, let's carry on. One of the points I made was that it doesn't seem to me that medical journals are doing all they could to combat ghostwriting. While it's probably not realistic to expect journals to eradicate the practice all by themselves, I do think they could very easily ask a few questions of people submitting articles to them. If journals did this routinely, it should eliminate all ghostwriting by those who are not dishonest but simply not aware of ethical standards in this area, who I suspect account for the majority of ghostwritten articles. Blatant dishonesty is a lot less common than ignorance of the latest guidelines. I and some colleagues have published a checklist that should help journals to do this, although to my knowledge, no journals have taken this up.

Anyway, my blog post prompted a discussion on Twitter, in which Trish Groves, deputy editor at the BMJ (tweeting as @trished) explained what the BMJ does in this area. It's probably worth making clear at this point that I think the BMJ is doing vastly more than many other journals, for which it deserves considerable credit.

Trish explained that the BMJ has a series of 3 questions which they ask authors, which are designed to make it harder for ghostwriters. The questions can be found towards the bottom of this page, under the section "Who prompted this submission?"

These are good questions to ask, and should go a long way towards eliminating ghostwritten articles. However, I was a bit concerned that the BMJ page said "We may ask authors..." (my emphasis), implying that they don't always. Trish explained that they are mainly for review papers rather than original research, and are only asked at the discretion of the BMJ editors. The reason why they are not always asked, apparently, is that there would be a significant resource implication for doing so.

Now, I don't want to have a go at the BMJ, who, as I said earlier, are streets ahead of most other journals in this regard. But I do find it disappointing that the questions aren't always asked, which suggests that the commitment to eradicating ghostwriting may be a little half-hearted. Surely it would actually be easier to send the same forms to everyone, rather than having to spend time deciding who gets asked these questions and who doesn't?

I appreciate that there is a resource implication to someone having to read the answers, but if all 3 questions are answered "no", then that really ought to take someone no more than a couple of seconds to do. If the questions are not answered "no", then that suggests that they really needed to be asked, and there is a substantial risk of ghostwritten papers getting through if the questions are not asked.

It would be nice if the BMJ would rethink this policy and ask the questions of all their authors. It would be better still if other medical journals would follow the BMJ's lead and start asking these questions as well (some already do, but really not many). Otherwise, I fear we are still going to be discussing ghostwriting in medical journals for many years to come.