1. Salcido, Richard MD

Article Content

How much are you influenced by the face validity or credibility of a written piece if the author is well published and from a prestigious institution with impeccable academic credentials? I believe that human nature prevails in this circumstance. I'm certainly impressed by the aforementioned common scenario. However, under the evolving demystification or transparency of what we do in academia, what we write about in our journals and how those writings are developed and used by various stakeholders are front and center to the way we do business.

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Who are the stakeholders? They are government, regulators of industry, manufacturers of products, investors, marketers, authors, writers, editors, peer reviewers, academicians, universities, professional organizations, patients, and society. Society is demanding transparency in the process and outcomes of scientific publication. Currently, the way we ensure this process is to ask authors to disclose ties to industry and sponsorship and to attest to their actual contribution to the writing of a given published work. A few of the leading journals have begun to ask for these prepublication attestations, and we at Advances in Skin & Wound Care certainly do. Authorship in the traditional academic sense means that you have actually participated in the writing. The more involvement in planning in the hypothesis, methods, materials, discussion, and conclusions of a given work implies order of authorship and furthermore responsibility for the thought and content of the manuscript.


In today's fast-moving pace, the perception is that we must accomplish more in less time and often with fewer resources-the 30 seconds of today was the hour of yesteryear!


Recent examples have emerged where big pharmaceutical interests used the name of prestigious members of academia to push their agenda for a certain product at an accelerated pace. And in some cases, "ghostwriters" who were influenced by the corporate agenda were used to bring a product to market without necessarily going through a time-honored process with scientific and ethical rigor in the publication process.


What Are Medical Ghostwriters?

Because there are no precise definitions for medical ghostwriters, and not all those who are referred to as ghostwriters are actually playing that role, a less pejorative term of "professional medical writers" (PMWs) has a more positive connotation and acknowledges the structure and function of those professionals who actually make rightful, ethical, and legitimate contributions to the editorial process. In fact, these professionals have achieved the knowledge and skill to be hired by pharmaceutical companies, academic institutions, journals, and publishing companies to help produce quality manuscripts for scientists or physicians for ultimate publication in a medical or scientific journal. However, sometimes the level of involvement by these scientists or physicians is variable from minimal to significant involvement in the research or the writing process. PMWs write manuscripts without being listed as authors of the manuscript and without being considered ghostwriters, provided their role is acknowledged; suffice to say, they are professionals and deserve credit for their contributions as agreed to by a contract, whether it be remuneration or credit through authorship or proper acknowledgment.


Several organizations, such as the World Association of Medical Editors and the American Professional Writers Association, have published guidelines for the conduct of this very important editorial function and have established ethical principles to guide the endeavors of PMWs. The fact is that PMWs have been involved and will continue to play an active role in the publication process. Some argue that enlisting a PMW may enhance the process by adding clarity, consistency, and efficiency to the oftentimes onerous task of publishing and meeting unrelenting timelines.


In a recent letter to the editor in the New York Times, where the issue of ghostwriting has been highlighted, Cindy W. Hamilton, PharmD, ELS, president of the American Medical Writers Association, clarified the issue in an erudite and concise statement: "Substantial confusion exists about the roles of different team members responsible for new drug development, including medical writers. Ghostwriting is unethical and must be distinguished from collaboration between researchers (authors) and professional medical writers, whose contributions and financing are disclosed. Authors determine content, and writers ensure that it is communicated effectively and promptly. This partnership advances science by facilitating timely publication of research findings, ultimately benefiting the public."


The taxonomy contrasting "ghostwriters" to PMWs in research publications or surveys complicates this less than straightforward nomenclature and may introduce other methodological problems of interpretation of the results of any published work about this issue. The term ghostwriters sells papers and rightfully catches the attention of the public. Although the purpose of this editorial is not to downplay the practice of ghostwriting, I always feel the truth is in the middle in most passionate debates. Most authors and industry partnerships want to do a good job, and most do not need the intervention of "Ghost Busters." The bottom line is that editorial assistance has a legitimate role, whether it is forprose, style, clarity, structure, methods, or statistical support.



At Advances in Skin & Wound Care, the peer-review process and disclosure about conflicts of interest and industry sponsorship are taken very seriously. Any potential issue that fails to meet the core ethical principles of scientific rigor, conflict of interest, or potential influence over a given manuscript will be dealt with in a professional, collaborative manner by involving publishers, editors, authors, writers, our chief ethics editor, and ombudsman.


Richard "Sal" Salcido, MD

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Selected References


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Wilson D, Singer N. Ghostwriting is called rife in medical journals. The New York Times. September 11, 2009; Business section, p. B-5.


World Association of Medical Editors. Ghost writing initiated by commercial companies. J Gen Intern Med 2005;20:549.