1. Kennedy, Maureen Shawn MA, RN,


Ghostwriting is pervasive in biomedical publishing.


Article Content

It's been quite a year for AJN. We launched a new Web site ( in February, followed by a blog ( in March, and, soon afterward, pages on Facebook and Twitter. The AJN editorial staff, with no additional resources, wholeheartedly forged ahead with each of these new ventures. And it seems that you like and value what we're doing. Each month we now welcome more than 50,000 visitors to the Web site and 15,000 visitors to the blog-which was recently named one of the top 100 nursing blogs-and count more than 2,000 Facebook fans and 4,000 Twitter followers. The Biomedical and Life Sciences Division of the Special Libraries Association recognized AJN as one of the 100 most influential journals of the century-the only nursing journal so honored. In November, we published Transforming Care at the Bedside: Paving the Way for Change, a comprehensive report on an initiative that's revitalizing patient care in hospitals. I'm still incredulous when I think of all that we achieved this year. We have a talented staff, though there are fewer of us now after the departures of several key staff members. I worry about whether we can continue to fulfill our commitment to providing AJN readers with accurate, high-quality information.


Meeting that commitment is becoming more difficult, despite our best efforts, because of an insidious problem: undisclosed ghostwriting. And it's industry-wide. Last month I attended a conference on biomedical publishing in Vancouver, at which the editors of JAMA reported findings that "overall, about 8% of articles published in major medical journals had ghostwriters." (For a related blog post, visit AJN has long required potential authors to sign a form disclosing any real or potential conflicts of interest and certifying that all who contributed substantially to the article have been named. Yet the problem persists.


It usually happens like this: I review a paper that's well written and appropriately referenced, and I think: it's almost too good to be true (Clue 1). Regardless of the topic, there's a lengthy section discussing pharmacology and citing studies supporting drug efficacy (Clue 2). Discussion of nursing implications-assessing effectiveness, monitoring adverse events and patient teaching, and so on-is minimal (Clue 3); the peer reviewers usually note that. At some point during revisions (or worse, during editing of an accepted paper), another name will emerge, someone deserving of acknowledgment for "editorial assistance." Further inquiry reveals that this person is a ghostwriter whose services were paid for by a pharmaceutical company and that the "assistance" was writing the first draft of the paper.

Figure. Maureen Shaw... - Click to enlarge in new windowFigure. Maureen Shawn Kennedy

On October 9 the International Committee of Medical Journal Editors (ICMJE), the group that sets the standards for biomedical publishing, announced the creation of a new disclosure form, the ICMJE Uniform Disclosure Form for Potential Conflicts of Interest (free at (AJN's editorial policies are based on ICMJE standards.) Because ghostwriting has become so pervasive, the ICMJE is requiring wider disclosure, extending to potential conflicts of interest involving authors' spouses and children that might influence an article's content. AJN will be following these new, stricter guidelines.


But ensuring transparency is time-consuming. We've spent countless hours on manuscripts that, once full disclosure was finally made, we couldn't in good conscience publish. How can we trust that all relevant studies are included in an evidence-based review? How do we know whether the hired writer had all the data necessary to do an accurate analysis?


So, readers, read between the lines. Is what you're reading evidence based? Was it peer reviewed? If what you're reading was handed out for free, who paid to have the content developed? At the Vancouver conference, Harold Sox, former editor of the Annals of Internal Medicine, said, "Good medical editing is a public good." The public relies on medical and nursing journals to provide practitioners with accurate information so they can make good decisions. It's a legacy we take seriously.