A recent essay in PLoS Medicine has highlighted the consistent failure of medical journals to control the practice of ghostwriting. In an attempt to stamp it out once and for all, legal experts have advised that doctors and scientists who ‘guest author’ papers written by ghostwriters should be charged with professional misconduct and fraud.

Fundamentally, medicine is based on trust. Whether trust between a doctor and patient or between science and the public, we expect that the information we are given is truthful and unbiased. Consequently, it is shocking to realise the number of medical papers signed off by ‘guest authors’ but actually written by ghostwriters. Described by the PLoS Medicine editors as the ‘systematic manipulation and abuse of scholarly publishing by the pharmaceutical industry’, ghostwriting in medical publishing is the subject of heated debate.

In the ghostwriting of medical papers there are three main players. First, and probably the most influential, is the pharmaceutical company. Second, is the scientist signing their name to the research carried out by the pharmaceutical company. And last, is the medical or ‘ghost’ writer in charge of the communication of this research in the form of a medical paper.

The reason often given for the existence of ghostwriters is that researchers have neither the time nor skill to write about their science in an engaging way. As a result, ghostwriters are necessary to help fill the gap in the market – as skilled medical writers they are able to communicate the science more effectively.

A study carried out by Nigel Praities, who graduated from the Imperial MSc Science Communication course in 2007 and is now the Clinical News editor of Pulse, revealed an interesting insight into the world of ghostwriting. It seems the influence and benefits held by each of these players have been grossly oversimplified. During his investigation, Praities interviewed a number of ghostwriters working for medical journals in order to gain a perspective from inside the profession.

The commercial interest of the pharmaceutical companies involved is a source of considerable concern and, it seems, rightly so. As described by one of the ghostwriters during an interview with Praities, the companies are keen to check their writing at every stage of the drafting process. Perhaps more shocking is that if a piece of data is found that portrays the company badly, they will frequently request to have it removed in order to skew the final conclusions to fit with the company message. The result is marketing dressed up as science.

Perhaps surprisingly, the interviews also revealed that ghostwriters have a bigger influence over the information published than was first assumed. In fact, the ghostwriters described frequently being required to act as the mediator between the concerns of the pharmaceutical companies over their commercial interests and those of the scientists over their scientific credibility.

Overall, it seems ghostwriting generates huge rewards for each of the parties involved. Hiring ghostwriters allows the pharmaceutical companies a considerable amount of control over what is happening; at what level the findings are pitched and how quickly the papers are being written. The scientists signing their name to their papers are rewarded by advancements in their careers and reputations in the medical world, while their name establishes accountability for the science. Finally, the ghostwriters, although their contributions to the final paper are usually hidden, are rewarded financially.

However, there is one party that has been largely ignored during this entire process–  the public. The research published by big pharmaceutical companies is read by doctors in order to guide the decisions they make about various drug options. Consequently, the distortion of this information for the financial gain of the company can have a very real and possibly dangerous effect on the everyday treatment of patients. Equally as detrimental is the filtering of these research papers into the mainstream media and subsequently into the hands of the public. By continuing to hide ghostwriters we are running the risk of worsening the already damaged public confidence and trust in science.

Ultimately, it is not the fact that the ghostwriters exist, more that their contributions are not acknowledged in the final published paper.  If they were no longer anonymous, they would no longer be ‘ghosts’. In addition to the ghostwriter’s name, it is essential that the name of the company or whoever is funding the research is included in the published paper. This would allow whoever is reading the paper to make their own judgment about the trustworthiness of what is written.

Transparency is key to the successful communication of science. More effective guidelines need to be put in place and more importantly, stuck to, in order to control the way in which ghostwriters are used. Medical papers should not be used as a form of marketing and it is important that the extent to which pharmaceutical companies are involved in the writing of these papers is regulated. Either way, to continue with the current practice of ghostwriters is to undermine what science is really about.

Julia Robinson is studying for a Masters in Science Communication at Imperial College.



  1. Reblogged this on engaging TALK and commented:
    I’ve had direct experience of this practice and it is really disturbing. The only thing that I would dispute is the financial reward for the ghostwriter. In my experience, they go through a lot of heartache and stress, trying to mediate commercial pharmaceutical marketing concerns, key opinion leaders’ (expert scientists and doctors) egos, and their own sense of moral behaviour and ethical conduct. And given the ridiculous requirements placed on them, they are not financially well rewarded. Especially compared to the other parties involved.

  2. Very interesting article. Would be interesting to see how much these companies pay each year on this!

  3. This is a very interesting piece, and I wonder if Nigel Praities’s research has been published? It should be. If it has, it would be good to give a reference. (Ironically, to do a piece of research and not publish it is regarded by some as misconduct.)
    I fear that the real villains in the ghostwriting saga are the scientists who allow their names to be misused. It’s ironic that they should see allowing this to happen as good for their careers—because if found out (even without a criminal charge) it might destroy their careers in a moment. The scientists clearly feel that they have little chance of being caught.
    Although there is lots of attention to ghostwriters, I fear that there are other still more powerful forces at work that, as I’ve written in PloS Medicine, make “medical journals an extension of the marketing arm of pharmaceutical companies.”

  4. Nigel’s research was written up as his dissertation for his MSc in Science Communication. There is a copy lodged in the library at Imperial but I don’t think it’s been published in any other form. The full reference is: Praities, Nigel (2007) What implications does ghostwriting of academic articles have for biomedical science? Imperial College, MSc Dissertation.

  5. Hi there, there seems to a bit more transparency now in terms of naming ghostwriters in medical papers. So they may not be ‘ghosts’ anymore.

    But, as I think I go into in my dissertation, when a pharmaceutical company is intimately involved in the design of a trial, how it is analysed and written up, the places it is published and then the secondary literature around it, it challenges the traditional idea of authorship.

    They frame the discussion that is around that paper, and that is kind of marketing is very hard to recognise.

    On another note, it is very comforting to see that all the hard work on my dissertation did not go to waste. Keep up the good work!

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