Medical Writer Challenges Negative Portrayal of "Ghostwriters"

Selling Psoriasis Online
A recent article in the New York Times (August 4, 2009), suggested that, "Medical Papers by Ghostwriters Pushed Therapy." The article describes revelations that Wyeth paid a medical communications firm to author scientific publications related to hormone replacement therapy.

Integrity, honesty, and transparency are the important issues in this story. My objection to the present article, and others I have seen in the Times, is the implication that medical writers are at the core of rampant misrepresentation of clinical data. I became a medical writer after years in research, marketing, and clinical affairs work, as well as participation in teaching at a medical school. I like my work because I enjoy learning and I enjoy writing. Technically, I am not a ghostwriter because I expect my contribution to a manuscript to be acknowledged along with the funding source. In reality, I do the editorial grunt work that most authors, who have clinical and teaching responsibilities, don't have time to do. My role is akin to a clerk for a Supreme Court Justice.

For those who may not be aware, I would like to explain what medical writers typically do to prepare a manuscript. The initial step typically includes a teleconference with the primary author(s) to discuss the concepts or study that becomes the subject of the article. We then create in collaboration with the primary authors a heavily referenced outline based on that conversation. The author(s) gives us the go-ahead to write the first draft, and review by the author(s) continues until the final version is ready for submission to a peer-reviewed journal. Someone from the sponsoring company usually looks at the drafts along the way for scientific accuracy related to their sponsored studies. The most common comment I receive from sponsor reviews is a request that I include additional references. For all but general information, primary sources are used to document data. The author(s) has final editorial control over all content. Keep in mind that the reputation of the author(s) is what is at stake if the article is not scientifically accurate.

I am interested in knowing why the assumption is made that because I am a writer not an author, I am merely a patsy for the big pharma. I use my training and experience to draft the words for the author(s). I modify the text until the author(s) is satisfied with the language. Obviously there are exceptions; in my experience, medical writers and their communications companies like ours and many other reputable ones can act as another level of scrutiny for the data being presented. If anyone is interested in more information about the code of ethics endorsed by the American Medical Writers Association, please go to www.amwa.com.

For many health care providers, review articles offer the easiest way to access peer-reviewed information about the pathophysiology of the diseases they treat, as well as the modalities to treat them. The reader has some responsibility to evaluate the data, as well. If an individual is concerned about bias, that person can be assured that for every article sponsored by one company, there is at least one more on the same topic that is sponsored by each of its competitors.

Finally, pharmaceutical companies, physicians and their universities, and journals are in business to make money. If people want drug development to be free of market influences, we need to have government funding of research, development, and clinical trials. In my opinion, that will inject another set of concerns, and I don't imagine it is an appealing alternative to most people in the US.

— Stacey Moore
Managing Director
Physician Resources, LLC
Montclair, NJ

MEDICAL EDITOR'S COMMENT:
The practice of ghost-writing has been an important part of Medical and Scientific publishing for some time. In earlier epochs, scientists employed secretaries or assistants who maintained their journals, drafted correspondence, and assisted in the development of manuscripts. As Ms. Moore (with whom I have worked on numerous projects) points out, medical writers offer their unique talents and abilities to ensure the quality and readability of published information. Quite simply, many of us who are expert in clinical care and research simply are not also great writers. The physician/researcher is ultimately responsible for the information published under his or her name and is intimately involved in the production of the first outline to the last revision. I believe the analogy to a law clerk is an accurate one and point out that there are also parallels to legislation. No member of Congress actually drafts the thousands of pages of legislation debated and enacted each year. There are clerks who write and revise bills for them. Furthermore, it is difficult to believe that any member of Congress reads every and all the content of every piece of legislation they "author" or vote on. Physicians and researchers, by contrast, actually read and take true ownership of the publications that bear their names.

CORRECTIONS:
An error appeared in the caption for the photos at right, which were published in the "Therapeutics Update" in the July 2009 issue. The patient is shown before and after SlimLipo Therapy. SlimLipo laser-assisted liposuction device (Palomar) was recently launched in a 40-watt model.

Please note that in the August 2009 "Dermatology Q&A," the only therapy discussed was SlimLipo. The answer to the question, "What do the dual wavelength channels offer patients and physicians?" should have read:

The choice of wavelength for laser thermolysis is essential for penetration, according to Dr. Weiss; this device includes a selective wavelength blend of 924 and 975nm. "The 924nm wavelength was found to be the peak in fat absorption and provide maximum selectivity for fat, while the 975 wavelength represents the peak in water absorption," he says. These two channels allow for speed and good results, not just due to the ease of treatment itself, but also because of the duration of fluid being in the skin, according to Dr. Weiss. Fluid remaining in the dermis delays healing, but 90 percent of fluid is drained within 12 hours of SlimLipo treatment, with gentle massages to release the fluid. "This draining is more easily achieved with laser-induced fat melting, because in standard liposuction the cannulas are relatively larger and don't allow for easy extraction of fluids," notes Dr. Weiss.

• On page 48 of the August issue, norgestimate and desogestrel were referred to as second-generation, rather than third-generation agents. The following is accurate:
  "Progestins found in OCPs exhibit varying degrees of binding to and activation of the androgen receptor. Some progestins bind to the androgen receptor and actually mimic the activity of testosterone on the sebaceous gland thereby potentially worsening acne. Third-generation progestins (norgestimate, desogestrel), however, demonstrate little or no risk of increasing the activity of the androgen receptor."