SNEAKY SCIENCE: Scientists who list themselves as authors on articles secretly written by pharmaceutical companies should be deemed guilty of academic misconduct.
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When students pawn someone else's work off as their own, they get expelled. But when some professors do the same thing, they get a "pat on the back," and maybe even a few extra bucks. Scientists credited for research articles that were secretly penned by ghostwriters from pharmaceutical companies often are not reprimanded for their misrepresentations; rather, their ranks and career trajectories often improve.

Although this practice of undisclosed authors (with undisclosed commercial interests) writing articles under the pretense of unbiased scientific inquiry raises serious concerns about academic integrity, few institutions have policies to discourage it. The authors of a new study published in PLoS One hope to make medical ghostwriting a faux pas on par with plagiarism and data falsification.

After the results from their survey on ghostwriting prohibition policies revealed that 37 of the top 50 academic medical centers in the U.S. have none, Jeffrey Lacasse of Arizona State University's School of Social Work and Jonathan Leo of Lincoln Memorial University in Harrogate, Tenn., took the opportunity to propose an unambiguous policy on the matter in their article. "I think some people think they don't need a policy addressing ghostwriting because it would fall under plagiarism," Leo explains. "Maybe an administrator would say the plagiarism policy covers ghostwriting, but I think the profs would adamantly disagree."

Once medical publishing's "dirty little secret," ghostwriting is no longer under wraps, thanks in part to a 2009 federal court decision to release 1,500 documents describing the strategic placement of marketing messages into peer-reviewed medical literature. In their article Lacasse and Leo say these cleverly crafted advertisements from pharmaceutical companies shape the literature in subtle but important ways, and can even affect how clinicians perceive and prescribe treatments.

"Your typical family practice physician is bombarded with glossy reprints," Lacasse explains. "The more prestigious the university and the researcher's name on it, the more weight that's going to carry with the doctor."

Policies prohibiting ghostwriting in U.S.-based academic medical centers were recommended in a 2009 report on conflict of interest in medical research, education and practice published by the National Academies' Institute of Medicine in Washington, D.C. In the report a quote from the dramatist Goethe reads: "Knowing is not enough; we must apply. Willing is not enough; we must do." But more than half of the centers investigated by Lacasse and Leo had no formal policies on ghostwriting or authorship whatsoever.

The top 10 academic medical centers have policies—five flat-out banning ghostwriting: Johns Hopkins University; Washington University in Saint Louis; Stanford University; the University of Washington in Seattle; and Columbia University. Five have "more ambiguous rules": Harvard Medical School (although the authors acknowledge that Harvard's authorship policy is so stringent that it makes ghostwriting nearly impossible); the University of Pennsylvania; the University of California, San Francisco; Duke University; and Yale University.

Despite a longstanding policy on authorship that indirectly prohibited ghostwriting, on July 1, 2009, Johns Hopkins University School of Medicine in Baltimore (ranked second among U.S. medical schools by a U.S. News survey) explicitly banned the act as part of a larger policy on interaction with industry.

"The policy was developed for many reasons," explains Julie Gottlieb, associate dean of policy coordination. "But our main concern was the role of industry in academic medicine—its effects on research and the education and clinical care we provide. Ghostwriting is an issue that has cut across these missions to some extent, largely in the area of research. I think the overwhelming feeling is that it's not in accord with standards of professional practice—in research, education or clinical care—to put your name to something that you had no role in writing."

An allegation of ghostwriting at Johns Hopkins spurs an intense review process, which can lead to serious consequences depending on the findings. Provisions for addressing ghostwriting ban violations are outlined in their policy.

Harvard Medical School has long prohibited faculty members from engaging in ghostwriting through authorship policies, which state that everyone who is listed as an author should have made a substantial, direct, intellectual contribution to the work, and that honorary or guest authorship is not acceptable—is even deplorable. Yet ghostwriting is not explicitly banned.