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Don't Be a Fool—Don't Use Fool's Gold

      To the Editor:
      When ghostwriting and legitimate professional medical writing are conflated, many are fooled. Professional medical writers are not ghostwriters, but your readers may not appreciate this distinction after reading the article “Ghostwriting: Research Misconduct, Plagiarism, or Fool's Gold?” by Bosch and Ross.
      • Bosch X.
      • Ross J.
      Ghostwriting: research misconduct, plagiarism, or fool's gold?.
      We agree with Bosch and Ross that ghostwriting is research misconduct, but we believe their definition of ghostwriting is incomplete. Ghostwriters are ghosts not only because their contribution is unknown (since they may or may not qualify for authorship), but also because their involvement and funding source are not disclosed.
      • Woolley K.L.
      Goodbye ghostwriters! How to work ethically and efficiently with professional medical writers.
      In contrast, professional medical writers adhere to ethical publication practices and disclose their involvement and funding source.
      • Graf C.
      • Battisti W.P.
      • Bridges D.
      • et al.
      Research methods & reporting Good publication practice for communicating company sponsored medical research: the GPP2 guidelines.
      If professional medical writers meet authorship criteria, they should be named as authors.
      • Graf C.
      • Battisti W.P.
      • Bridges D.
      • et al.
      Research methods & reporting Good publication practice for communicating company sponsored medical research: the GPP2 guidelines.
      The distinction between ghostwriters and professional medical writers is not a matter of semantics. Ghostwriting is unethical; professional medical writing is an ethical and legitimate practice and profession.
      • Woolley K.L.
      Goodbye ghostwriters! How to work ethically and efficiently with professional medical writers.
      • Graf C.
      • Battisti W.P.
      • Bridges D.
      • et al.
      Research methods & reporting Good publication practice for communicating company sponsored medical research: the GPP2 guidelines.
      As reinforced in a paper co-authored by BMJ editor Trish Groves, “many journal editors recognize that help from a professional writer can raise reporting standards, improve compliance with guidelines, and elevate overall editorial quality.”
      • Chipperfield L.
      • Citrome L.
      • Clark J.
      • et al.
      Authors' submission toolkit: a practical guide to getting your research published.
      Indeed, the World Association of Medical Editors advises that “editors should make clear in their journal's information for authors that medical writers can be legitimate contributors.”
      WAME Editorial Policy Committee
      Ghostwriting initiated by commercial companies.
      Evidence shows that manuscripts prepared with professional medical writing assistance are:
      • 1
        Rarely retracted for misconduct
        • Woolley K.L.
        • Lew R.A.
        • Stretton S.
        • et al.
        Lack of involvement of medical writers and the pharmaceutical industry in publications retracted for misconduct: a systematic, controlled, retrospective study.
      • 2
        More compliant with CONSORT guidelines
        • Jacobs A.
        Adherence to the CONSORT guideline in papers written by professional medical writers.
      • 3
        Accepted more quickly for publication.
        • Bailey M.
        Science editing and its effect on manuscript acceptance time.
      This evidence and concerns about nonpublication support the increased use of professional medical writers. Ross et al recently concluded that “… substantial amounts of publicly funded research data are not published and available to inform future research and practice.”
      • Ross J.S.
      • Tse T.
      • Zarin D.A.
      • et al.
      Publication of NIH funded trials registered in ClinicalTrials.gov: cross sectional analysis.
      Do Bosch and Ross think professional medical writers (not ghostwriters!) could help address the unethical practice of nonpublication?
      Finally, your readers should know that the latest published evidence on ghostwriting indicates that the prevalence of ghostwriting is low. Staff from JAMA surveyed 896 authors of articles published in 6 high-ranking journals in 2008, and the prevalence of ghostwriting was 0.16%.
      • Wislar J.S.
      • Flanagin A.
      • Fontanarosa P.B.
      • et al.
      Honorary and ghost authorship in high impact biomedical journals: a cross sectional survey.
      This prevalence does not seem “common.” On a practical note, authors can use a free “anti-ghostwriting” checklist, published in PLoS Medicine, to document appropriate use of medical writers.
      • Gøtzsche P.C.
      • Kassirer J.P.
      • Woolley K.L.
      • et al.
      What should be done to tackle ghostwriting in the medical literature?.
      They can show editors they aren't fools, and they're not using fool's gold!

      References

        • Bosch X.
        • Ross J.
        Ghostwriting: research misconduct, plagiarism, or fool's gold?.
        Am J Med. 2012; 125: 324-326
        • Woolley K.L.
        Goodbye ghostwriters! How to work ethically and efficiently with professional medical writers.
        Chest. 2006; 130: 921-923
        • Graf C.
        • Battisti W.P.
        • Bridges D.
        • et al.
        Research methods & reporting.
        BMJ. 2009; 339: b4330
        • Chipperfield L.
        • Citrome L.
        • Clark J.
        • et al.
        Authors' submission toolkit: a practical guide to getting your research published.
        Curr Med Res Opin. 2010; 26: 1967-1982
        • WAME Editorial Policy Committee
        Ghostwriting initiated by commercial companies.
        (Accessed March 25, 2011)
        • Woolley K.L.
        • Lew R.A.
        • Stretton S.
        • et al.
        Lack of involvement of medical writers and the pharmaceutical industry in publications retracted for misconduct: a systematic, controlled, retrospective study.
        Curr Med Res Opin. 2011; 27: 1175-1182
        • Jacobs A.
        Adherence to the CONSORT guideline in papers written by professional medical writers.
        Write Stuff. 2010; 19: 196-200
        • Bailey M.
        Science editing and its effect on manuscript acceptance time.
        AMWA J. 2011; 26: 147-152
        • Ross J.S.
        • Tse T.
        • Zarin D.A.
        • et al.
        Publication of NIH funded trials registered in ClinicalTrials.gov: cross sectional analysis.
        BMJ. 2012; 344: d7292
        • Wislar J.S.
        • Flanagin A.
        • Fontanarosa P.B.
        • et al.
        Honorary and ghost authorship in high impact biomedical journals: a cross sectional survey.
        BMJ. 2011; 343: d6128
        • Gøtzsche P.C.
        • Kassirer J.P.
        • Woolley K.L.
        • et al.
        What should be done to tackle ghostwriting in the medical literature?.
        PLoS Med. 2009; 6: e1000023

      Linked Article

      • Ghostwriting: Research Misconduct, Plagiarism, or Fool's Gold?
        The American Journal of MedicineVol. 125Issue 4
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          Traditionally, personal integrity and professional accountability have guaranteed appropriate authorship of biomedical journal articles. However, recent controversies, including exposés of ghostwriting and guest authorship, have shown the fallibility of this trust.
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      • The Reply
        The American Journal of MedicineVol. 125Issue 10
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          I appreciate the distinction made by Woolley et al between ghostwriters and professional medical writers. I agree that medical writers are not ghostwriters, so long as their contributions are acknowledged; and recent evidence shows a favorable trend.1,2
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