On the importance of definitions

I just received a link from a colleague on an AMWA listserv to an article in PLoS on one medical writer’s experience with ghostwriting. It got me all worked up, so I thought I’d share. First, let me make it clear that I completely agree that there is a problem, called ghostwriting, in which medical writers are asked to write a manuscript—based on someone else’s research, with very little transparency or author contact, and no acknowledgement of their contribution as either an author or in the acknowledgements section—for publication in the peer-reviewed biomedical literature. These medical writers might be freelancers or work directly for a publications planning or healthcare communications company, which is in turn hired by a pharmaceutical company. There are financial interests all over the place in this arrangement, no doubt about it, and that’s why it’s such a hot-button issue. Was the author of the PLoS article a ghostwriter? Sounds like it. Was she right to take a stand and question the ethics of what she was being asked to do? Absolutely.

So why did the PLoS article make me upset? Nutshell: It introduces confusion about medical writers, types of medical writing, and the types of companies that utilize medical writers and for what purpose. I’ll give the author the benefit of the doubt–something obviously got lost in translation as the article was repurposed from a presentation at a conference at the University of Toronto.

That said, the article would have benefited from some concrete definitions and descriptions of what kinds of medical writing are done at each of type of company mentioned: medical education companies, publication planning companies, healthcare communications agencies, and pharmaceutical advertising agencies. All of these entities work in some capacity with the pharmaceutical industry and either indirectly or directly with physician authors (thought leaders). But not all of these companies, or the medical writers they hire, ghostwrite manuscripts for physician authors to be submitted to peer-reviewed journals.

On first read, I came away asking, why was the med ed company part of an ad agency, and if it was, why were they doing pub planning? These seemed like some pretty big ethical red flags, but that issue was not explained to readers.

But then I re-read it several times, particularly the part about why she stopped. It wasn’t because of ghostwriting. It was because of the marketing doublespeak she was being asked to insert in her pieces, some of which were manuscripts. Lack of access to physician authors to confirm content and wordsmithing to fit a marketing plan are definitely ethical issues, and she was right to take a stand, particularly if she was working in a med ed company, which is supposed to produce content independent of the pharma company. (Again, those distinctions were not discussed.) Instead, issues about wordsmithing at a med ed company were presented in an article about ghostwriting. I am going to go ahead and assume that readers of this article are now really confused about what medical writing is.

The author ends with the suggestion that med ed companies be eliminated to remove the middleman, and that centers for guest authors be used to help researchers prepare manuscripts. That last part is a great idea, but all I read was “med ed companies are the middlemen between pharma and physician.” Again, definitions that distinguish between med ed, pub planning, healthcare comm, and pharmaceutical ad agencies would have been helpful here.

While the article had many valid points, and I recognized some of the unethical wordsmithing issues from my experience in med ed and healthcare communications, I came away confused about the ghostwriting issue and what those pesky medical writers are really up to. Which is why I got upset. Done.

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