Medical Journals' Ethics on Authors Questioned

Commentator Douglas Kamerow raises ethical questions over medical journals that publish articles by ghost and guest authors, such as: What's the source of the information? Who paid for the research? Who wrote the article? Who benefits from the conclusions?

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MICHELE NORRIS, Host:

Medical journals plays a crucial role in our health care system. They provide medical researchers, doctors, and patients with the latest advances, the best new drugs, the most successful surgical procedures, and they warn about dangerous side effects.

But in recent years, there's growing concern that the pharmaceutical industry has insinuated itself into the medical literature. Distinguished doctors and esteemed scientists are paid fees to lend their names to studies funded by drug companies - studies they've had little or nothing to do with.

That's the case described in a report published today in the journal of the American Medical Association. It involves the painkiller Vioxx, and it lays out a system of ghostwriting used by the drug company Merck to promote Vioxx. Later, the painkiller was pulled from the market because of safety concerns.

Commentator Douglas Kamerow has these thoughts on ghost authorship in science.

D: I used to work for a medical journal, and we worried about fraudulent authorship all the time.

First, some definitions. Ghost authorship is when a drug company hires scientists or professional writers to write a medical journal article. Their names never appear on the paper. Guest authorship is when doctors and scientists are paid to add their names to an article they didn't write or contribute to.

Guest and ghost authorship are used in many situations, including research studies of new drugs and review articles that help doctors learn about a disease and its treatments. This kind of deception has two obvious effects - increasing the credibility of the articles, because they now have academic experts as authors, and masking the drug company's role in masterminding the research and its dissemination. It's dishonest, but it happens all the time.

For example, a study of a new lung cancer screening test was published recently in The New England Journal. It was funded by a foundation. But an investigation last month revealed that the foundation was essentially started and funded by a tobacco company.

No one knows how common guest and ghost authorship really is. Some investigations have found that they occur in between 10 and 15 percent of articles. Although we've known about these practices for years, the case of Merck and Vioxx presented in the studies published today offers a frightening picture of how much one drug company can do to create and shape dozens of articles about just one of their blockbuster drugs.

Why should you care about this? Because all the medical information you read and hear about comes originally from these journals. It's not being overly dramatic to say that public trust in clinical research, and in medicine in general, is at stake here.

Unless we can be confident that research results and review articles are unbiased, we can't know if doctors are giving and the public is getting correct advice and care. What can we do? Proper disclosure of research funding and authorship helps a lot, allowing readers to know who is behind the work.

Some journals require outside statistical analysis on every drug company-sponsored trial, and independent peer review catches some fraud. But unfortunately, unscrupulous companies will continue to get away with these practices some of the time.

Does this mean that doctors shouldn't trust what's published in medical journals? That patients and the public shouldn't believe what they read in newspapers and hear on the air? No. But it's really important to ask, what's the source of the information? Who paid for the research? Who wrote the article and who benefits from the conclusions?

NORRIS: Douglas Kamerow is a family physician and former U.S. editor of the British Medical Journal.

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