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Medical Schools Contribute to the Problem of Ghost-Written Faculty Articles

Posted Aug 27 2009 11:18pm

In a previous note, I discussed the issue of ghost-written medical journal articles (see: Details Emerge About Ghost-Written Medical Articles for Wyeth ) and phony medical journals, created-from-scratch, by drug companies (see: Merck Creates Phony Peer-Reviewed Medical Journal to Dupe Physicians ). In my opinion, such ethical lapses are closely related to other medical faculty problems such as under-the-table payments from pharmaceutical companies for scripted lectures and other types of "consulting" activities (see: Medical Schools Share Some Blame in Scandals Involving Pharma Payments to Faculty ). In this latter blog note, I indicated that medical schools have been complicit in these problems by not aggressively monitoring the behavior of faculty members. Here's a quote from it:

I am certainly in favor of the greater transparency regarding these payments that will occur when the pharmaceutical companies publicly report such data.  However, I don't think that the medical schools should emerge from these scandals untarnished. How is it possible for major medical schools to be "incapable of policing their faculty’s conflicts of interest."

Now comes a follow-up article in the New York Times about ghost-written articles by medical school faculty (see: Senator Moves to Block Medical Ghostwriting ) and once again the school's leadership comes up short. Here is an excerpt from this new article:

Many universities have been slow to react to evidence about the extent of the practice. In December, for example, Mr. Grassley released documents indicating that DesignWrite had drafted an article that was published under the name of a gynecology professor at New York University School of Medicine. Eight months later, a spokeswoman said the school had not looked into the matter. “If we had received a complaint, we would have investigated,” said Deborah Bohren, the vice president for public affairs at New York University Langone Medical Center. “But we have not received a complaint.” She added N.Y.U. never condoned ghostwriting and was now drafting a written policy to that effect. Faculty members, however, are responsible for the integrity of their own work, she said. But bioethicists said that medical schools must take responsibility for faculty members whose publications do not explicitly acknowledge the work of writers receiving industry support.... Duke has a policy that prohibits ghostwriting and advises faculty to keep records of their participation in preparing scientific articles.

In my view, most of these ethical problems boil down to money, a lot of which flows from pharmaceutical companies to medical school faculty and to the medical schools themselves. Medical school deans really don't have much interest in closely scrutinizing the behavior of their faculty members. Instead, they fall back on tired old bromides such as the lack of accurate self-reporting by the faculty members, insufficient funds to police their own conflict of interest policies, or the need for a formal complaint in order to launch a faculty investigation. As the heat increases, they may suddenly develop an interest in addressing faculty ethical conduct.

Drug companies, under pressure, are now making public their payments to medical school faculty. Medical school personnel need to cross-reference such lists against their own faculty reports of outside income. They also need to closely review the published articles of faculty members who report drug company income. How about emulating Duke's policy of prohibiting ghost-written articles? I am very sure that most academics could quickly come up with a working definition about what constitutes ghost-writing. In my mind, the first author of an article should physically write most it. I am not sure exactly what record-keeping and documentation is required by Duke in such matters but I am hoping that it is not too onerous.

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