Medical Writing, Editing & Grantsmanship

The Sept issue of Public Library of Science Medicine includes an essay by Sergio Sismondo on “Ghost Management” of the medical literature by the pharmaceutical industry. Dr. Sismondo reports data suggesting that as many as 40% of published articles focusing on specific drugs are ghost authored/managed (ie, company controls or directs multiple steps in the research, analysis, writing, and publication of articles). No matter their derivation, these articles genuinely affect physician behavior in treatment planning and prescribing – and the ghost managed manuscripts are most definitely designed to manipulate this behavior.

How can I say this so authoritatively? I was briefly a ghost in the machine many years ago.

The pay is obscene, so pharma will have no trouble finding willing ghosts. My company offered to double my payments if I’d keep writing for them when I said no thanks after a couple of assignments. Essentially, for purely ghosted manuscripts such as mine, I’d be told to write a X,000-word review article on topic XYZ (bulleted outline of major points to cover provided – including clinical practice points) for Journal ABC. I didn’t know the term for what they were doing, but I quickly realized it wasn’t right (for me or whoever was getting their name slapped on these papers). At my current institution, faculty participation on pharm-ghosted papers is verboten – a policy that can be fairly well overseen when you not only use a standard ethical industry contract template so deviations are obvious but also have someone in a leadership position who monitors manuscripts accepted for publication by health sciences faculty.

Update: The 5th annual Junior Achievement/Deloitte Teen Ethics Survey finds that 38% of teens who “feel fully prepared to make ethical decisions when they enter the workforce” also believe it is sometimes necessary to cheat, plagiarize, lie or even behave violently in order to succeed. Among all teens surveyed, 24% think cheating on a test is acceptable on some level, and 54% give their personal desire to succeed as the rationale.

Perhaps research on research integrity needs to take a page from the NSF playbook and start during the K-12 period.

In June 2007, nine 17-year-old male students from Hanover High School (NH) used stolen keys to break into a teacher’s filing cabinet and take final exams first from various high-level math courses; chemistry final exams were stolen in like manner five days later. About 50 students are suspected to have participated directly in the theft, as look-outs, and/or as recepients of ill-gotten exam answers. Because the incident involved breaking and entering, it was reported to the police, much to the fury of parents, who feel the misdemeanor charges will impact their children’s acceptance at desirable colleges.

Apparently, mere cheating isn’t worth a second thought. Honor system? When it doesn’t interfere with ambitious plans perhaps. In an interview on NPR All Things Considered, Aine Donovan, executive director of the Dartmouth College Ethics Institute, said “kids today are more apt to rationalize their behavior as a means to an end; and they seem to have invented their own particular code of right and wrong.”

The Detroit Free Press published statistics from a Josephson Institute of Ethics report that found “entrenched habits of dishonesty” among young people. About 28% of 36,122 public and private high school students who were surveyed admitted stealing from a store within the past year; 23% said they stole something from a parent or other relative; 82% said they lied to a parent about something significant; 60% said they cheated on a test.”

I went to a pretty high-powered college that made a huge deal about its honor system, and I personally knew of no incidents of cheating or other academic misconduct among the students. My roommates each failed a course freshman year, and I swallowed a huge dose of reality. And we all took the humbling grade point hit rather than try to better our average in a less than honorable manner. This was well before these kids were born, though, and these are the sort who would seek admittance at my alma mater. One wonders whether current students are willing to accept grades below a B … or an A … or if they take “justifiable” steps to better their standing for their future good.

So they get over the hurdle of admission to Harvard or Princeton and years later face the pressure of getting “good” data to publish and support a grant application – with the same ingrained rationalizations in tow. Consider this “foundation” in light of new data suggesting mentoring has the potential to increase misconduct or recent discussion of plagiarism as a “victimless crime” at the First World Conference on Research Integrity.

Is RCR (responsible conduct of research) training at the graduate school level too late perhaps?