Opinion: Ghost Writing is Fraudulent

A legal remedy is needed to curb unethical “guest authorship” in medical journals.

Simon Stern and Trudo Lemmens
Nov 2, 2011

WIKIMEDIA COMMONS, GUILLAUME CARELS

In August, we proposed, in an article in PLoS Medicine, that medical “guest writers” might be sued for fraud. For some time, commentators have called for sanctions against academic doctors who agree to sign their names to articles that are planned and developed by medical writing companies and pharmaceutical manufacturers.  Some have even called these practices fraudulent, but have not confronted the legal difficulties with that approach—namely that the grounds for fraud are hard to establish: those who have been harmed by the drugs (the patients) are unlikely to have read the article, and therefore cannot claim to have believed that the “guest” was the true author, while the doctors who found the article persuasive are unlikely to have used the drug themselves.

We argue that the readers of medical journals are also victims. The value of their subscription is diminished when the editors unwittingly...

Some researchers worry that allowing lawyers to interfere with a problem of medical ethics will only make matters worse, and that the issue of “guest writers” might better be handled by the journals themselves or licensing organizations such as the American Medical Association. However, we recommend a legal solution precisely because no one within the community of biomedical researchers and publishers has dealt effectively with this problem. Universities, licensing organizations, and medical journals have only just begun creating effective sanctions, and most have yet to implement them. These organizations have divided loyalties and are reluctant to punish prestigious doctors who otherwise reflect credit on the institution and often help impress donors.

Thus, the only way to solve that problem is from the outside. The climate for disinterested research is already endangered, and an effective sanction, if one can be found, is needed to preserve the integrity of biomedical publishing. The threat of legal liability may not be the only solution, but it has the virtue of speaking a language that most guest writers will readily understand.

Others have said that “fraud” is too harsh a term for the authorship practices we discuss. We rely on the legal definition of fraud, which involves making knowingly false statements to secure a benefit from someone else. In the context of medical authorship, this is not merely a technical application of the term. Guest authors are sometimes paid for their signature, and are always rewarded in the coin of prestige. More publications in good journals can translate into conference invitations, pay raises, and grants—and that is a primary reason why academic doctors agree to let their names be used.

A pending lawsuit against Donald Trump raises similar fraud claims, alleging that he was paid for the use of his name to market a condominium community when he had nothing to do with its development. The academic rewards are sometimes less direct, but the process is essentially the same. Our proposal draws on the Racketeer Influenced and Corrupt Organizations Act (RICO), which was originally created to combat racketeering in organized crime. Since its inception, the RICO Act has also been used in many other contexts, involving alleged conspiracies or intimidation by groups such as anti-abortion protestors and cigarette manufacturers. We propose that the principles outlined in RICO could also be applied to the problem of fraudulent authorship in medical journals, and if enforced, could make potential “guest writers” think twice before allowing their names to be used.

Simon Stern is Assistant Professor on the Faculty of Law, University of Toronto. Trudo Lemmens is Associate Professor on the Faculty of Law and the Faculty of Medicine, University of Toronto.