The New York Times prints today a great story on ghostwriting medical research reports. And, more interestingly, the research topic is hormone replacement therapy (HRT), with an emphasis upon how the pharma, Wyeth, funded publications of dozens of reports offering positive scientific evidence for its HRT product, Prempro. This made the light of day because of litigation from the health disaster caused by women taking HRT and then getting breast cancer. Given my prior posts on the persuasion implications of HRT, cancer, and the medical community, this article affords yet another take.
Plot, Character, and Moral Theme
Most readers are doubtless surprised that scientific reports are ghostwritten. That surprise largely stems from most folks’ ignorance of how medical research and practice operates. Folks like to believe that the physician sitting there opposite them is a composite of contradictory traits: the icy brilliance of a lonely scientist in a lab with the warm concern of a caring clinician wanting to ease your pain.
Medical research is a complex, specialized, and coordinated web of different people playing different roles. Rarely does one doc contain both a great researcher and a great clinician. People tend to specialize not only in this big split between research and practice, but within these larger categories, take the research side for example, and people will specialize as grant writers, stats analysts, program managers, and so on.
Given this specialization, you should not be surprised to learn that there is a special job for writing research reports. If you’ve never been involved in a large, complex project, this kind of specialization sounds both silly and suspicious, but, believe me, you don’t want a health care system where each person is a Renaissance Worker. It won’t happen and it won’t work.
Writing a research report is a skill that many doctorally trained people never master. Once, as a doc student, I did a study of publication patterns in communication journals, simply counting how many publications were completed over a five year period, then ordering the list by name. What I found astonished me. Publication is dominated by a relatively small number of researchers with most people in a field publishing only one paper in five years, most often something out of their dissertation. This kind of research has been replicated in every scientific field I know about it. Writing for publication is a gift most people lack. But they need publication, so they partner with people holding different skills so that everyone benefits and actually does good work.
So, ghostwriting for scientific publication is a well known practice. No one hides from it, many teams use it, and it occurs in all areas of research, not just medicine, and certainly not just HRT.
But, since you don’t know about it, smart folks can use your ignorance in a court of law and the court of public opinion to knock the hell out of a pharma like Wyeth. If you read the NYT story (and you did, right?) you see the persuasion point clearly emerge. Wyeth bought bogus research and got it published to support its marketing aims with Prempro. Wyeth therefore used bad science to mislead the medical community into prescribing Prempro which caused thousands of excess cases of premature morbidity and mortality, particularly from breast cancer.
The Deconstruction of “Ghostwriting” or Clear Thinking
You can believe this if you wish, but you’re not thinking it through.
Before we begin let me admit my biases: I’ve worked all sides of most fences. I worked as a academic research professor on a wide variety of medical research projects, most with external funding. I ran a Fed research operation and hired and supervised people who did this kind of research. As a Fed I also designed research programs that provided external funding mechanisms, sat on funding review committees, and worked on inter Agency teams. I also have worked as a consultant with pharmas and have received “Cue-balls,” those little trinkets and toys pharmas hand out at all kinds of meetings, just for being in the room. I know women who used Prempro and had breast cancer. And, of course, I’ve been a patient myself dealing with both physicians, researchers, and pharmas. Like I said, I’ve got biases, but I’ll try to think like scientist.
Now, to the persuasion analysis!
1. “Ghostwriting” is a perjorative term used by the Good Guys to describe the Bad Guys. It is a persuasion act to get folks to describe a neutral activity, writing, with a weasel word, “ghostwriting,” and a sneering attitude. In many respects, “ghostwriting” in this context is like calling it “propaganda,” rather than “persuasion.” Bad Guys produce ghostwriting and propaganda. Good Guys don’t. This distinction is not important as long as we can keep everyone looking at the “bad” ghostwriting Wyeth sponsored on HRT, but as soon as we start looking at other research reports that were written by Somebody Who Didn’t Actually Do The Research, what shall we call that? I’ll bet dollars to donuts that somebody will want to cite Good Guy research that attacked Wyeth that was, surprise, ghostwritten by somebody paid by a different pharma or other going concern (like a foundation that is a going concern). You see the problem now with the “ghostwriting” metaphor or meme or frame or whatever some postmodern hipster calls it?
2. While the ghostwriter actually structures and writes the report, it would never pass peer review at the journal for publication if the ghostwriter was the only name on the author line. Other folks with respectable reputations in the research community have to put their names on the author line to get the ghostwritten piece in print. This means that dues-paying, card-carrying members in goodstanding must have sold their scientific reputations. Now, you have to burn down their reputations along with Evil Wyeth. Or, of course, it was possible that Evil Wyeth deceived these smart and honorable scientists, so then you destroy their reputations not with charges of sellout, but with charges of willful naivete.
3. How did this ghostwriting crap get past peer review and into print? If Wyeth manufactured research reports the same way they manufactured pills, any smart reviewer and journal editor should have seen it. That’s why they are reviewers and editors. Remember the persuasion claim here is that ghostwriting hides bad science. Wyeth hired a skilled writer, then paid respectable scientists to sell their reputations for the author line, and packaged it with bad science. “Bad science” has to be the key point. Ghostwriting good science cannot be a serious problem in this instance. Why didn’t the journal catch this? Let’s burn down the reputation of numerous reviewers and editors for their carelessness, cluelessness, and stupidity.
4. The NYT article asserts that nearly 25 ghostwritten papers hit the research literature between 1998-2005. That’s a lot of authors selling their names to hide bad science. It’s also nearly a lifetime in a research cycle. In other words, this practice had to be widespread and well known within the research community and NO ONE FIGURED IT OUT. How stupid and gullible are the people in the research community? Here’s Evil Wyeth buying and selling respectable scientists over a seven year period with widespread coverage promoting bad science and the community doesn’t raise an eyebrow. No one catches this conspiracy. None of the respectable scientists who sold out has a flash of guilt or a pang of conscience. No driven doc student follows the ghost trail back to a gleaming corporate headquarters. Let’s burn down the reputation of the research community.
5. There’s the problem of all those Good Researchers who didn’t sell their reputations to Wyeth, didn’t use ghostwriters, but still thought HRT was the greatest thing since L’Oreal Ash Blonde Hair Coloring. They said so in print while they were with Harvard and they’re still at Harvard. Just look for all those bright epidemiologists who can invert matrices in their heads. They thought HRT was All That. So we’ve got Evil Wyeth and Wholly Harvard saying the same thing. And “ghostwriting” is the difference?
6. And, now, clinicians come off as complete idiots. There they sat, year after year, reading bad science in journals and watching bad science at professional meetings, and every man and woman in the audience fell for it. “Wow,” they thought, “this Prempro is some hot stuff, baby!” falling into a disco meme, perhaps. And they fell for it because they were too stupid or careless to read the research and think for themselves, but rather in sheeplike fashion they followed the party line offered by their research peers.
There’s A Difference Between What You Want and What You Get
Law describes the “fruit of the poisoned tree,” which means helpful information obtained illegally must be tossed. For example, an agent may unknowingly participate in an illegal search and during that illegal search, the unknowing agent finds culpable evidence. But, because the evidence (the fruit) came from an illegal search (the poisoned tree), it must be discarded.
I’d like to turn around this beautiful metaphor: Poisoned fruit will kill the tree.
Lawyers and academic researchers offer ghostwriting as a kind of persuasion play that kills Evil Wyeth, but this play is actually a poisoned fruit that kills the tree of medical research. If Wyeth did what these ardent advocates claim, that fruit of dishonesty and deception poisons the tree of leaves, stems, branches, trunk, and roots that forms the organic system we call medical research. The living organism itself will be poisoned from this fruit.
Remember the Rule: All bad persuasion is sincere.
Do not doubt the sincerity of those who see ghostwriting as fruit that proves a guilty tree. But that sincerity clearly blinds their vision. They care more about looking good (I’m mad as hell and I’m not going to take it anymore!) than doing good (Make It Right).
Remember the Rule: Persuasion is strategic or it is not.
The ghostwriting play achieves tactical goals – hey, the New York Times fell for it and we get all this cool press! – but misses the strategic mark – I just ate a poisoned pill that can destroy me, my colleagues, and my community.