Policy Forum

Legal Remedies for Medical Ghostwriting: Imposing Fraud Liability on Guest Authors of Ghostwritten Articles

  • Simon Stern mail,

    Affiliation: Faculty of Law, University of Toronto, Toronto, Ontario, Canada

  • Trudo Lemmens

    Affiliation: Faculties of Law and Medicine, University of Toronto, Toronto, Ontario, Canada

  • Published: August 02, 2011
  • DOI: 10.1371/journal.pmed.1001070
  • Published in PLOS Medicine

Reader Comments (2)

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An interesting suggestion

Posted by AdamJacobs on 03 Aug 2011 at 08:25 GMT

I congratulate Stern and Lemmens for an interesting and novel solution to an old problem. Everyone knows that ghostwriting and guest authorship are bad, but it is rare for those guilty of the practice to face meaningful consequences. I am particularly impressed with Stern and Lemmens's insightful dissection of the reasons why this is so.

So, would legal action be a useful way of dealing with the problem? I doubt that it could be an answer by itself. Legal action is expensive and cumbersome, and unlikely in practice to be used in any but the most extreme cases. Nonetheless, the deterrent effect may be useful, even if only a very small number of guest authors are brought to justice this way. So I think it is certainly an interesting option, and I look forward to seeing some cases brought as Stern and Lemmens describe.

But I do think that any meaningful attempt to solve the problem must involve journal editors. They are in a unique role as gatekeepers, and they must do more. Guest authors and ghostwriters will persist while journals fail to ask searching questions about how articles were developed as a matter of routine.

I and some colleagues published a paper in this journal in 2009 with a checklist designed as a practical tool to help journal editors avoid ghostwritten articles with minimal resources [1], but disappointingly, I'm not aware of any journal that is currently using it.

There are, however, some parts of Stern and Lemmens's article with which I have to take issue. Professional medical writers are mentioned only in the context of ghostwriting. In fact, professional medical writers can, when transparently acknowledged, provide a valuable and ethical service. It is quite wrong to assume that professional medical writers are the same thing as ghostwriters. The European Medical Writers Association has published guidelines on how medical writers can contribute to papers responsibly [2].

It is also wrong to assume that guest authorship is only a problem with industry-sponsored publications. Guest authorship is also common in academia. I am not aware of any data comparing the frequency of ghost authorship in industry and non-industry publications, but given that a 2002 publication found that 39% of Cochrane reviews (which are independent of industry) had guest authors, it is clearly not a problem confined to industry.

It is important to ensure that standards are maintained in all biomedical publications, rather than focusing on one specific subgroup. This is particularly true in the light of recent evidence which suggests that fraud is more common in independent papers than in those sponsored by the pharmaceutical industry [4].


1. Gøtzsche PC, Kassirer JP, Woolley KL, Wager E, Jacobs A, et al. (2009) What should be done to tackle ghostwriting in the medical literature? PLoS Med 6: e23. doi:10.1371/journal.pmed.1000023.

2. Jacobs A, Wager E. European Medical Writers Association (EMWA) guidelines on the role of medical writers in developing peer-reviewed publications. Curr Med Res Opin 2005;21(2):317–321 Available online at

3. Mowatt G, Shirran L, Grimshaw JM, et al. Prevalence of honorary and ghost authorship in Cochrane reviews. JAMA 2002;287:2769–71.

4. Woolley KL, Lew RA, Stretton S. Lack of involvement of medical writers and the pharmaceutical industry in publications retracted for misconduct: a systematic, controlled, retrospective study. Current Medical Research and Opinion 2011 27:6, 1175-1182

Competing interests declared: I have written extensively about ghostwriting. My company provides transparent and ethical medical writing services (ie not ghostwriting!) to both pharmaceutical companies and academic researchers, but more often to the former.

RE: An interesting suggestion

jonleo replied to AdamJacobs on 05 Aug 2011 at 12:28 GMT

Adam makes some interesting points here. He says that " It is quite wrong to assume that professional medical writers are the same thing as ghostwriters." This is true,but only as long as the medical writers are listed in the byline. If they are only mentioned in the acknowledgement section then the article is using unnamed authors and an article with unnamed authors has been ghostwritten. My colleagues and I have just published a paper which looks at this idea in more detail. It is available at:http://jeffreylacasse.squ...

No competing interests declared.

RE: RE: An interesting suggestion

AdamJacobs replied to jonleo on 08 Aug 2011 at 13:21 GMT

It seems that jonleo believes that medical writers should be listed as byline authors. I don't have a huge problem with that personally, but it's important to realise that this goes against the definition of authorship as specified by the ICMJE criteria. So until the ICMJE revise their criteria, I'm afraid ethical medical writers do not have the option of listing themselves in the byline.

jonleo really should know this, as I've explained it in some detail previously:

Competing interests declared: As stated above