In this article, we extend our previous discussion of the ethics of manuscript authorship to an issue that haunts both academia and industry: ghost authorship. Ghost authorship is essentially the opposite of honorary authorship, entailing a significant contribution to a manuscript without acknowledgment of that contribution. The most well-known scenario involves a professional medical writer or an industry researcher who drafts an article on behalf of a pharmaceutical company but is not credited for this work. These ghostwriters may be concealed to obscure industry backing for research, improving the apparent objectivity of a paper while maintaining the company’s control over its content. This concealment is often coupled with guest authorship, the practice of adding a reputable academic researcher’s name to a manuscript to increase its credibility, despite little to no actual involvement. In other cases, a scientist may employ, but not acknowledge, a ghostwriter to overcome an obstacle to publication, such as poor writing skills, limited time, or a lack of familiarity with journal requirements. Additional unattributed contributions may entail data collection or analysis or other potentially critical facets of the research process. One BMJ survey found that such ghost authorship was present in approximately one-tenth of papers published in six medical journals in 2008.
How does ghost authorship relate to the authorship guidelines established by the International Committee of Medical Journal Editors (ICMJE)? Based on the previously discussed criteria, solely writing or editing a manuscript, for example, does not merit author status; involvement in the study design or data collection/analysis, approval of the final draft of the paper, and accountability for the entire work are also required. Similarly, industry researchers who conduct a study and draft a report based on its results but do not approve the final version are technically not eligible for authorship, whereas a guest author who makes minor contributions to these steps and performs the approval is qualified. As a result, so-called “ghost authorship” may not truly constitute authorship, although in extreme cases, a ghost author may have met all four ICMJE criteria.
Even though the ICMJE guidelines do not support writing alone and other focused activities as “substantive intellectual contributions,” they do state that “writing assistance” and other non-author-level technical aid should be cited in the acknowledgments section of a paper. However, it has been argued that writing a manuscript is in fact a significant contribution, particularly because communicating complex scientific findings frequently requires understanding and interpreting the data. Based on this argument, the ICMJE definition of what merits authorship attribution would have to be revised or even replaced with a list of diverse contributions.
From an ethical standpoint, ghost authorship, particularly in conjunction with guest authorship, entails deception of the research community, which may not be able to properly assess a study’s validity and credibility. The named authors’ integrity may additionally be eroded, including due to falsification of their publication records. In the worst instances of ghost authorship, when the suppression of industry ties also hides biased data collection and/or interpretation, derivative research studies and clinical care may be negatively affected. Moreover, these practices may violate the standards of the ICMJE and the Committee on Publication Ethics (COPE) on the disclosure of potential conflicts of interest. Given these ethical breaches, researchers Peter C. Gøtzsche and Xavier Bosch, among others, contend that ghost authorship should be treated as research misconduct by governments, research institutions, funding agencies, and/or editors’ associations, which is currently not a widespread approach.
COPE and the World Association of Medical Editors have published explicit statements against ghost authorship. Several of their recommended methods to combat both ghost and guest authorship are as follows:
- Journals should set clear authorship criteria
- Authors should disclose all contributors, regardless of author status, and their specific individual contributions and affiliations
- Authors should sign a formal declaration about their contributions
- Authors should complete a checklist if they received help from a medical writer (as outlined in Table 1 in this 2009 PLOS Medicine article)
To further reduce the frequency of ghost authorship and to improve transparency about contributors, other approaches outlined in the PLOS Medicine paper cited above and a subsequent editorial include
- Publishing the comprehensive list of contributions described above and a detailed acknowledgments section
- Asking authors specific questions about the writing of the manuscript, including who wrote the first draft
- Requiring all company, drug, and medical writer involvement to be described in a supplement, possibly with legal validation
In sum, whether or not a ghost author merits author status, concealing contributions to a manuscript is an unethical practice that runs counter to current guidelines and will likely be increasingly targeted by future policies. As you conduct your own research, be sure to keep a careful record of all contributors and affiliations so that you can give credit where credit is due in your paper. Please email us at [email protected] with any questions about authorship issues or publication practices in general.