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Exorcising Ghosts and Unwelcome Guests

Christine Laine, MD, MPH, Senior Deputy Editor; and Cynthia D. Mulrow, MD, MSc, Deputy Editor
[+] Article, Author, and Disclosure Information

Acknowledgment: The authors thank Harold C. Sox, MD, for critical review of the manuscript and for his helpful suggestions.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Customer Service, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106-1572.

Ann Intern Med. 2005;143(8):611-612. doi:10.7326/0003-4819-143-8-200510180-00013
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Ghosts and guests haunt medical journals. We don't usually notice them, but they occasionally rattle their chains, making us acutely aware of their presence. The author of an article we published in 2003 (1) sent more than a few shivers up the spines of the editors when he admitted to a New York Times reporter in 2005, “Merck designed the trial, paid for the trial, ran the trial…Merck came to me after the study was completed and said, ‘We want your help to work on the paper.’ The initial paper was written at Merck, and then was sent to me for editing” (2). Spooked by this evidence that authorship is not always what it seems, we reflect on practices that cast dark shadows across scientific publications: guest authoring and ghostwriting.

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European Medical Writers Association guidelines
Posted on November 2, 2005
Adam Jacobs
Dianthus Medical Limited
Conflict of Interest: None Declared

I was pleased to read Laine and Mulrow's editorial about ghosts and guests, which I thought steered a very sensible course through a difficult topic [1]. I feel that one minor point of clarification is in order, however. The "˜GATE principles' referred to in the editorial were not described by the European Medical Writers Association (EMWA), but were described in an editorial that accompanied EMWA's guidelines. Readers of the Annals may also be interested in the original guidelines [2], which were not cited in Laine and Mulrow's editorial.


1. Laine C, Mulrow CD. Exorcising ghosts and unwelcome guests. Ann Intern Med 2005;143:611"“612

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

Conflict of Interest:

I am immediate past president of EMWA and was an author of EMWA's guidelines. My company provides medical writing services to pharmaceutical companies.

Exorcising Ghosts and Unwelcome Guests
Posted on November 16, 2005
Stella S. Daskalopoulou
Dept. of Clinical Biochemistry, Royal Free Hospital, University of London, UK
Conflict of Interest: None Declared

We applaud the editors of the Annals for their effort to increase awareness regarding "˜ghost writing' (1).

Laine and Murlow (1) cite our editorial (2). There is a need for a slight correction; they imply that the "˜GATE principles' were proposed by the European Medical Writers Association (EMWA). They were actually proposed by us in our editorial (2). However, they were influenced by the EMWA statements together with our own experience.

There is increasing concern about "˜ghost writers' since it is difficult to prove their existence. Therefore, whenever help from professional writers is necessary, it is imperative to ensure that the "˜GATE principles' are maintained. Maybe a uniform policy should be implemented by journals. We proposed a formula of acknowledgment statements to achieve maximum transparency (2).

One key issue not touched by Laine and Murlow (1) is the possibility of regulating professional writers. In other words, they would need to be registered and evaluated to maintain minimum standards (2). Perhaps our colleagues across the Atlantic can lead with this initiative leaving more conservative Europe to follow?

The earliest publication (listed on PubMed) on "˜ghost writing' that we identified was in 1934 (3). It is about time that we sort out this issue.

Professional writers, if they have to be used, should have a legitimate role in assisting (not substituting) experts to provide a quality document while maintaining high ethical standards. However, the experts should always play a key role and have the final say. Hidden ghosts, unwelcome guests and "hired" experts do not have any place in the medical literature. Remove the masks, Halloween is over!


1. Laine C, Mulrow CD. Exorcising ghosts and unwelcome guests. Ann Intern Med. 2005;143:611-2.

2. Daskalopoulou SS, Mikhailidis DP. The involvement of professional medical writers in medical publications [Editorial]. Curr Med Res Opin. 2005;21:307-10.

3. Place F. Ghost writing. Bull Med Libr Assoc. 1934;22:209-13.

Conflict of Interest:

None declared

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