Medical Ghost Management (2017 List)

You should be afraid of this ghost.

Medical ghost management is a comprehensive program for controlling the dissemination of medical research. It is generally done for pharmaceutical companies by professional publication planners who map out the entire process of publication, from the initial research design through to publication of results. Sometimes publication planners work directly for pharmaceutical companies, but often they work for specialized planning agencies that provide services to pharmaceutical companies.

Photo: Minh Uong/The New York Times

The goal of publication management is to derive maximal scientific and commercial value from medical research. To achieve this, the ghost management begins before the research itself. The publication planner will start by developing the key messages that the publications should communicate. The planners are in control of the data and the ways it’s interpreted; they can write up the results to make a drug look like its been effective. The planner then shepherds the research through a carefully controlled process that maximizes the effective communication of key messages, based on the interests of the pharmaceutical company. Because the planner/ghostwriter’s name can’t be on the publication, they often recruit famous academics with long publication records to attach their name to the paper just prior to submission to targeted journals. Sometimes the academics are merely asked to comment on a paper, and by suggesting changes, find that the planners have listed them as co-authors.

Ghost managed manuscripts are often published in good journals that are widely read. What they do not reveal is the role that pharmaceutical companies (Pfizer, for example) played in the production of the results. Given that big pharmaceutical companies get most of their revenue from blockbuster drugs (and that their share prices are evaluated based on potential blockbusters in the pipeline) the careful communication of information about key drugs is vital to the success of big pharma. Ghost management allows pharmaceutical companies to influence the literature that concerns their product. This in turn influences the prescribing practices of doctors who read the literature and effects their clinical practice.

Obviously, from the perspective of patients and prescribers this is an enormous ethical violation; good scientific research follows a completely different path. Those of us taking medications have a right to ask: To what extent was the drug effective in a randomized, controlled clinical study? How might an unbiased reviewer interpret the results? How are negative results dealt with – are they just ignored? If money has been dumped into the production of a drug, to what lengths will drug companies go to make sure it hits the shelves?


Ghost management: How much of the medical literature is shaped behind the scenes by the pharmaceutical industry? (PLOS Medicine, 2007)
Ghostwriting: The dirty little secret of medical publishing that just got bigger (PLOS Medical, 2009)
Corruption and justification in the ghost management of medical research (Harvard’s Safra Center for Ethics)
Ghostbusters: Authors of a new study propose a strict ban on medical ghostwriting (Scientific American, 2010)
Serious risks and few new benefits from FDA-approved drugs (Health Affairs Blog, 2015)
Ghostwriting: the importance of definition and its place in contemporary drug marketing (British Medical Journal, 2016)