Six of the top medical journals published a significant number of articles in 2008 that were written by ghostwriters financed by drug companies, according to a study released Thursday by editors of The Journal of the American Medical Association.
Among authors of 630 articles who responded anonymously to an online questionnaire created for the study, 7.8 percent acknowledged contributions to their articles by people whose work should have qualified them to be named as authors on the papers but who were not listed.
In the scientific literature, ghostwriting usually refers to medical writers, often sponsored by a drug or medical device company, who make major research or writing contributions to articles published under the names of academic authors.
The concern, the researchers said, is that the work of industry-sponsored writers has the potential to introduce bias, affecting treatment decisions by doctors and, ultimately, patient care.
According to the study, responding authors reported a 10.9 percent rate of ghostwriting in The New England Journal of Medicine, the highest rate among the journals.
Editors of the Boston-based journal said Thursday that they were Ã¢â‚¬Å“puzzledÃ¢â‚¬Â and Ã¢â‚¬Å“skepticalÃ¢â‚¬Â of the findings.
The study also reported a ghostwriting rate of 7.9 percent in JAMA, 7.6 percent in The Lancet, 7.6 percent in PLoS Medicine, 4.9 percent in The Annals of Internal Medicine, and 2 percent in Nature Medicine.
Ã¢â‚¬Å“These journals are the top of the medical field,Ã¢â‚¬Â Joseph S. Wislar, a survey research specialist and lead author of the study, said in a phone interview. He recommended that they take more action to require that all contributors be listed in acknowledgments if they are not named as authors.
Three JAMA editors, Annette Flanagin, Phil B. Fontanarosa and Catherine D. DeAngelis, joined Mr. Wislar in the study.
The new study, which has not yet been peer-reviewed or published in a medical journal, was made public Thursday morning at an international meeting of journal editors in Vancouver.
Ã¢â‚¬Å“It was very compelling, and I find it quite shocking, to be honest,Ã¢â‚¬Â Ginny Barbour, chief editor of PLoS Medicine, the journal of the Public Library of Science, said after the meeting. Ã¢â‚¬Å“We are a journal that has very tough policies, very explicit policies on ghostwriting and contributorship, and I feel that weÃ¢â‚¬â„¢ve basically been lied to by authors.Ã¢â‚¬Â
Some of the same researchers (though not Mr. Wislar) also sent out a questionnaire to authors of articles published in 1996 in three of the same publications. That study reported ghost authorship rates of 16.2 percent in The New England Journal of Medicine, 15.3 percent in The Annals of Internal Medicine, and 7.1 percent in JAMA.
Comparisons between the studies may not be valid because they relied on different methodologies and covered different authors. The older study involved a mail-in questionnaire sent to authors based in the United States while the new study, involving an online questionnaire, solicited responses from authors based both inside and outside the United States. In both cases, the studies have the potential for reporting bias because they did not choose respondents randomly but relied on authors to elect to answer the questions; moreover, authors were asked to disclose their own behavior, with the potential for them to underreport the use of a ghostwriter, which is considered an academic crime akin to plagiarism.
Finally, the response rates from authors of articles varied widely, ranging from 58.3 percent for one journal to 85.9 percent for another journal, the researchers said.
Karen P. Buckley, spokeswoman for The New England Journal of Medicine, said she was Ã¢â‚¬Å“completely shockedÃ¢â‚¬Â at the high rate of ghostwriting reported by its authors. She said the journal was continually strengthening its safeguards.
Editors of the journal released a statement through Ms. Buckley saying the JAMA study used an improperly broad definition of ghostwriting. But Annette Flanagin, a JAMA editor and co-author of the new report, responded that it was the standard definition of the term.