Author: Sergio Sismondo
Position: Associate Professor
Institution: Queen's University
E-mail: sismondo@queensu.ca
Submitted Date: December 19, 2007
Published Date: December 20, 2007
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

In my article on the ghost management of the medical literature on pharmaceuticals (1) I used available data sources to document some practices that shape journal articles in the service of marketing. Indeed, I cited and drew on a number of studies published especially in the past four years ("rehashes previous anti-industry critiques," say Dr. Hirsch and Mr. Snyder). In my argument I also relied heavily on articles written by publication planners and promotional material created by publication planning companies themselves; these should have a certain authority.

Publication planning is normally unseen by the readers of medical journals. As Andrew Robinson, Deputy Managing Director at Wiley-Blackwell, said at the 2007 International Society of Medical Publication Professionals (ISMPP) meeting (which I attended after writing the article), "Why all this cloak and dagger stuff?" (2) I do not think that it is because editors of journals discriminate against industry, as Hirsch and Snyder suggest. Editors knowingly publish much material that comes through publication planning firms, and some actively engage with those firms. At the 2007 ISMPP meeting several editors and former editors of major medical journals spoke, and some took the opportunity to promote their journals to the assembled audience. (3) I have an alternative suggestion, that readers of journal articles would look upon the conclusions of those articles less favorably if they knew the extent of industry involvement.

There is an important difference between questionable authorship practices that lie purely within academic medicine and questionable practices — considerably broader than mere authorship — in which there are considerable, broad, and consistent interests in the content of scientific articles. I do not want to excuse questionable practices of any sort, but whereas the former are of concern primarily to those involved, the latter are of much more widespread concern.

Responding to Dr. Nori, I stated in my article that professional medical writing is sometimes valuable and appropriate. However, medical writers who participate in the ghost management of journal articles are participating in an activity to which many readers of those articles would object.

I am aware of the ISMPP's Code of Ethics, and the organization's efforts to engage in discussion of good publication planning practices. I would be interested to know whether Hirsch and Snyder believe that publication planning as represented by prominent firms in the business, and quoted in my article, is consistent with that Code of Ethics. It does not appear to be so. Moreover, there are some people who would not want publication planning to be consistent with that Code. As Dr. Thomas Stossel, a speaker invited to a session moderated by Dr. Hirsch at the 2007 ISMPP meeting, said: "My message to you is the same as it was last year, which is, stop with the integrity crap, OK, and let's fight back. So I'm never coming back here if we have any more trust and integrity trust-athon events again." (4)

1. Sismondo S. (2007) Ghost Management: How much of the medical literature is shaped behind the scenes by the pharmaceutical industry? PLoS Medicine 4:1429-33.
2. Handout and author's notes, 3rd Annual Meeting of ISMPP, April 23-25, 2007.
3. Handout and author's notes, 3rd Annual Meeting of ISMPP, April 23-25, 2007.
4. Author's notes, 3rd Annual Meeting of ISMPP, April 23-25, 2007.