Ethical Guidelines, Plagiarism, and Ghost Writing

This is my thinking on the subject—please tell me if you think it is incorrect; in particular, if you have any hard data to prove me right or wrong I would be delighted to see it.

I think that ethical guidelines are always a bad idea if they are unenforceable or unenforced or randomly enforced—like having a gun sitting somewhere for the occasional vigilante to use for bad or good. They make the community look good to outsiders but do not address the problems they pretend to address. In fact they probably make them worse because they suggest that something is being done about the problems, taking away momentum from those who might want to get something real done.

Has there been any scientific misconduct rate that has gone down since ethical guidelines were introduced?

The recent discussion about the plagiarist author drives home a similar point. Ethical discussions on WAME or any other non-anonymous bulletin board serve to give the impression that (1) there are very few problems out there and (2) everybody is vigilant in stopping the perpetrators.

Why? Because the responses are very selective and not representative. Most editors chose not to write in and report problems. And why would they? Who wants to give a bad impression of one's journal and tell of one's ethical failings?

Had people answered the plagiarism question honestly, we would have probably found that 5% of manuscripts have plagiarized text in them and that if one would choose to find and deal with it, there would be no end to an editor's work. Without enforceable guidelines I venture to guess that the only rewards waiting the occasional enforcing editor are law suits and angry calls from department heads and deans.

Eugen Tarnow

___________________________

I am of the opinion that there is need for ethical guidelines in everything we do. Without it many things will go wrong. The only problem is that until everyone has the same sense of value or respect for other people's ideas or dignity the rules cannot be followed. Achieving this will require a lot of sincerety from everyone involved in the issue, as most people pay lip service to ethics in the business place.

This does not, however, stop us from having a set of rules to guide the profession.

James Falaiye
Managing Editor, African Journal of Reproductive Health

___________________________

Medical journal editors need to know that authors aren't always who they say they are. See Revealed: how drug firms 'hoodwink' medical journals: Pharmaceutical giants hire ghostwriters to produce articles—then put doctors' names on them. Antony Barnett, The Observer. Sunday December 7, 2003 observer.guardian.co.uk/uk_news/story/0,6903,1101680,00.html

Bruce Squires
Secretary, WAME

___________________________

This issue proves both my previous points:

1. Discussing ethics over a bulletin board does not lend itself to honesty—according to this article half of all published articles are done by ghost writers—I venture to say that 100% of all medical editors must know about this issue but almost nobody mentioned it here before as a problem they have to deal with.
2. It also proves that unenforced guidelines are useless—I am assuming that at least half of the cheating authors know about the guidelines and the guidelines have had little influence over the cheaters.

Eugen Tarnow

___________________________

Bruce has called attention to an important problem, one which 'unfortunately' does not apply to journals that are not able to profit from the pharmaceutical industry's generosity, ie, my own journal. But all of us may have another, subtler problem when 'ghost writers' are used to polish papers of authors who then sign them but fail to acknowledge the assistance they have received. Some may not see this as a problem and may even welcome the well-written paper; I find it troubling and believe authors should routinely state that someone else has written their paper. What do other editors think? Am I way off base?

Barry Pless

___________________________

Actually, I posted a note to WAME about a year or more ago, noting that I had found several articles which had been surreptitiously ghost-written. I found out by checking the File | Properties of the MS Word document. When I have found it, and I routinely check now, I confront the author and ask for a signed statement explaining the authorship. Also, our journal (American Family Physician) does not accept articles which have been authored or co-authored by pharma employees or supported by pharma dollars (ie, an "unrestricted grant" to write the article, or ghostwriting). Not perfect, as they may slip by, but I think we're doing pretty well. Unfortunately, it has limited the number of manuscripts to some extent, but that's another issue.

Mark Ebell
Deputy Editor, American Family Physician

___________________________

Though your method of checking for ghost authors is simple, it is not foolproof! One can always change the name of the author in the properties window. It only shows that the author is unaware of that fact.

Johnson Francis, MD, DM
Executive Editor, Indian Pacing and Electrophysiology Journal

___________________________

I've never actually waded into a WAME discussion before but this one drew my attention. (Bruce's salute notwithstanding. Waving my red & white flag). Please pardon my "consumer" approach.

Ghost writing...Is it ethical? I'd rather read a manuscript from a writer who's a great researcher than from a doctor/expert who's a so-so writer. To me, the question shouldn't be about "ghost writing" but rather about ethical, non-biased, objective reports, whatever their source. Yes, if a writer is paid by a drug company, that's problematic. Yes, if a scientist is supported by a drug manufacturer, that's also problematic.

If a doctor, researcher or scientist has completed a study, without influence from government or corporation, then he/she should be "allowed" to have their work developed or "fine-tuned" by a professional, objective, non-biased writer. A writer is there to add clarity, refine grammar, enhance structure, acknowledge/write for the reader, etc. and this writer should be acknowledged in the article.

I don't know if it's a matter of who's written the article (definitely acknowledged) but under what circumstances that writer works. (not paid by the drug company or government PR agency) There's a world of difference between an expert writing and a writer communicating.

Just my two cents...

Stephen Douglas
Senior Health Editor/Writer, The Health Press
Lombardi Publishing Corp
___________________________

Couldn't agree more—many authors could desparately use your help! I think my concern and that of most listmembers is with participation (disclosed or undisclosed) of authors paid by a pharmaceutical company and therefore having an almost inevitable bias.

Mark Ebell

___________________________

I don't want the discussion to stray too far from questioning the activities of drug companies, but there is a corollary to Stephen Douglas's proposal to acknowledge writers who have contributed to articles.

If publications ought to identify the people who 'fine tune' articles, then should they also identify who edited the paper? Editorial teams also 'add clarity, refine grammar, enhance structure etc.' but they usually have a ghostly presence in the published article. Can we always assume that the staff named in the journal have done the editing?

John S Dowden
Editor, Australian Prescriber

___________________________

As I learned in Singapore several years ago from ST Lee's associates, it is one of the editor's jobs to "flush out the guests", meaning no "authors" who have not satisfied the ICMJE criteria for authorship, and "flesh out the ghosts"—meaning make them real named authors or label them by name as contributors with their contribution stated.

Then there is no problem of accountability.

George Lundberg

___________________________

I agree with Stephen's comments. I think it is important to distinguish between "ghost writing," which is widespread, necessary, desirable, and probably here to stay, and "ghost authorship," which is only quasi-ethical and probably undesirable.

"Ghost writing," in my definition, is assistance with preparing early drafts of an article to save the author of record the time and effort of choosing words to express the author's intellectual content. That is, the ghost writer packages information provided by the author. "Ghost writing," in my definition, is the act of preparing an almost final draft of an article before an author is identified. The implication is that the "author" cannot take responsibility for the article because he or she had little or no input into its ideas. However, I can imagine an author agreeing with, say, a review article, and allowing his or her name to be listed as an author. I couldn't do this, but I'm willing to consider that authors who DO do it are quasi-ethical, as opposed to being outright frauds.

You may also be interested to know that the European Medical Writers Association is developing a position statement on the topic of ghosting writing/authoring, to guide writers especially in the pharmaceutical industry on this issue.

For what it's worth.

Tom Lang
Tom Lang Communications and Training

___________________________

I agree with both Stephen Douglas and George Lundberg. We need to distinguish the issue of funding / conflict of interest with the legitimate role of professional writers, authors' editors and maybe even other editors.

However, it is often hard for journal editors to act as authorship police and ensure there are no 'guests' or 'ghosts'. The move to listing individuals' contributions may help, since there may be obvious gaps in the list, or contributions that do not merit authorship but, ultimately, the information about who did what and responsibility for representing this truthfully lies with the researchers/authors/writers.

WAME members may be interested to know that the Good Publication Practice guidelines for Pharmaceutical Companies set out principles for the involvement of professional writers in industry-funded publications, and also make proposals for greater transparency in acknowledgements, and practical steps to flesh out company-employed ghosts.

The guidelines are available at www.gpp-guidelines.org.

If journal editors agree that the GPP guidelines are helpful, we hope they might consider adding a link to the GPP website from their Instructions to Contributors and, perhaps, asking authors of industry-sponsored studies if they have followed them. That may not remove the need for editors to be vigilant in this area, but it should raise awareness of the issues and state explicitly what is (and is not) acceptable practice in this area.

Liz Wager
(Freelance Medical Writer & Member of GPP Working Group)
___________________________

If there is to be a significant discussion on this issue, precise problems, eg, undue lack of objectivity, data smoothing or omission, inducement payments, exclusion of certain investigators from the writing process, need to be considered. Consider reporting of clinical trials, already the subject of the CONSORT guidelines. If there are no specific issues, and the data analysis is investigator-led, followed by close review by the investigators it is difficult to find fault in what is essentially an academic collaboration between investigators and Pharma (regarding clinical trials).

If the article is simply a review suggested by the Pharma, with a clinician's name attached then all is not well, however. Nonetheless, clarity as to the rules and fault lines is needed. Reviews do have a place after all, and it is inevitable that Pharma will want to control that process! Even so, honesty remains the best policy for Pharmas, as well as clinicians, in both the short and the long term. That must be the starting assumption in any professional relationship. If is questionable, then all is not well.

Michael Swash

___________________________

A comment here, are "ghosts" not the shadowy figures who can no longer influence events directly and are between two worlds?! I think a much harder line is needed. If the authors writing skills are so poor that they need such help, or they are so busy with other projects they have needed the paper to be written, how can their research guarantorship be realistically of quality? The only area I would think "ghost writing" is acceptable in is if people have language difficulties (English not first language or vice versa if translating English to another language) or specific disabilities. I think authors should at the very least dictate their intentions on manuscript structure, but even here there are difficulties—to paraphrase an old saying about the danger of ghost writing—there is "many a slip twixt pen and lip."

Sean Lynch
Primary Care Psychiatry
___________________________

In an ideal world, researchers would be both well trained and highly motivated to write up their research. Sadly, in my experience, one, and often both, attributes are lacking. In such cases, I think it is preferable to involve a professional writer who will at least produce a workable publication and ensure the results enter the public domain.

Inability to communicate results clearly is not restricted to those whose native language is not English—in fact, I sometimes feel that the reverse applies and those who have learned English as a second language treat it with greater respect than those who've learned it from birth.

Whatever their language, it does not always follow that good researchers are good communicators. Professional writers tend to be better informed about guidelines such as CONSORT and the best ways of presenting data than clinicians/scientists who publish only rarely.

I agree entirely that authors should discuss their thoughts about a publication before writing begins. It is also essential that writer and investigators work closely throughout the process. When that happens, the collaboration can be truly synergistic and the result is that readers get access to well written papers. That, to me, seems preferable to impenetrable or unpublished papers.

Liz Wager
(Medical Writer)
___________________________

I think these are valid points, but I would be skeptical about how effective someone who is not a good communicator is at research.

Sean
___________________________

I'm glad to hear a somewhat more balanced discussion about "ghostwriting" here than I perceived in the original Observer article!

While I have no doubt that some of the "hoodwinking" described in this article takes place, my experience suggests that it is not anywhere as common as the author tries to portray. Seeing things from all sides of the issue (as a biomedical journal editor, a researcher, and a research communicator) this appears to me a very biased article with the objective of scandalizing the public about the shenanigans of the big bad pharma industry, exaggerating the opinions of a few. It uses inflammatory language and questionable and unverifiable stats. Surely as editors and communicators WAME members recognize the tools of emotional manipulation at work? I would take this story with a big grain of salt.

Yes, there are many in the industry (pharma and consulting) without rigorous scientific training who have no concept of the requirements for scientific rigor or transparency. They usually come from marketing divisions, or if in research, are not very professionally advanced. I have spent a good part of the last decade explaining to these people correct procedures for authorship, acknowledgment and publication, and informing them of the Uniform Requirements, etc. Usually they listen. For the most part it isn't malicious evil doers who carry out the described activities but overeager marketers following marketing principles or inexperienced researchers trying to please their bosses.

It behooves those who know better, especially those who work with or within the industry, to work towards good (better) publishing practices. In many cases this only needs someone taking responsibility and speaking up when a questionable situation arises. In-house medical writers and medical writing consultants are in the perfect position to do this and associations like AMWA and EMWA and WAME can help by educating and empowering their members and the industry.

Donna Rindress
___________________________

As far as I understand, these types of articles are exactly what might be expected if the field is not policing itself. Newspaper articles and law suits. And they will all lack an understanding of what is really going on. That is the consequence of not having enforced rules.

Eugen Tarnow
___________________________

I have sat this out but I have to say there are many good researcher/scientists who may not be good writers—some as Liz says in their own language and others because English is not their language—as a medical student I helped with many manuscripts from non-English speaking researchers who did great work but could not write well—the content is what matters and the honesty in its presentation—whoever does the actual writing.

Michael Gordon
___________________________

MIKE AND OTHERS ARE MISSING THE POINT: EVERYONE WELCOMES GOOD WRITING—THE ISSUE IS SIMPLY THAT IT BE CLEAR WHO GETS CREDIT FOR IT AND THAT A RESEARCHER WHO WRITES POORLY AND GETS HELP, SHOULD ACKNOWLEDGE THAT HELP...

Barry Pless
___________________________

Agreed.

Michael
___________________________

I'm an author's editor. In addition to my agreement with what I take to be the gist of this discussion:

1. the need for editors to try to detect and NOT publish promotional material disguised as scientific articles (the work of ghost writers as hired pens),
2. a recognition that author's editing is not, or at least not necessarily, ghost writing, and
3. that editing (either author's editing or in-house editing) can add to readability and may be necessary.

I would like to add that while Sean is surely right that authors whose native language is not English (E2) are the ones who need helpful editing most, they're not the only ones. In fact I've been hearing from competent E1 investigative journalists based in New York and Europe that there is some tendency for E1 authors to hire their own editors these days too.

Why would professional E1 authors need editors? Well, perfectly good authors have always appreciated good editors—a second pair of eyes in a good head and patience for detail is much appreciated. But it seems they've been noticing that publishers aren't giving their texts that added round of polishing any more. There's no more help with with phrasing for readability, absolute correctness with grammar, spelling and style consistency. In other words, those value-added services we once assumed would be provided by a publishing house are not always in the process anymore.

I've seen such messes published by big publishing houses and some pretty big journals that it's led me think it's merely old-fashioned force of habit that makes us believe there's a difference between a publisher and a printer these days.

M. E. Kerans
Barcelona, SPAIN
___________________________

Three quick points:

First, I meant to define 'ghost authorship,' not "ghost writership," the second time in my post.

Second, I suggest that writing in the tradition of the sciences differs substantially from the tradition of writing in the humanities, which is the only tradition taught in school. We all learn how to write, but few of us learn how to communicate technical information in writing. That is, "knowing how to write" is not enough for the sciences. A true story illustrates the point: a well known medical writer and a neurosurgeon are talking, and they learn about each other's professions. The neurosurgeon says "I've thought about taking up medical writing when I retire." The writer responded, "What a coincidence. I've thought about taking up neurosurgery when I retire." They are both being unrealistic, but only the writer knows that.

Third, if we take the argument (that researchers should do their own writing) to it's logical conclusion, I suggest biomedical research would slow considerably and probably be reported with much less completeness and accuracy than it is now. What would the pharmaceutical industry look like if every PI had to spend time choosing the words to document the research?

Tom Lang
Tom Lang Communications and Training
___________________________

I absolutely agree with Tom Lang that learning to write one type of text (essays in humanities for example) doesn't mean you don't need to learn the peculiarities of a new genre (research articles for example). Readers of certain types of prose do have their expectations and a writer violates them at his/her own risk!

(Clearly, my other "declared interest" (besides being an E2 author's editor) is research in applied linguistics—genre analysis!)

Text types do overlap, however. That's why a person who's grown up writing increasingly competent student essays often learns to handle a cohesive Discussion section a bit faster than a person who's grown up memorizing the facts an instructor dictates or copying information cut-and-paste style in school and even at university (a medieval practice still used in some educational systems).

I can't agree, though, with what Tom Lang seems to imply in his last point—that researchers needn't take the time to learn to write up their thoughts about research well because it will just slow them down. Hmmm.

Isn't explaining the results clearly part of making sense of the science? As far as whether writing slows down science, well, I've often heard scientists lament that there's too much information for them to "assimilate" these days. So what's the sense of bench and clinical scientists producing yet more unassimilated information even faster—by hiring ghost writers—if the scientists don't also do their own thinking about it. My own experience is that (good) scientists need to write and then take (good) peer reviewers' and (good) editors' comments on the chin and do some further thinking about their criticism as part of moving on to the next step. Regardless of whether that step is at the bedside (evidence-based practice) or at the bench.

Or am I living on some other, more idealistic, planet? I invite correction!

M. E. Kerans
Barcelona, SPAIN
___________________________

The ghost who "flees" and refuses to participate in the writing up of an article that carries her/his name as principal author is not an uncommon phenomenon as far as I have been able to determine.

This ghost will be a recent graduate from a doctoral program in medicine or science who has complied with all the requirements, new sheepskin in hand, and is looking for a job. Her/his former doctoral advisors plead with her/him to write up the doctoral dissertation as an article for such-and-such medical or biomedical journal, mentioning all the prestige it will bring her/him later.

She/he refuses, as getting a job or doing a postdoc is more important than staying around med school struggling with translating the most important parts of the dissertation into English; however, the advisor(s) go(es) ahead; and the work of translating and working up the dissertation into an MS is carried out, and according to the promise, the former doctoral candidate is given the place as principal author. The MS is submitted. The article is accepted and is published. Tutti contenti!

Why would the recent graduate's advisors want to incur so much work for the benefit of an uncooperative graduate from their institution? The answer is easy. They want the credit for being coauthors to be able to satisfy the requirements of participating in creating knowledge that their appointments demand as reseachers of their national council of science and which grants them a substantial sum of money each month as long as they publish articles in journals with acceptable impact factors.

How easy (or difficult) would it be for an editor to "flesh out the ghosts" or "flush out the guests" in the above case? Does it count as unethical behavior on part of the so-called coauthors to give credit to a "ghost who fled?"

RM Chandler-Burns
EMPM/Medicina Universitaria
___________________________

In the article addressed by Bruce, it was mentioned that "almost half of all articles published in journals are by ghostwriters!" Is this a correct guestimate?

Farrokh
___________________________

Getting back to Barry Pless' reminder that the issue we are trying to solve is one of transparency and accountability (who gets help and who gets credit for clear writing)—

Readers deserve to know who was responsible for the content of texts they read, and what factors might have influenced how and what the content generators wrote. Transparency in reporting who the content generators were and what factors might have influenced them gives critical readers a basis for deciding whether the text might be biased or not.

Content generators (or at least "shapers" of the content) can include clinicians and technicians who obtain the data, researchers, statisticians, author's editors, medical writers, translators (in the presubmittal arm of publication) and journal reviewers, editors, copyeditors and technical editors (in the postsubmittal arm of the process). Any of these contributors can be biased in any number of ways. Although ideally, all of them should be able to prevent their biases from influencing their work (the mark of a true professional), this is not a realistic view.

So it may be useful to readers to know who all these people are, and what potential conflicting interests they all had. Whether the journal's reviewers and editors deserve (or desire) public recognition for their role in shaping the final text as it appears before the public has been debated in the pages of European Science Editing. These colleagues, however, seem to be reluctant to step out of the shadows. Why should criteria for accountability be different for contributors acting on only one side of the "submittal event" horizon?

An excellent overview of the roles and responsibilities (now perhaps superseded, as ME Kerans suggested) of different colleagues who contribute to the content of scientific articles was recently published in:

Burrough-Boenisch J. Shapers of published NNS research articles. Journal of Second Language Writing. 2003;12:223-243.

"NNS" stands for "non-native speaker". If anyone wants a photocopy just contact me off-line.

On the subject of how biases cannot be assumed to be eliminated through systematic review methods (with interesting ideas on assumptions we tend to make about the quality of evidence), this editorial is fascinating:

Schriger DL. Finding truths in clinical medicine: through the looking glass—cracked. Ann Emerg Med. 2001;38:566-569.

Thanks to all for making this WAME debate so intense!

Respectfully,
Karen
___________________________

I think Dr Kerans has hit the nail on the head with her comments. As a writer of scientific articles I rely on the Editor's and referees comments to sharpen my article (provided it is provisionally accepted). As an Editor, I am thankful for referees comments to make a contribution to our Journal better. We must not loose sight of the fact that the main criteria of a good research article are originality, appropriateness of methodology, and do the results justify the conclusions of the authors. Likewise, a good review article must be up to date and balanced. If the English and/or grammar of the submitted article is not perfect, this does not preclude possible publication, provided the above criteria apply. It is then up to the Editor and his/her team to guide the authors in making their articles more readable and understandable.

Rob Siebers
___________________________

As researcher, I think that there is no point in discussing whether researchers must write alone all their papers. How many professionals involved in the biomedical research have equally developed both science and communication skills? How many of them acquired comprehensive communication skills during their college and university studies? On the other hand, the amount of information has grown so much that the limiting factor now is the reader's time. Nobody has anymore the time to read a poor structured, unclear, unfocused paper. So, the author's editors do have their function. The question is: are they ghost authors? In my opinion, they are not, because they help to clarify an intellectual product but they do not produce it. Therefore, their work should and must be acknowledged, but not as authors, as they can not be responsible for the content, e.g. the design and the results.

On the postsubmittal arm of the process, the journal editors also improve the paper readability from a baseline quality provided by authors and author's editors. Their contribution is acknowledged in the journal credits.

Then, the main ethical problem of ghost writing does not point to the author's editors and medical writers, but to those professionals who participate in the "redefinition" of the paper in such a way, that they prefer not to be included among the authors. Can an editor police this kind of ghost authors? Probably not in an efficient way. Can the author's institution do it? Probably yes. It is a responsibility to share, but the main role should be played by the authors' institutions.

It is encouraging to see a debate like this in our forum and I am very grateful to all who have contributed to the discussion. It has been very useful.

Guillermo J. Padron, PhD
Editor, Pan American Journal of Public Health
___________________________

The only way in which author's editors will not appear ghostly is for them to reveal themselves...

Barry Pless
___________________________

Scientists are not unusual in finding clear communication an effort. I think it's safe to say that none of us acquired good communication skills in our university days, scientists or otherwise!

Scientists are special, however, in having a growing parallel core of communication helpers for hire available. This emerging independent profession is quite unorganized (not disorganized necessarily) and its practices are only beginning to be studied by academics and to be subject to efforts at self-regulation and self-improvement. Variations in practice are only beginning to be scrutinized by those who need us or those who suspect we might be up to no good.

I congratulate Dr. Padrón on taking the reader's part. The reader is often forgotten, yet it pays a writer and editor to remember that it's a reader's respect s/he's after.

Finally, just a note on why (sometimes) author's editors do not always like to be "acknowledged". We do not have control over the state of the typescript the author sends to be reviewed. There have been papers I've had a hand in that have gone out in states I have not approved of, but not being an author I've had no say in the matter.

Journal editors don't seem too concerned about how manuscripts are produced. Only one journal editor (in my 15 years' of experience) ever wrote to an author—after seeing the very different state of the manuscript after revision I suppose—to say that if someone helped in revising the paper, that person's name should be in the acknowledgments.

M. E. Kerans
Barcelona, SPAIN
___________________________

I have been following the ghost writing discussion with great interest and believe that it has been an example of the value of internet discussion lists such as WAME.

I would like to contribute by reference to Mary Ellen Keran's comments and ask her to which efforts she is referring by 'self-regulation'. I know that there are training seminars given by various organizations on scientific editing and writing and Bell's exams, which would qualify for 'efforts at self-improvement' but know of nothing which would qualify as regulation. We have been offered guidelines but here I concur with Eugen Tarnow's lament that they do not catch the cheaters and those are the people who really cause the trouble. In my earlier career as a solicitor regulation and control was accepted without question as a necessary protection for the public. Although I accept that medical writing and editing draws on a potpourri of backgrounds added to which there is no universally accepted right style and grammar in English, if an independent profession is arising shouldn't those who practice it be subjected to ethical controls and compulsory membership of a professional society to control them in order to protect the public?

Another point made by Mary Ellen which I would like to re-enforce is that she is absolutely right about the author's editors reluctance to be acknowledge unless the version submitted to a journal is the final version approved by the author's editor. This is not always the case. Authors and marketing departments can make little adjustments after the author's editor has worked on the manuscript which at the least and on the innocent level can embarrassingly reflect on the quality of the English.

Elise Langdon-Neuner
___________________________

I respond to Elise Landon Neuner's interesting letter about self-regulation. Re' the..."independent profession"..."subjected to ethical controls and compulsory membership of a professional society"...Would you (Elise) be so kind as to identify and list some "independent profession(s)" (including the model countries)that have such "compulsory membership".

George Lundberg
___________________________

In reply to George Lundberg, the UK but other countries too have professional societies e.g. The Law Society for solicitors I mentioned and similar societies for accountants, patent agents, estate agents etc. not forgetting bodies that govern doctors such as the BMA (British Medical Association). They are as independent as you can hope for and better than a free for all.

Elise
___________________________

But Elise's comment and Marie Ellen's original point about AEs not wanting to be acknowledged for fear of embarrassment if someone were to change their edits must be balanced by the supposed (but unlikely) embarrassment of a researcher-author who is willing to appear to be a far better writer than he or she really is...and, of course, this is what readers conclude as well.

Barry Pless
___________________________

Self-improvement is certainly a better way to describe the present stage.

Sorry if "self-regulation" overstated the level of organization that editors (not just author's editors) attempt through the organizations Elise mentions and through the CSE and EASE, where both journal editors and author's editors mix. When such organizations develop guidelines through discussion, it's a small step toward self-organization it seems to me. I come from a US American background in which even our universities are "accredited" by each other rather than by a coercing authority, so such efforts seem to me to be the beginnings of self-regulation.

M. E. Kerans
Barcelona, SPAIN
___________________________

To build on Barry's post, I again refer to the fact that writing in the sciences is not about "style," in which the clarity of a written article is attributed to the author. It's about the accuracy and completeness of the reporting. (Style can be defined as that part of writing that is associated with a specific author.)

This approach differs from writing in the Humanities, which pairs the author of the thoughts with the chooser of the words. Writing in the Humanities evolved from the perspective of writing as self-expression and is largely still taught that way in the US and in many other countries. BIG problem in my view because the single most common problem with authors is that they have no sense of audience. Most authors have been taught to write to audiences of one (a teacher or professor), audiences that have no real need to understand them, and audiences that know more about the topic than they do. Although this circumstance is my job security, I find it frightening because the impact of poor, misdirected, and unread communication can have tragic consequences.

Tom Lang
Tom Lang Communications
___________________________

Medical writers have considered "certification" for a long while. I personally am opposed to the idea, and the first and only 2 long-range planning committees of the American Medical Association determined that certification is not what we wanted to do.

The BELS (Board of Editors in the Life Sciences) exam has not been validated, in that there is no proof that passing the exam distinguishes stronger writers from weaker ones. Communication is still an art as much as a science, and evaluating a medical writer is akin to evaluating art; beauty is in the eye of the beholder. Tom Lang
Tom Lang Communications
___________________________

I'd be happy to join an accredited/regulated (even compulsory) professional body for medical writers...just as soon as there is one for medical journal editors too.

More seriously, I agree with Tom Lang that certification is not the answer, but that should not stop good writers, trainers, journal editors, and researchers from working hard to educate each other and together creating a publishing culture in which transparency and honesty flourish, and bad practice is discouraged.

Cultures are hard to change, and the issues of ghosting, authorship and competing interests have a bearing on methods of academic appointment and promotion as well as drug marketing. Like most complex human behaviours, both carrots and sticks are probably needed to encourage change, but also dialogue and real understanding of what the different constituencies are trying to achieve. Eugene Tarnow is right that guidelines will not solve everything—but I think they are a necessary component of this complex jigsaw. The CONSORT guidelines have contributed to an improvement in the reporting of clinical trials. Guidelines on the process (rather than the content) can, I believe, achieve similar improvements.

Liz Wager
Sideview
___________________________

I strongly agree with Tom Lang's main point that writing is not style. I think that's not limited to the sciences, though.

But when Tom makes the statement about scientific writing differing from "writing in the Humanities, which pairs the author of the thoughts with the chooser of the words," does it imply that in scientific writing we accept that there are authors of thoughts only who do not choose the words they put their names to?

That would be a very very strong position and somehow I doubt it would hold up. If we all decide it's so, however, it would be a good reason for abandoning authorship altogether and adopting contributorship!

Apart from whether thoughts can even be identified without words (well with fNMR we can observe events that we can define/infer to be thinking?), thoughts can't be communicated and judged without words—yet! I wonder if scientist-editor-authors sign on to that strong position. I don't see scientists, to their credit, telling challengers, "Oh, no my thoughts were different. You're objecting to another's words." If E2 authors use that argument it might get them a bit of indulgence in the review process, but would it get more than sniffs afterwards?

Even when a scientist signs his/her name to a ghostwritten article—don't we take signing to imply a choice? Doesn't signing affirm that those are the right words for the thoughts as far as the author-thinker knows at that moment, ruling out other candidate words at that time?

May I suggest that what medical writers do, then, is offer candidate words, which the author chooses to use or not? Author's editors do that too, but the process is perhaps more back-and-forth. As our clients are often E2 scientists, we're also called on to explain the implications of one choice over another. And as the writing/revising process can be slower for some E2 scientists—with thinking often racing ahead if language proficiency is fragile—we're also called on to warn when cohesion breaks down and information gaps develop. Etc.

M. E. Kerans
Barcelona, SPAIN
___________________________

Yes indeed, what's important is what the READERS actually want and need, in terms of content, reporting, editing, accountability, whatever.

Guillermo notes that the contribution of editors in improving readability is acknowledged in the journal credits. I'm not so sure. Not all editors actually amend the texts, and not all are actually competent at copyediting (nor do they see this as part of their job), although they may be highly skilled at gatekeeping. So readers don't usually know to what extent the editor helped the authors to improve their text.

The same can be said for reviewers, who mostly remain anonymous to this day despite their often very significant influence on both the content and the reporting.

Any author's editor has stories about how well-edited manuscripts were massacred, not improved, by peer review, copyediting, or both. In some papers I've helped authors with, the final, published version, after rejection from two or three journals and revision with input from any number of anonymous reviewers (all with different interests and priorities), has ended up an incoherent mish-mash of cut-and-paste, irrelevant references, overemphasis on secondary matters and underemphasis on the really novel aspects of the findings. In other words, the main messages end up getting lost. And yes, when the authors develop the manuscript on their own, guided by reviewers' comments with no further advice from me, the final result can be an embarrassment to an author's editor, although the editor of the publishing journal was happy to accept the final product.

Why do authors follow the reviewers' and editors' advice for additions and deletions blindly, rather than staying focussed on internal logic and coherence? Because authors are afraid that if they don't "obey", the manuscript will be rejected.

So what he have is a complex process with inputs from people who all want the best, but who sometimes have conflicting ideas about what is "best" for the text or for the readers. We are very, very fortunate in having WAME to provide us with a forum where all of us on both sides of submittal can talk.

Un abrazo,
Karen Shashok
___________________________

Mary Ellen responded to my statement that "writing in the Humanities, which pairs the author of the thoughts with the chooser of the words", by saying "does it imply that in scientific writing we accept that there are authors of thoughts only who do not choose the words they put their names to?" The answer is yes, of course.

I don't dispute that authors use words to shape their thoughts. I only suggest that they do not choose these words efficiently or correctly for communicating their thoughts. I think tables and figures are a case in point. The authors can analyze their data with figures and data tables (content), but the editor may substantially revise, create, or delete these figures or tables in the effort to communicate the results of the analysis (presentation).

The distinction between content and presentation has long been made in scientific writing. The presentation is supposed to be transparent so that the content can be judged without the ambiguities of the text getting in the way. Thus, the sciences value writing for its "instrumental" characteristics.

In contrast, the Humanities value writing for its "intrinsic" characteristics; the value of a good novel or poem is the writing itself; the well turned phrase, the allegory. Too many people in the sciences continue to assume that because writing has intrinsic value it must be written by authors, not writers, at the expense of accuracy. clarity. and completeness.