Haunted manuscripts: ghost authorship in the medical literature.

Ghost authorship occurs when an individual who contributed substantially to a manuscript is not named in the byline or acknowledgments. Ghost authors may be employed by industry to prepare clinical trial results for publication. An expert is then "hired" as author so as to lend an air of credibility and neutrality to the manuscript. Ghost authorship is difficult to detect, and most articles that have been identified as ghostwritten were revealed as such only after investigative work by lawyers, journalists, or scientists. Ghost authorship is ethically questionable in that it may be used to mask conflicts of interest with industry. As it has been demonstrated that industry sponsorship of clinical trials may be associated with outcomes favorable to industry, this is problematic. Evidence-based medicine requires that clinical decisions be based on empirical evidence published in peer-reviewed medical journals. If physicians base their decisions on dubious research data, this can have negative consequences for patients. Ghost authorship also compromises academic integrity. A "film credit" concept of authority is one solution to the problems posed by ghost authorship. Other approaches have been taken by the United Kingdom and Denmark. A solution is necessary, as the relationship between authorship and accountability must be maintained.