The spectre of ghostwriting: eroding public trust in physicians, clinical trial integrity and biomedical authorship.

The impact of medical ghostwriting, a violation of authorship ethics, remains unclear within the biomedical literature and among the public, potentially raising concerns about the integrity of the biomedical evidence base. Core texts in authorship and ghostwriting from the clinical literature and the 2010 Senate Minority Report on ghostwriting were reviewed as were uses of the term 'ghostwriting' in contemporary (2009-2011) and more recent (2015-2016) journalistic news coverage originally printed in English. Journalistic coverage oversimplified key concerns about ghostwriting identified by the medical community and the US government. More recent journalistic uses of the term 'ghostwriting' suggest confusion with topics such as financial disclosures or patient monitoring. Pharmaism in the medical literature, an expression of bias against pharmaceutical companies that casts doubt on the credibility of physicians and scientists, may be a source for confusion. The tendency for medical journal editors to discuss ghostwriting in the context of clinical trial transparency or data integrity is another possible source for misinterpretation via oversimplification. Journalistic descriptions of ghostwriting consistently downplay the critical reasoning abilities and competence of practising physicians and deflect attention away from patient concerns and back to pharmaceutical companies. Some uses of the term ghostwriting in news coverage may implicitly undercut belief in the competence of physicians, a troubling trend. Further work is needed to characterise the impact of ghostwriting in the medical literature and to reassure the public that their trust in medical practitioners is well placed.