Recently in Terminology Category

The president of the American Medical Writers Association (to which I belong) has written to its members (below) regarding the practice of medical ghostwriting, and AMWA's response to the NYT article about Merck's use of guest authoring and ghostwriting has been printed. I agree with AMWA's assessment.

Hello, AMWA colleagues,

As many of you have been discussing, the articles in this week's JAMA about alleged misuse of medical writing resources by Merck in publications about Vioxx garnered a lot of press coverage. As is often the case, the JAMA articles and the associated press coverage tend to blur the distinction between "guest authorship" (putting an author's name on an article he/she did not help to write) and the unacknowledged use of medical writers (ghostwriting, a term AMWA tries to avoid). A number of people have asked whether AMWA should do something.

Several of us saw this as an opportunity to assert AMWA's leadership in promoting ethical practices in medical writing. Accordingly, we have submitted letters to the editors of the NY Times, Philadelphia Inquirer, and Chronicle of Higher Education, all of which carried stories about the JAMA articles. All letters are signed by me as AMWA president.

Key points in all the letters:

• While ghostwriting (the undisclosed contribution of a medical writer) is unethical in scientific publications, the use of professional medical writers may be appropriate and ethical.
• Using their skills in communicating complex data, professional writers help researchers report their findings effectively, making contributions comparable to those of professional statisticians who analyze data or artists who create illustrations.
• The 5500-member American Medical Writers Association promotes ethical practices in scientific publication, including acknowledgment of medical writers' roles, adherence to applicable guidelines (eg, authorship rules of the International Committee of Medical Journal Editors), and full disclosure of potential conflicts of interest, including financial support.
• Transparent disclosure of the roles of all contributors avoids ghostwriting and allows readers to evaluate the credibility of research reports.

We're also drafting a response to JAMA. We'll keep you posted to let you know if these letters are published. In addition, Lori Alexander will include an editorial in the summer issue of the [AMWA] Journal, bringing these issues to members' attention.

Best regards,
Sue Hudson

A recent New York Times article draws attention to an ill-considered problem of using medical eponyms. Beside the fact that these names—like Parkinson of Parkinson's disease—do nothing to illustrate the nature of a disease, they may honor a physician of dubious or even reprehensible character. Such is the case with Friedrich Wegener, the German pathologist who, in the 1930s, described an uncommon systemic vasculitis, now referred to as Wegener's granulomatosis.

In 2006, Alexander Woywodt and Eric Matteson published their investigation of Wegener's Nazi background in the journal Rheumatology, arguing that the German doctor's voluntary association with the National Socialist German Workers Party and his related activities as physician should preclude the use of his name—in more or less tributary fashion—to describe the disease. According to their research of publicly available documents throughout Europe, Wegener was a brownshirt, or Nazi "stormtrooper" (SA), as early as September 1932. Among notable activities, the brownshirts colluded with the SS to create the terror of Kristallnacht in November 1938.

During that year, Wegener was promoted to lieutenant colonel in the SA medical corps and began working in 1939 as a military pathologist in Łódź, Poland, according to Woywodt and Matteson. Wegener's 1941 reports to the local health office suggest or outrightly indicate knowledge of conditions in the Łódź Jewish Ghetto and of deportation transports to the Chelmno extermination camp. Woywodt and Matteson discovered evidence that Wegener occasionally performed autopsies on victims of deportation, and that Wegener was a contemporary of Łódź physicians who were implicated in the murder of hospital inpatients.

In files concerning the German regional government of Poznań, Poland, the authors found a single letter written by Wegener, in which he comments on an unidentified manuscript about air embolism, possibly the product of human experimentation. Wegener's embrace of Nazi ideals is supported by his close academic association with pathologist-mentor Martin Staemmler. Staemmler was a fervent Nazi supporter and, among other duties, was coeditor of the Nazi propaganda magazine Volk und Rasse (People and Race).

Woywodt and Matteson acknowledge that their investigation did not reveal Wegener’s unequivocal involvement in war crimes; however, his behavior was clearly in sympathy with, if not direct support of, Nazism. In a related editorial, they recommend that the use of eponyms in medical literature be dropped altogether on the basis of a number of compelling arguments. They summarize,

Eponyms often provide a less than truthful account of how diseases were discovered and reflect influence, politics, language, habit, or even sheer luck rather than scientific achievement. Moreover, the continued use of tainted eponyms is inappropriate….

 

I would add that the use of eponyms promotes an unhealthy throwback to the adulation and narcissism of the individual physician—particularly the physician of academia. The investigation of Wegener prompts the renewed consideration of other physicians' histories, and not just those practicing within the European theater during World War 2. Case in point is America's J. Marion Sims, so-called "Father of Gynecology" and known surgical experimenter on unanesthetized African-American slave women. No matter his other contributions to gynecologic practice: His name should be being dropped from whatever device or procedure that bears it; and moreover, that ridiculous Central Park statue (above) across from the New York Academy of Medicine should be dismantled.