Ben Almassi

Ghostwriting in its various forms has received critical scrutiny from medical ethicists, journal editors, and science studies scholars trying to explain where ghostwriting goes wrong and ascertain how to counter it. Recent analyses have characterized ghostwriting as plagiarism or fraud, and have urged that it be deterred through stricter compliance with journal submission requirements, conflict of interest disclosures, author-institutional censure, legal remedies, and journals' refusal to publish commercially sponsored articles. As a supplement to such efforts, this paper offers a critical assessment of medical ghostwriting as contrary to good patient care, on the grounds that it contradicts established general principles guiding clinical ethics. Specifically, I argue that ghostwriting undermines trust relationships between authors and their readers, and between these readers and their trusting patients, and in so doing contradicts the duty of respect for patient autonomy by obstructing informed consent. For this reason, complicity in ghostwriting practices should be understood as a violation of the professional ethical duties of physicians and other healthcare workers

Throughout his work on the rationality of epistemic dependence, John Hardwig makes the striking observation that he believes many things for which he possesses no evidence (1985, 335; 1991, 693; 1994, 83). While he could imagine collecting for himself the relevant evidence for some of his beliefs, the vastness of the world and constraints of time and individual intellect thwart his ability to gather for himself the evidence for all his beliefs. So for many things he believes what others tell him, as we all do. Epistemic dependence is the responsible choice, he argues, because he can be reasonably sure that those on whom he depends know more about the subject than he does. Epistemic dependence on experts is a smarter bet than epistemic autonomy: after all, Hardwig reasons, “if I were to pursue epistemic autonomy across the board, I would succeed in holding relatively uninformed, unreliable, crude, untested, and therefore irrational beliefs” (1985, 340) [...] In this paper I argue against what I call Hardwig’s no-evidence thesis: that knowledge and belief based on testimony are knowledge and belief for which the knower possesses no evidence. Against the no-evidence thesis, I propose we recognize that layperson B’s good reason to believe that expert A has good reason to believe proposition p constitutes evidence for B for p. I argue that the reasons Hardwig gives for the no-evidence thesis are inconclusive at best; at worst the no-evidence thesis coupled with his recognition of expert interdependence exposes him to recent criticisms by Stella Gaon and Stephen Norris. By rejecting the no-evidence thesis, we can recognize with Hardwig the importance of expert epistemic interdependence while avoiding the paradoxical implications of his position.