More on Ghost Management: Thoughts About Rhetoric

Roy Poses over at Healthcare Renewal has a lengthy analysis of the recent article out in PLoS Medicine on ghost management, the process by which so-called medical education and communications companies (called "med-eds" or MECCs) manage all aspects of publication planning for industry sponsors of clinical research.  I agree with Poses's analysis, and heartily encourage you to read it.

However, there were some aspects of the article I wonder about.  First, I wonder if it is the case that "[c]urrent practices in the medical sciences legitimately allow people to serve as authors on the basis of narrow contributions" (Sismondo 2007, 1431).  There certainly exists such a tradition within biomedical publications, but it has come under significant fire in at least the last decade.  The Uniform Requirements for Manuscripts Submitted to Biomedical Journals lists extensively the standards required for authorship, including II.A.1:

Authorship credit should be based on 1) substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data; 2) drafting the article or revising it critically for important intellectual content; and 3) final approval of the version to be published. Authors should meet conditions 1, 2, and 3.

Accordingly, I wonder whether it is really the case that current practices legitimately allow people to serve as authors on the basis of "narrow contributions."  The World Association of Medical Editors provides:

Only an individual who has made substantial intellectual contributions should be an author.  Performing technical services, translating text, identifying patients for study, supplying materials, and providing funding or administrative oversight over facilities where the work was done are not, in themselves, sufficient for authorship, although these contributions may be acknowledged in the manuscript, as described below.  It is dishonest to include authors only because of their reputation, position of authority, or friendship (“guest authorship”).

Of course, it could well be the case that the practices depart from the established standards.  I am just cynical enough to suspect that this might well be the case.  I honestly do not know, but I do wonder.

But this post is not meant to be a critique of Sismondo's paper.  Far from it; the paper is an original, important contribution on a topic of grave significance.  As Sismondo explains, "the ghost management of articles is a step in the intervention into medical practice" (Sismondo 2007, 1431).  Because medicine is just as Sismondo describes, one could fairly use a phenomenological term and say that the ghost management of articles is constitutive of medical practice.

There is another approach I want to take in unpacking some of the significance of the article, from a medical humanities perspective.  Here at MH Blog, I've tried to stress how important the art of rhetoric was to the humanists, and how significant it remains to the medical humanities and to contemporary medical practice.

And what struck me most about Sismondo's article is that the med-eds are essentially professional, corportatized rhetoricians.  And they are extremely proficient rhetoricians, as the article demonstrates.  What is it effective rhetoricians do?

First, they identify the audience for whom persuasion is intended.  (And make no mistake about it, rhetoric is ineliminably persuasive in nature).  Second, they tailor their voice, language, tone, diction, they refine their narrative, to the persuasive aims intended.  Third, they tell a story or multiple stories that convey meaning and facilitate interpretations favorable to the rhetorical objectives.  Consider these notions in light of Sismondo's description of one of the med-eds' promotional literature on its web site:

Another [med-ed], Envision Pharma, says that "data generated from clinical trials programs are the most powerful marketing tools available to a pharmaceutical company."  Envision will work from early on in the process to ensure "consistent message dissemination," will plan and track the "data dissemination plan" and will produce "scientifically accurate, commercially focused abstracts, posters, and primary and secondary publications."

(Sismondo 2007, 1431).

Envision is a corporate rhetorician.  They collate the information, the res, and construct narratives suitable to the chosen medium (biomedical journals), such narratives being verba.  Sismondo notes that "[med-eds] are effective at creating publishable articles and getting them published in peer review journals" (Ibid., 1432).  These rhetoricians are highly skilled at what they do, then.  And why shouldn't they be? One med-ed "boasts a team of 40 medical writers, editors, and librarians" (Ibid., 1431).

In thinking about this in context of the medical humanities, in my haste to participate in the reclamation of rhetoric that has picked up some mild academic traction, I have omitted to acknowledge that which Socrates and Plato warned of: the Dark Side of rhetoric.  Since res and verba can be separated, skill in the art of persuasion is not inherently connected to the good.  Hence the Socratic challenges posed to the rhetors Lysias and Prodicus in the Phaedrus.

Medieval mind, if such a thing even existed, was all too aware of the dangers of rhetoric.  This was partly why discursive argument, or logic, was emphasized over rhetoric in the trivium.  But at MH Blog I've also mentioned the medieval focus on order, reflected in the crystalline spheres of cosmogony, and resonant in many of the most significance pieces of medieval literature (the Divine Comedy being one excellent example).  Respect for authority was a means of sustaining order for medieval (wo)man, and too much time spent bandying words about could conceivably affront the commitment to gradualism (the historiographical term for this medieval focus on order).

The separation of res from verba would continue to resonate during the Renaissance and into the early modern era.  Indeed, as Bouwsma demonstrates nicely, it is one of the characteristic themes of the waning of the (humanist) Renaissance.  Poor misunderstood Machiavelli, so insistent that the good was not necessarily the useful, did nothing to ameliorate the growing suspicion of rhetoric disconnected from conceptions of the good.

While the humanists privileged rhetoric, and with good reason, a skilled rhetorician is no guaranteed of moral goodness.  But this says nothing about the power the skilled rhetorician wields; it is an awesome meaning-making device, and we would do well to pay more attention to its effects on our daily practices, including our medical practices, as Sismondo explains.

 

Comments

[Patrick S. O'Donnell]

I was delighted to see the reference to Socrates and Plato with regard to rhetoric, especially in light of the fact that Platonic philosophy itself took the rhetorical form of the dialogue, a fact often forgotten in discussions of Platonic/Socratic hostility to rhetoric. As Guyora Binder and Robert Weisburg make clear, with Plato, rhetoric "strives to achieve ethos, the inner harmony of language, character, and truth made incarnate in the person. Under this model, the speaker must actually *have* good character to impress his audience; the quality of one's discourse is an index and instrument of one's moral health, so that as one lives so one speaks." Moreover, "the choice of [rhetorical] style or form was also a moral choice, and it was therefore significant that he [i.e., Plato] rejected the available model of the tragic poem in favor of the discursive and relatively dispassionate dialogue. [....] Though Plato obviously opposed the crass trickery of the sophistic rhetoricians, and though he opposed tragic theater because it distracted the mind with emotion, the dialogue nevertheless engages in a form of seduction [cf. Platonic eros]. Whereas a treatise by, say, Parmenides announces its purpose and asserts its authority, the Platonic dialogue draws the perhaps resistant reader into philosophizing by exploiting the context of ordinary conversation between ordinary people. Indeed, it relies on the sense of honor of any person capable of articulating a self-image, and experiencing humiliation on being forced to admit that he cannot live up to it. The dialogue also 'models' ethical behavior by demonstrating the moral development of the characters in process. This ethical 'role-modeling' is the heart of rhetoric." (From Binder and Weisburg's Literary Criticisms of Law, 2000). On just how this modeling of ethical behavior takes place in the Socratic dialogues and how it exemplifies key elements of Platonic philosophy, please see Francisco J. Gonzalez's Dialectic and Dialogue: Plato's Practice of Philosophical Inquiry, 1998.