Behind the scenes with the authors: Ghost Managed Medicine

Sergio Sismondo, author of Ghost Managed Medicine, takes us on a journey through the writing and development of his ideas.

> What sparked your interest in studying the inner workings of big pharma?

I owe my interest to some excellent presentations and papers by people like Jeremy Greene, Jennifer Fishman, Andy Lakoff and David Healy. I happened into an excellent panel at 4S in 2002 that included presentations by some of these scholars, and I was instantly convinced that it was a great topic – though it took me four or five years to actually begin doing research in the area. But once I got into it, I felt that we could find almost all of Science and Technology Studies (STS) and more by studying Big Pharma.

>How did the ghostly metaphor emerge in your research and writing? 

Medical researchers have been concerned about Big Pharma’s ghostwriters for a while. That concern was my starting point, though meditating on it made me think that there were a lot more ghosts involved: Who hires ghostwriters? Who sets out the parameters for their work? Who provides the links between them and authors? It seemed that all these other people were ghosts, too, “ghost-managing” work for Big Pharma. And then I started to see other spectral figures, too: zombies, vampires and more. I couldn’t pass up the opportunity to use them in my book. Oh yes: For the past twenty years I lived on a part known as Skeleton Park, though I just moved away this year.

>What surprised you when researching and writing it?

One thing that surprised me was how openly all of these spectres spoke, admittedly when they presumed they were talking amongst themselves. I was attending conferences, and they would tell stories of manipulation and corruption that would chill many idealistic people who primarily see how medicine operates in the daylight.

>Who are you trying to speak to with this book? 

I’ll speak to anybody who will listen or read. But more specifically, I’d like to reach a wide variety of audiences. Of course, I would like my colleagues in STS to read this book, and I’ve been pleased to see them do that, and to see that the book has already made its way into people’s courses. But I would love it if the book made its way into the medical community; most doctors understand that Big Pharma is doing lots in the background, but they probably don’t understand just what and how much. And I would like other educated readers to pick up this book – after all, we’re all invested in medical care.

>What might surprise people about the book? 

I think that just about everybody, except the most hardened of conspiracy theorists, will be surprised about the scope of Big Pharma’s actions.

Although I am highly critical of Big Pharma in this book, and although much of it is about medical knowledge, I don’t want to rely on the standard fear that pharmaceutical companies falsify data and lie about their products. Undoubtedly, they sometimes lie and more often exaggerate, but a more fundamental problem is that they have enormous influence over what doctors and others pay attention to, shaping questions, providing spin on answers, and so on.

> How did it feel to write this book? 

It was exhilarating! I’ve been working on this material for a long time, and have had various different versions of this book in my head for years, and it felt great to actually write and finish one of them.

>What do you hope readers feel when they finish GMM? 

I hope that they’ll be less exhilarated than I was writing it. Among other things, I want to show what a completely ghost-managed economy of knowledge would look like, and how effectively Big Pharma is moving toward such an economy. But that probably means that readers will feel a certain amount of despair.

>What makes you feel proud about this book?

Several things: I’m really excited by the primary research that I did, that’s part of almost every chapter. I also feel that I was able to make the whole book accessible, even if I did sneak in some theoretical ideas here and there.  

>Whose work inspires you? 

I feel incredibly lucky to have landed in a field like STS, where we have more than four decades of brilliant and often iconoclastic studies of science, technology and medicine. I won’t narrow those down to a few authors, but my Introduction to Science and Technology Studies probably gives the best account of whose work I really respect. Going forward, I am the editor-in-chief of Social Studies of Science, and I’m routinely inspired by the best manuscripts I read by young scholars in the field, representing amazing research and thoughtful working out of theoretical concepts.

>Why did you want this to be an open access monograph? 

I wanted to tell an important story that’s right for all educated readers, so I wanted it to be as accessible as possible. Mattering offers the perfect balance, producing a completely open access pdf copy of the book, and at the same time producing an inexpensive paperback – because, we should recognize, not everybody wants to read a book on their screen. 

>What was it like having a collaborative editing process? 

I would recommend it to anybody, as long as they’re willing to take advice and criticism seriously. Endre Dányi read the draft manuscript with a superb eye; this was editing the way that it should happen, but rarely does. And the reviewers had excellent suggestions and requests.

>How did you know when it was ‘ready’?

Is it ‘ready’? In the case of this particular book, there were only so many separate elements that fit into the overall story, or at least the story that worked for the diverse readership I envisioned. Yes, I could have had a full chapter about pharmaceutical sales reps, but I hadn’t done the research for that, and it would have taken a while to go out into the field. So I relied on the research I had done, and some secondary research, to write half of a chapter. There were also parts that ended up on the cutting room floor, even fairly late in the day; these were stories that might have lost some readers. 

>What advice would you give to early career academics thinking about writing a monograph?

Have a clear narrative that you want to lay out, and that genuinely needs the length afforded by a book. Have a good sense of who you want to read that narrative, and be realistic – in my case I was ambitious for this book, and I don’t recommend that. Have a developed sense of how you would like to write it for those readers. If you can afford to, take your time.

>On the Halloween theme, what scares you? 

Living on Skeleton Park has meant that I can’t be scared by any of the normal spectres. And through my research I’ve met plenty of friendly ghosts, zombies and trolls. But conspiracies between light and darkness are making the world increasingly closed and inhospitable for many people.