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When doctors are deciding which drug to prescribe a patient, the idea behind evidence-based medicine is that they inform their thinking by consulting scientific literature. To a great extent, this means relying on medical journals.
醫生給病人開藥時，通常會參考一些科學文獻所推薦的藥物，而所謂的文獻一般就是醫學期刊。
The trouble is that pharmaceutical companies, who stand to win or lose large amounts of money depending on the content of journal articles, have taken a firm grip on what gets written about their drugs. That grip was strong way back in 2004, when The Lancet's chief editor Richard Horton lamented that "journals have devolved into information laundering operations for the pharmaceutical industry." It may be even tighter now.
于是問題也就出現了，制藥公司的盈虧依賴于這些期刊文章，所以他們對文章內容有著很強的控制力。早在2004年，著名雜志《柳葉刀》的主編Horton就感嘆道“科學期刊已經淪落為制藥工業的信息過濾器”。如今，情勢愈演愈烈。
Drug companies exert this hold on knowledge through publication planning agencies, an obscure subsection of the pharmaceutical industry that has ballooned in size in recent years, and is now a key lever in the commercial machinery that gets drugs sold.
醫藥公司靠選題策劃代理來搞定文章，這個曾在制藥業不起眼的小行業近些年經歷了爆炸式的發展，現在已成為藥物銷售的重要支持。
The planning companies are paid to implement high-impact publication strategies for specific drugs. They target the most influential academics to act as authors, draft the articles, and ensure that these include clearly-defined branding messages and appear in the most prestigious journals.
策劃公司受雇為特效藥制定能產生高度影響力的發行策略。他們會找最有影響力的學者來掛名發文、起草文章、同時確保該文能出現在最有影響力的雜志上，旗幟鮮明的宣傳其產品。
Over the past few months I've tried to find out as much about these companies as possible. I wanted to know how big this industry is, exactly how it operates, and how people in the business think about their work. It's a nervous, opaque industry, but I did find answers to some of my questions.
過去幾個月我都忙于挖掘更多的內幕信息，他們到底有多龐大、如何運轉以及內部人員的真實想法。盡管該行業謹慎隱秘，可我最終還是找到了答案。
There are now at least 250 different companies engaged in the business of planning clinical publications for the pharmaceutical industry, according to the International Society for Medical Publication Professionals, which said it has over 1000 individual members.
至少有250家公司身處此行，為制藥工業提供臨床報告出版策劃的服務；而國際醫療出版學會（ISMPP，官網http://www.ismpp.org/index.html）有1000多名會員。
Many firms are based in the UK and the east coast of the United States in traditional "pharma" centres like Pennsylvania and New Jersey.
許多公司位于英國與美國東海岸的傳統制藥中心，如賓夕法尼亞、新澤西。
Precise figures are hard to pin down because publication planning is widely dispersed and is only beginning to be recognized as something like a discrete profession. These numbers are higher than any previous estimate, yet in truth the industry is likely to be bigger still.
由于選題策劃人員分布廣泛、離散性強，所以很難給出一個精確的在行從業數字。但數量肯定是要高于以往任何一次的估量，而且正不斷發展壯大。
In selling their services to drug companies, the agencies' explain their work in frank language. Current Medical Directions, a medical communications company based in New York, promises to create "scientific content in support of our clients' messages". A rival firm from Macclesfield, Complete HealthVizion, describes what it does as "a fusion of evidence and inspiration."
為了把服務賣給醫藥公司，這些代理公司會很直白的詮釋自我。紐約的一家醫藥通信公司Current Medical Directions承諾提供“支撐客戶需求的科學內容”。另一家來自麥克斯菲爾德的競爭對手Complete Healthvizion標語則是“數據與靈感的完美融合”。
Having talked to over a dozen publication planners I found that the standard approach to article preparation is for planners to work hand-in-glove with drug companies to create a first draft. "Key messages" laid out by the drug companies are accommodated to the extent that they can be supported by available data.
在與數十位選題策劃交流后，我發現發表論文的標準做法就是策劃人和藥物公司合伙先寫下初稿。而公司拎出來的“重要信息”最終會有理有據的呈現在文中。
Planners combine scientific information about a drug with two kinds of message that help create a "drug narrative". "Environmental" messages are intended to forge the sense of a gap in available medicine within a specific clinical field, while "product" messages show how the new drug meets this need.
通常有兩種信息有助于“描述”藥物。首先是“環境”信息：偽造某臨床領域的現有藥物存在缺陷的假象；其次就吹一下文中的“產品”可以填補這個空缺。
But the issue that dominates industry discussions is authorship.
然而主導行業言論的要素是著述者（譯注：即掛名作者）。
In a flow-chart drawn up by Eric Crown, publications manager at Merck (the company that sold the controversial painkiller Vioxx), the determination of authorship appears as the fourth stage of the article preparation procedure. That is, only after company employees have presented clinical study data, discussed the findings, finalised "tactical plans" and identified where the article should be published.
從Merck公司的發行經理Crown繪制的流程表中，可發現著述者處于論文發表程序的第四階段。前三階段分別是提供臨床研究數據，制定“戰術策略”，以及確定發文期刊。（該公司出售爭議性止痛藥Vioxx（萬絡，抗關節炎藥））
Perhaps surprisingly to the casual observer, under guidelines tightened up in recent years by the International Committee of Journal Editors (ICMJE), Crown's approach, typical among pharmaceutical companies, does not constitute ghostwriting.
在制藥公司里Crown所述的方法是非常典型的，也許旁觀者會驚訝的認為，有國際期刊編委會（ICMJE）近些年來的強力約束，該流程中不存在“代筆”。
What publication planners understand by the term is precise but it is also quite distinct from the popular interpretation.
選題策劃者對這個詞的理解與大眾的理解不同，那是相當的精確。
"We've never done ghostwriting, per se, as I'd define it", says John Romankiewicz, president of Scientific Therapeutics Information, the New Jersey firm that helped Merck promote Vioxx with a series of positive articles in medical journals. "We may have written a paper, but the people we work with have to have some input and approve it."
“確切的講，我們從不代筆”，新澤西科學療法信息公司的主席John說“也許我們寫過一兩篇文章，但寫這些文章的人還是有點料的”。這家公司曾幫助Merck公司寫了不少提升Vioxx聲譽的文章。
The industry has grown despite its prominent involvement in a succession of medical ghostwriting scandals.
事實上，與該行業的茁壯成長不可分割的，就是其深陷代筆囹圄。
In the early 2000s, court documents released through litigation over controversial drugs - such as Vioxx and the hormone replacement therapy Prempro - showed pharmaceutical companies frequently hiring medical communication agencies to ghostwrite articles and place them in influential medical journals under the "authorship" of well-known academics paid thousands of pounds for their endorsement.
早在2000年初，諸如Vioxx與激素取代療法Premo等爭議藥物的相關訴訟案公文就流之于世。其內容指出制藥公司頻繁的雇傭醫藥通信人員代筆論文，發表于頗有影響力的期刊，并向著名學者支付上千英鎊的掛名費以獲取掛名推薦權。
The ICMJE tweaks, plus a new willingness to disclose their involvement in the preparation of articles, has fostered a remarkable confidence among industry proponents.
ICMJE也有意向承認曾涉足于所謂的“流程表”中，這極大地加強了支持者對該行業的信心。
"I feel that we're doing something good for mankind in the long-run," said Kimberly Goldin, head of the International Society for Medical Publication Professionals (ISMPP). "We want to influence healthcare in a very positive, scientifically sound way."
“長久來看，我感覺我們正在做些有益人類的事情，”國際醫療出版學會ISMPP的主席Goldin說：“我們致力于在人類健康方面做出正面、科學有效的影響。”
"The profession grew out of a marketing umbrella, but has moved under the science umbrella," she said.
“這個行業成長在市場的保護傘下，卻利用科學這把保護傘掩飾了自己的不當行徑。”
But without the window of court documents to show how publication planning is being carried out today, the public simply cannot know if reforms the industry says it has made are genuine.
然而若沒有訴訟文件的公之于世，公眾很難了解到該行業是否真的實行了改革。
Dr Leemon McHenry, a medical ethicist at California State University, says nothing has changed. "They've just found more clever ways of concealing their activities. There's a whole army of hidden scribes. It's an epistemological morass where you can't trust anything."
加州大學的的醫學倫理學教授Leemon卻說一切都是扯淡。“他們只是找到了更好的途徑。要知道代筆者是成千上萬的。這是一個你無法信任的謊言。”
Alastair Matheson is a British medical writer who has worked extensively for medical communication agencies. He dismisses the planners' claims to having reformed as "bullshit".
Matheson是一名英國醫學論文寫手，已為醫療通信代理做了相當多的事情。他也認為這些所謂的改革簡直就是“扯淡”。
"The new guidelines work very nicely to permit the current system to continue as it has been", he said. "The whole thing is a big lie. They are promoting a product."
“新規定對現行系統做了相當好的傳承與發揚，”他說，“一切就是個大謊言。”
Matheson expects an article he wrote about a new cancer treatment to appear in print later this year, with an oncologist considered a "key opinion leader" (KOL) by planners listed as the author in his stead. "You'd do the same thing if you were selling cornflakes," Matheson told me. "It's no different."
Matheson希望他的新論文明年能夠發表，是有關抗癌療法的，而策劃公司圈定的一名“關鍵意見領袖(KOL)”將會掛名其上。Matheson說“這跟買脆玉米片沒什么不同，沒什么不同！”
And with the industry business model that is all about facilitating the influence of business over science thriving as it is, it's hard to see when, if ever, we will again see the thick line one likes to imagine there once was between the sale of cornflakes and the analysis of medicine. It has all become rather blurry.
事實上，這種商業影響高于科技繁榮的行業經營模式已經固化，也許我們永遠都看不到這種賣藥手段和賣玉米有什么明顯的界限了，這是一條越來越模糊的分界線。
