1 April 1991
A panel of medical writers explained how pharmaceutical companies pay them $300 to $700 a day ghostwriting articles bylined by doctors and published in "throwaway" medical publications.
They also explained how they did it, and how they broke in, with nothing more than intelligence, writing skill, and the ability to understand scientific subjects, but without scientific degrees.
One effective strategy is to start out by writing freelance journalism for the low-paid tabloids, use that to get expertise on pharmaceutical subjects, and use your clips to market yourself to the PR agencies.
Larry Husten, Laurie Lewis, and Joan Reisman comprised the panel, "Ghost Writers in the Sky, or Salvation through Writing for Docs," moderated by Walter Alexander, on 15 January 1991 at the Medical Writers Affinity Group of the Editorial Freelancers Association.
A typical job, explained Husten, would be 2,000 words on the topic of "How to choose a thrombolytic agent" for a publication like Primary Cardiology, Family Practice, Diagnosis, or Cardio. It would be based on 20 to 25 references, and a half-hour phone interview with the doctor bylining the article. It might or might not include citations. The writer might or might not be responsible for the library research or the figures and charts. It would take a week and pay typically $2,000, with a range of $1,200-2,500.
"I pride myself on being expensive," said Reisman, who charges $700 a day--a top rate. Reisman can get it because she has contacts and experience from major PR firms, and a specialty in cardiology drugs. Others charge $60-75 an hour.
But Lewis is a bargain at $40-50 an hour. And when she works for a doctor, rather than for a PR agency or pharmaceutical house, she might charge as little as $30 an hour.
The rates are high, and the market is strong. The panel passed around a Wall Street Journal story, "Budget Cuts at Agencies Mean Free-Lancers Face Lean Times," by Joann S. Lublin, Jan. 2, 1991. "That hasn't been my experience," said one writer. "Nor mine," said another. Freelancers in fields like business and finance do report slacking demand, however.
What's the catch? The ethical problems that come up when the pharmaceutical company insists that you slant the article to favor their product. Can you follow your conscience--nullius in verba, as they say? The writers who do this work say that they can usually convince the client that a more objective article would have more credibility. But some journalists said that they avoid PR, because they would have to compromise too much.
Husten stumbled into medical publishing 8 years ago as a freelance proofreader. He got his experience writing news stories for low-paid medical tabloids like the McMahon Group, which pay about $100 for a quick rewrite of a medical journal article and an interview with the doctor.
Like many of these writers, Husten broke into this work by direct mail marketing. He had friends who knew key people in PR agencies, and sent out an initial mailing of 50-60 letters. Most of them didn't respond. "I only got one or two replies--but they were great clients," he said.
Alexander got 25 names from O'Dwyer's PR Directory in the library, with similar results.
Reisman described how she worked. "I almost never have any contact with the doctor," she said. "They provide me with a pile of data so I don't have to do any research. They tell me what points they want to make in the article." She takes the data home and translates it into an article.
"I don't understand much of the statistics," said Lewis, "but I do know what's important and what I need to question." Sometimes she will prepare tables for review and completion by the statistician.
A review article, said Alexander, would involve reading 30 or 40 journal articles, and coming up with a point of view to suggest to the doctor. "Many of these review articles are pasteups of other articles," he noted. "There's about one new article a year," said Husten.
"You have to know your target publication," said Lewis. For example, requirements differ for footnotes. "If you're doing an 8-page newsletter, you don't have the room. But if you're writing an article which is called a review article, you'd better reference everything." And if you have contact with the author, find out what the author is comfortable with, she said.
Dealing with the doc. Dealing with the doctor is an important skill. "If you do an article for American Health, they take it or not, and it's a very simple relationship," said Husten. "Here, you have to deal with the doctor, the publication, and the pharmaceutical company that hired you. You have to balance all that and make them happy. And know that you can live with it."
Doctors will often spend lots of time with journalists, but PR jobs are different. "Very often they're being done this way because the doctor doesn't want to spend the time," said Reisman. "So if you come up with hours of interviews and thousands of questions the doctor is likely to come back and say, 'You people are driving me crazy and I don't want to deal with you any more.'" Often a tape recorder is appropriate.
Another problem is doctors who can't admit that they can't write. There is the doctor who was "frightened by his 8th grade English teacher who told him that every noun has to have 3 adjectives," said Lewis. These issues can be negotiated. "But if they insist on keeping control, just give them control."
Richard Bergman suggested a solution from the audience. "If the doctor insists on doing it all himself, I say, 'Fine, send it in. When will you send it to me?'" He can hear them flipping through their calendars over the phone, and when they realize how much work it is, they give in.
"I never let not knowing the material stop me," said Reisman. More important is cutting through to the essential points that the agency is trying to get across.
"After a while you get to be very efficient with learning the code," said Bergman. "Every topic has an inherent logic, and you have to find it."
Doctors respect you when you've at least learned the basic terminology, said Alexander. You can get around being ignorant, but you can't get away with refusing to admit your ignorance. Husten's humble approach is, "You know I'm not a doctor."
"You also have to know when to cut bait," said Bergman. "When a doctor is truly impossible to work with. "
Work is bid on a project basis. "You have got to be able to estimate," said Husten. Most people estimate by comparing the proposed job to work they've done in the past.
"There is the possibility of suffering," and the possibility of doing very well, said Husten. A friend took a job for $2,000, thinking it would take a week, "and it winds up taking them a month, and they're crying."
"I have earned as much as $100 an hour on a project rate," said Lewis. However, one job several years ago worked out to only $16 an hour.
"I tell them it's going to cost them so much based on $700 a day," said Reisman. "If I can do it in a quarter of the time, I'm going to dance around my living room." A lot of times she does the work in half her estimated time, but it doesn't matter to the client. Like many writers who work on a project basis, Reisman argues that she works faster than other people, and the benefit of her efficiency should accrue to the writer, not to the client. "However, sometimes it takes me twice as long as my estimate, and then I use that as a hard lesson for pricing future jobs," she said.
In the standard arrangement, Reisman offers one revision of her work. "Revision" means revising it to the original specifications. If the client decides he wants it done another way, that's a new job, not a revision. The revision has to be done "within a short time after I turn it in," said Reisman. It's much more difficult to revise something 6 months after you've finished the job and forgotten it.
Bergman himself had just done that. He asked the panel for an estimate: A monograph, 16 printed pages, from a verbatim transcript of a presentation and photocopies of the slides, with responsibility for verifying every reference in every article.
$10,000, the panel agreed. "It's a huge project," said Husten, although he found it very easy to work from a meeting presentation with slides.
Generally, you can work faster, and make more money, in a field that you've covered before, but there are times when a writer will take on a job that will pay less. Alexander noted that he just took on a project involving arterial wall metabolism. He had to invest more time into it, because he wasn't familiar with it, but this is where the research is going, and he gambled that he would be positioning himself well in the long run.
Ghosting directly for doctors, nurses and other medical professionals, for scholarly articles, theses and books, is much more pleasant, most people agreed, but it pays less, and there is less work. Doctors are often shocked at pharmaceutical company rates, and $30-$50 is about as much as they are willing to pay.
nullius addictus iurare in verba magistri,
quo me cumque rapit tempestas, deferor hospes
(Epistles I.i 14-15)
(My words are not owned by any master,
where the winds [of reason] lead me, there I find home.)
By this they mean that writers should be free to follow the scientific evidence and state the truth. Is it possible to write PR and still write nullius in verba? Opinions differ. What do you do if the client wants you to slant the truth?
Alexander recently found himself with a PR agency that wanted him to write a piece in a way that would claim advantages for their drug that it didn't have. He knew from his reporting that the bylined doctor wouldn't go along with it, so he persuaded the agency to make the article more balanced. Generally, though, the PR agency knows what the doctors are going to say before they get them to write the article.
Another writer described a job interview she had with a PR firm. "You come from a reporter background," the interviewer said.
"She kept hinting, but I made her come out and say it," said the writer. Finally the interviewer came out and said it: "Would you mind highlighting the favorable opinion?" The writer did mind, and didn't take the job.