The Elsevier fake journal scandal is expanding in two directions. First, it's now "fake journals", plural. Elsevier has admitted to publishing six of these things:

• Australasian Journal of General Practice
• Australasian Journal of Neurology
• Australasian Journal of Cardiology
• Australasian Journal of Clinical Pharmacy
• Australasian Journal of Cardiovascular Medicine
• Australasian Journal of Bone & Joint Medicine

Only one, Bone & Joint Medicine, is on the list I posted yesterday of Excerpta Medica "Australasian journal of..." titles from WorldCat. That leaves thirteen titles in the same series, none of which are listed in PubMed, Science Direct, Ulrich's or (thanks to Peter Murray, see comments on that post) Scopus. Jonathan Rochkind has pointed out how to find the rest of their titles in WorldCat; there are around 50 all told.

That's the tip; I await the rest of the iceberg.

The second direction in which the scandal is expanding is towards ghostwriting: I think probably Laika was the first person to make this connection clear. This is a separate but related issue, and Excerpta Medica appears to be up to their armpits in this sleazy practice as well. There's quite a large literature on ghostwriting, so here are just a few quotes (mentioning Excerpta Medica) to whet your appetite (if indeed one could be said to have an 'appetite' for something so nauseating):

Anna Wilde Mathews, At medical journals, paid writers play big role

When articles are ghostwritten by someone paid by a company, the big question is whether the article gets slanted. That's what one former free-lance medical writer alleges she was told to do by a company hired by Johnson & Johnson.

Susanna Dodgson, who holds a doctorate in physiology, says she was hired in 2002 by Excerpta Medica, the Elsevier medical-communications firm, to write an article about J&J's anemia drug Eprex. A J&J unit had sponsored a study measuring whether Eprex patients could do well taking the drug only once a week. The company was facing competition from a rival drug sold by Amgen Inc. that could be given once a week or less.

Dr. Dodgson says she was given an instruction sheet directing her to emphasize the "main message of the study" -- that 79.3 percent of people with anemia had done well on a once-a-week Eprex dose. In fact, only 63.2 percent of patients responded well as defined by the original study protocol, according to a report she was provided. That report said the study's goal "could not be reached." Both the instruction sheet and the report were viewed by The Wall Street Journal. The higher figure Dr. Dodgson was asked to highlight used a broader definition of success and excluded patients who dropped out of the trial or didn't adhere to all its rules. The instructions noted that some patients on large doses didn't seem to do well with the once-weekly administration but warned that this point "has not been discussed with marketing and is not definitive!"

The Eprex study appeared last year in the journal Clinical Nephrology, highlighting the 79.3 percent figure without mentioning the lower one. The article didn't acknowledge Dr. Dodgson or Excerpta Medica. Dr. Dodgson, who now teaches medical writing at the University of the Sciences in Philadelphia, says she didn't like the Eprex assignment "but I had to earn a living."

The listed lead author, Paul Barre of McGill University in Montreal, says Excerpta Medica did "a lot of the scutwork" but he had "complete freedom" to change its drafts. Dr. Barre says he helped design the study and enroll patients in it. In statements, J&J and Excerpta Medica offered similar explanations of the process. J&J says it regularly uses outside firms "to expedite the development of independent, peer-reviewed publications."

Carl Elliott, Pharma goes to the laundry: public relations and the business of medical education

One of the most ingenious pieces of the Fen-Phen public relations strategy was its ghostwriting scheme. In 1996 Wyeth hired Excerpta Medica Inc, a New Jersey-based medical communications firm, to write ten articles for medical journals promoting obesity treatment. Wyeth paid Excerpta Medica $20,000 per article. In turn, Excerpta Medica paid prominent university researchers $1,000 to $1,500 to edit drafts of their articles and put their names on the published product. Wyeth kept each article under tight control, scrubbing drafts of any material that could damage sales. One draft article included sentences that read: "Individual case reports also suggest a link between dexfenfluramine and primary pulmonary hypertension." Wyeth had Excerpta delete it. (21)

What made Excerpta Medica such an inspired choice is that it is a branch of the academic publisher, Reed Elsevier Plc., which publishes many of the world's most prestigious science journals. Excerpta Medica manages two journals itself: Clinical Therapeutics and Current Therapeutic Research. According to court documents, Excerpta Medica planned to submit most of the articles it produced to Elsevier journals. In the actual event, Excerpta managed to publish only two articles before Fen-Phen was withdrawn from the market in 1997. One appeared in Clinical Therapeutics, the other in the American Journal of Medicine (another Elsevier journal). In neither case did the authors of the articles disclose that they were paid by Excerpta Medica. So clean was the laundering operation, in fact, that many of the authors did not even realize that Wyeth was involved. Richard Atkinson of the University of Wisconsin wrote a letter to Excerpta Medica congratulating them on the thoroughness and clarity of their article. "Perhaps I can get you to write all my papers for me!" he wrote. He did have one reservation about the piece he was signing: "My only general comment is that this piece may make dexfenfluramine sound better than it really is." (22)

Sergio Sismondo, Ghost Management: How Much of the Medical Literature Is Shaped Behind the Scenes by the Pharmaceutical Industry?

Several of the publication planning firms identified are owned by major publishing houses. For example, Excerpta Medica is "an Elsevier business" and writes that its "relationship with Elsevier allows... access to editors and editorial boards who provide professional advice and deep opinion leader networks" [40]. Wolters Kluwer Health draws attention to its publisher Lippincott Williams & Wilkins, with "nearly 275 periodicals and 1,500 books in more than 100 disciplines," and to Ovid and its other medical information providers, emphasizing the links it can make between its different arms [41]. Vertical integration is attractive in the industry as a whole: at least three of the world's largest advertising agencies own not only MECCs, but also CROs [contract research organizations] [13].