Medical Journals - welcome to the marketing department of Big Pharma
Posted Aug 09 2013 7:01am
A number of medical editors from journals such as The BMJ, PLOS Medicine and The Lancet (of GSK fame) are all effectively saying the same thing and that is that pharmaceutical companies are using their considerable wealth to influence what is and what is not published. This can be done in a number of ways, the most obvious being the advertising revenue, but advertising is probably a red herring to distract from other less transparent activities.
The Lancet's Richard Horton back in 2004 said, "“Journals have devolved into information laundering operations for the pharmaceutical industry”.
The New England Journal of Medicine's Marcia Angell, said that pharmaceutical companies used journals, “primarily as a marketing machine” and co-opting “every institution that might stand in its way”
BMJ Group's Richard Smith says, "Medical journals are an extension of the marketing arm of pharmaceutical articles".
Another former editor of The New England Journal of Medicine, Jerry Kassirer says that the industry has deflected the moral compasses of many physicians, and the editors of PLoS Medicine have declared that they will not become “part of the cycle of dependency…between journals and the pharmaceutical industry”.
According to an essay published in PLOS Medicine by former BMJ editor Richard Smith, "Something is clearly up".
He says, "The most conspicuous example of medical journals' dependence on the pharmaceutical industry is the substantial income from advertising, but this is, I suggest, the least corrupting form of dependence. The advertisements may often be misleading and the profits worth millions, but the advertisements are there for all to see and criticise. Doctors may not be as uninfluenced by the advertisements as they would like to believe, but in every sphere, the public is used to discounting the claims of advertisers".
Richard Smith argues that the big problem lies with the original studies, particularly the clinical trials, published by journals. A large trial published in a major journal has the journal's stamp of approval (unlike the advertising), will be distributed around the world, and may well receive global media coverage, particularly if promoted simultaneously by press releases from both the journal and the expensive public-relations firm hired by the pharmaceutical company that sponsored the trial. For a drug company, a favourable trial is worth thousands of pages of advertising, which is why a company will sometimes spend upwards of a million dollars on reprints of the trial for worldwide distribution. The doctors receiving the reprints may not read them, but they will be impressed by the name of the journal from which they come. The quality of the journal will bless the quality of the drug.
He says, "these trials rarely produce results that are unfavourable to the companies' product. The editor then goes on to describe the methods used by pharma to get the results they want from clinical trials: These are as follows:
Conduct a trial of your drug against a treatment known to be inferior.
Trial your drugs against too low a dose of a competitor drug.
Conduct a trial of your drug against too high a dose of a competitor drug (making your drug seem less toxic).
Conduct trials that are too small to show differences from competitor drugs.
Use multiple endpoints in the trial and select for publication those that give favourable results.
Do multicentre trials and select for publication results from centres that are favourable.
Conduct subgroup analyses and select for publication those that are favourable.
Present results that are most likely to impressfor example, reduction in relative rather than absolute risk.
He who pays the piper calls the tune.
Journals more profitable than oilwells
In a more recent article for BMJ Group, Richard Smith says that, "journals are considerably more profitable than oilwells". Richard shares his own experience of running scientific journals and produces a profit and loss statement for the 'average journal'. He points out that obtaining this sort of information on specific titles can be difficult, and he is therefore calling for greater transparency from all publishers especially for The New England Journal of Medicine. He says, "the Massachusetts Medical Society has grown fatOne of the three main food constituents (with carbohydrate and protein), and the main form in which energy is stored in the body. and has an expenditure per member way above any other state medical society."