Medical Journals, Ads And Industry Ties
5 CommentsBy Ed Silverman // September 10th, 2007 // 5:37 pm
In a rather pointed essay in Slate, Kent Sepkowitz, a New York City physician, argues that ’scientific fraud comes in several varities.’ Such as? The relationship between medical journals and advertisers. And he proposes that journals start disclosing the revenue received from a company whose drug or device is discussed, and provide detail about the number of ad pages or the amount spent to purchase reprints and supplements. He also suggests professional societies that sponsor journals disclose their dealings with manufacturers.
“Just as pharmaceuticals fund studies and pay doctors to give lectures, so too do they buy journal ads and reprints of favorable articles - lots of them. Often a drug company may find one of its products featured in a scientific article while another of its products is dolled up in a high-gloss ad a few pages later. Yet the journals keep quiet about these financial arrangements. When an article is published that shows a specific drug at great advantage, the reader may learn plenty about the author while nothing - absolutely nothing - is disclosed about the medical journal itself,” Sepkowitz writes.
“Such disclosures would take work, annoy scads of people (most of them honorable), and be completed under protest,” he continues. “But they’re worth it, to help assure the integrity of medical literature. Just as compromised relationships are unusual among researchers, they are likely, in the end, to be unusual among medical journals. But it is naive to think that only authors are influenced by who is writing the checks.”
This isn’t a new idea. One source for his inspiration was a study published last year in the British Medical Journal, which made the same argument. But the issue is whether such an approach would make a useful difference. What do you think?
Should Garino have disclosed the payments to the patient?
- Yes (91%, 102 Votes)
- No (10%, 11 Votes)
Total Voters: 112
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Atlex
With apologies to Claude Rains, “I am shocked, shocked to find that journals accept advertising for revenue.” Does anyone really believe that relatively well-educated professionals don’t know that drug companies pay for the advertising of drugs in journals?
I’d like to ask Dr. Sepkowitz, in the interest of transparency, to fully disclose his revenues by payer. I’d like to know which payers have the greatest influence on his practice of medicine.
Hank
Claude - If you haven’t read the BMJ article cited, check it out. The immediate question is not the influence on docs but the influence on journal editors.. The withdrawal of ad revenuefrom journals that publish negative studies on particular drugs in well documented. The question is, does that impact the editorial policy of those journals? That’s what requires more systematic study.
If the answer is yes, then the “influence on docs” would be the studies that are never published and thus the science they would never know.
Atlex
I think you misunderstood my comment. I’m not commenting on whether or not the ad revenues influence what does or does not appear in journals. What I am suggesting is that some “pure” commentators such as Dr. Sepkowitz find conflicts of interest with everyone else, but don’t seem to be as transparent about thier own conflicts of interest.
aids articles
aids articles…
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Paul
I think it’s an important article and I work in pharma. It’s a reality that big money has corrupted many authors and journals. It’s important to understand that just like in any industry every big marketed product will have a Marketing Plan. And in Pharma a piece of that will involve medical strategies, including new trials … and also more publications. So if you were to look in one of those plans, then right after they talk about their Professional Marketing Plan and their DTC Plan there might be the publications plan and there will be a whole laundry of things they’d like see published. And when there is nothing new to publish, the medical folks will dredge up old stuff, pull together a bunch of old data and try to get some sort of ad hoc pooled analysis published making it sound exciting and new. Sadly, it often involves a medical writing firm that drafts it and then shops it around for authors. And then once it’s written they have to shop it around to journals. If it’s not original data then obviously the higher tier journals won’t take it so they move to second and third tier journals and so on. And certainly there are journals out there which have relaxed requirements for big advertisers. There are always some standbye journals who will take some crappy piece when everyone else rejected it. And this whole process may repeat itself 10 or 20 times a year or more on a big brand. Just as our reps get intense pressure to sell, so to do our medical folks get pressure to get stuff published. And when it’s a mature product without a lot of interesting new data, that’s a feat. So I like the article but I think the problem is deeper and will require a broader set of repairs.
1. We need to do more across the board to eliminate ghost-writing. Medical authors should be invovled in reviewing the data, reaching conclusions and drafting the piece at every phase. The practice is far more common then anyone cares to acknowledge.
2. We need to do more about transparency of relationships from authors and journals. I look at the disclosures sometime and they are a joke. You could have an author who serves as a speaker for a company, has served as a consultant for the company and has acted as a principal investigator, all told on magnitudes of $100’s of thousands of dollars a year and the discloure might read “Dr. _____ has served as a consultant for _____.” This could be a doctor working with a particular marketing team on a host of projects, and the disclosure does not in any way provide that kind of insight.
3. We need some organization to really look at all the journals and categorize them according to the integrity of their authorship requirements, editorial vigor and transparency. I have no objection to there being slip-shod journals, but we should be doing more to let people know what they are getting.
4. And sadly we need stronger FDA that will do some research to look for situations where companies are using an aggressive Publications Plan to get off-label data out to physicians and maybe even consumers. It’s not real difficult. You take a big product, then you look at some of the clinical studies done in off-label areas, then you google the names of the studies. In some cases you can be amazed at what you find. Now some of that will be legitimate and IMPORTANT scientific exchange. But the volume of things you find is often alarming, and you will find all sorts of articles and slide decks and mini-CME programs often written or hosted by physicians who serve as speakers for the pharma company who funded the study.
It is clear that some journals and medical societies have been taking steps to restore credibility, but I can promise you there is a long way to go.
As a starting place, readers of all sorts need to start looking closer at the disclosures. You will find whole websites that look like a medical society, then you will see the entire website is funded by a few sometimes only one pharma company, then you will read the author disclosures of the pieces on the same site and you may see the same company . . . you sart to see a picture. It’s the same with journals. The ties can be far-flung but more and more there are disclosures and people need to read all of them to even start to get a sense of how much integrity the piece or program might have.
I wish this wasn’t the case. There are many many great people in big pharma who try to move all of this in a better direction, but when you have multi-billion dollar products like Lipitor, Plavix, Ambien, Actos etc. the pressure on individuals is just intense.