18 May 2005
Medical Journals Too Influenced By Pharmaceutical Marketing
by Kate Melville
Richard Smith, a former editor of the British Medical Journal, has launched a stinging attack on medical journals in an essay appearing in PLoS Medicine. "Medical journals are an extension of the marketing arm of pharmaceutical companies," said Smith. While most medical journals carry pharmaceutical advertising, this is not the focus of Smith's complaint. The much bigger problem, he believes, lies with journals publishing clinical trials funded by industry. "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. Unlike ads, readers see these trials as the highest form of evidence," said Smith.
"Fortunately from the point of view of the companies who fund these trials - but unfortunately for the credibility of the journals who publish them - these trials rarely produce results that are unfavourable to the companies' products," he said. Smith cites what he believes is evidence from 86 studies that the results of a trial are influenced by who funds it. "The evidence is strong that companies are getting the results they want, and this is especially worrying because between two thirds and three quarters of the trials published in the major journals are funded by the industry."
Smith says that journal editors are well aware that company-funded trials bring in thousands of dollars in reprint sales, and he believes this can put editors in a difficult position given that they are increasingly responsible for the bottom-line of their publications. "An editor may thus face a frighteningly stark conflict of interest: publish a trial that will bring $100,000 of profit or meet the end-of-year budget by firing an editor," said Smith.
Smith does believe the cycle of dependency between journals and drug companies be broken. "Firstly, we need more public funding of trials, particularly of large head-to-head trials of all the treatments available for treating a condition. Secondly, journals should perhaps stop publishing trials. Instead, the protocols and the results should be made available on regulated websites. Instead of publishing trials, journals could concentrate on critically describing them," he concluded.