Medical journals: “information-laundering for Big Pharma”?

Whenever you read a medical journal article with a title like Medical Journals Are an Extension of the Marketing Arm of Pharmaceutical Companies, you know it’s a bad day for patients.

As a heart attack survivor who spends way too much of my time hanging out with cardiologists, pain specialists and other doctors who read these journals, I especially hate seeing this article written by a person like Dr. Robert Smith, who was himself the editor of the British Medical Journal for 25 years.*

Dr. Smith’s not alone. Consider Dr. Richard Horton of the medical journal, Lancet, who once wrote:

“Journals have devolved into information-laundering operations for the pharmaceutical industry.”

Or how about this frank observation from Dr. Marcia Angell:

It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines.

“I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.”

Dr. Jerome Kassirer, another former editor of the New England Journal of Medicine, argues in his book, On The Take: How Medicine’s Complicity with Big Business Can Endanger Your Health:

“The industry has deflected the moral compasses of many physicians”.

Harriet Washington is not a medical journal editor, but she is a medical ethicist and author of Deadly Monopolies: The Shocking Corporate Takeover of Life Itself – And the Consequences for Our Health and Our Medical Future.  She published a highly recommended American Scholar article last summer about a particularly alarming scandal in the world of medical journal publishing:

“In 2003, Elsevier, the Dutch publisher of both The Lancet and Gray’s Anatomy, sullied its pristine reputation by publishing an entire sham medical journal devoted solely to promoting Merck drugs.

“Elsevier publishes 2,000 scientific journals and 20,000 book-length works, but its Australasian Journal of Bone and Joint Medicine, which looks just like a medical journal, and was described as such, was not a peer-reviewed medical journal but rather a collection of reprinted articles that Merck paid Elsevier to publish.

“At least some of the articles were ghostwritten, and all lavished unalloyed praise on Merck drugs, such as its troubled painkiller Vioxx. There was no disclosure of Merck’s sponsorship. Librarian and analyst Jonathan Rochkind found five similar mock journals, also paid for by Merck and touted as genuine.

“The ersatz journals are still being printed and circulated, according to Rochkind, and 50 more Elsevier journals appear to be Big Pharma advertisements passed off as medical publications.”

How much more slimy can Big Pharma marketing possibly get? And how has industry managed to succeed at deflecting the “moral compass” of so many doctors, as Dr. Kessirer accuses?

The journal editors themselves are hardly lily-white when it comes to supporting marketing-based medicine. Here’s an example:

Medical journals accept up to $500 million worth of full-page drug ads placed by Big Pharma every year. In some cases, as Harriet Washington points out, pharmaceutical advertising can provide between 97 and 99 percent of advertising revenue for medical journals.

And Dr. Smith adds that many drug makers “agree to buy journal advertising only if it is accompanied by favorable editorial mentions of their products.”

According to a study published last April in the Journal of the American Medical Association, the drug giant Merck hired medical ghostwriters who drafted dozens of flattering ‘research’ studies for their now-discredited and deadly pain drug Vioxx. Next, they  lined up well-known doctors who agreed to fraudulently claim to be the actual authors for submission to journals.

The prestigious New England Journal of Medicine then sold 929,400 reprints of a single Vioxx-friendly ‘research’ article they’d published  – mostly sold directly to the drug’s own manufacturer Merck.  Merck’s sales reps distributed these reprints to physicians on their daily call routes as part of the aggressive Vioxx sales pitch.

Reprint orders from this one ghostwritten Vioxx article brought in more than $697,000 in revenue for the NEJM.  Medical journal editors who don’t want to bite the Big Pharma hand that feeds them evidently learn to hold their noses and accept this.

As Harriet Washington adds:

“Despite the ubiquitous mantra of ‘evidence-based medicine, a curious lack of skepticism pervades journals about experts who accept money from the makers of the products they evaluate.”

Dr. Angell also has a uniquely informed broader perspective on what’s now become known as “marketing-based medicine”:

“No one knows the total amount provided by drug companies to physicians, but I estimate from the annual reports of the top nine U.S.-based drug companies that it comes to tens of billions of dollars a year in North America alone.

“By such means, the pharmaceutical industry has gained enormous control over how doctors evaluate and use its own products. Its extensive ties to physicians, particularly senior faculty at prestigious medical schools, affect the results of research, the way medicine is practiced, and even the definition of what constitutes a disease.”

As I’ve written here previously, revelations like this from medical profession insiders cast disturbing doubt on more than what’s printed on the pages of medical journals.

The sad reality is that medical journals are to a large extent financially dependent on Big Pharma.

Here’s how what medical journals report can actually affect you and me and the way our health care is impacted. For example, take the 2011 Essential Journal Study.

This is an independent study issued annually from the research organization, Matalia Group, Inc., commissioned by The New England Journal of Medicine in order to better understand their readership. Matalia researchers survey physicians in 12 medical specialties each year in order to find out what journals physicians consider essential to their daily practice.

As the report explains, physicians rely on a limited number of “must-read” journals:

“An essential journal is one that reports medical breakthroughs and has practice-changing impact. Physicians consider it essential to their practice. They spend significant time reading these journals, read them soon after receiving them, and are highly likely to re-read them.”

Because I’m particularly interested in how cardiologists use medical journals, let’s look at this study’s Top Ten Essential Journals in Cardiology:

  1. Journal of the American College of Cardiology (read by 78%)
  2. The New England Journal of Medicine (61)
  3. Circulation (30)
  4. Journal of the American Medical Association (18)
  5. American Journal of Cardiology (15)
  6. Annals of Internal Medicine (6)
  7. Journal of the American Society of Echocardiography (6)
  8. Heart Rhythm (5)
  9. Mayo Clinic Proceedings (4)
  10. Medical Economics (4)

What is striking about this list is that half of the journals here are not specifically cardiology journals.  Well, that, and also that the journal Medical Economics (a business resource for physicians covering issues like liability, business operations, personal finances and risk management) was new to the Top 10 list last year.

Not surprisingly, more cardiologists spend more time reading each issue of the heart journals on their essential list. For example, 24% of those surveyed spend >46 minutes reading the Journal of the American College of Cardiology compared to 12%  who spend the same amount of time reading the New England Journal of Medicine and 3% for the Journal of the American Medical Association.

Cardiologists also tend to read their essential journals sooner than other specialists do: 35% read the Journal of the American College of Cardiology and 41% read Circulation within three days of receiving it.

Cardiologists apparently re-read essential journals more often as well:  11% report that they re-read both the Journal of the American College of Cardiology and the New England Journal of Medicine three times or more.

But here’s the part of the Essential Journal Study that should stop patients cold – especially after you’ve just read what journal editors themselves openly admit about medical journals being essentially just an extension of Big Pharma marketing:

“Cardiologists use content from essential journals for clinical decisions.”

The percentage of cardiologists who report that they “always” or “often” use content from each issue when making clinical decisions about patient care is a whopping 61% for the Journal of the American College of Cardiology, 57% for Circulation, and 39% for the New England Journal of Medicine.

What does this mean? It means that physicians read medical journals, treatment decisions are changed, care is affected, drugs are prescribed, medical practice altered – all based on Big Pharma-funded, insider-prepared journal articles that the journal editors themselves describe as “information-laundering operations for the pharmaceutical industry“.

Then we walk out of our doctor’s office with a prescription for a drug or recommendation for a medical procedure that may or may not help/hurt us,  based on treatment protocols written by doctors who are likely on the take from industry.

Shame on you, doctors.

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* Smith R (2005) Medical Journals Are an Extension of the Marketing Arm of Pharmaceutical Companies. PLoS Med 2(5): e138. doi:10.1371/journal.pmed.0020138

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4 thoughts on “Medical journals: “information-laundering for Big Pharma”?

  1. Thanks for continuing to draw people’s attention to this problem. One point I like to make is that the device industry, particularly for surgery, but also for interventionists (stenters etc) is just as bad as the pharmaceutical industry, if not worse, and it often flies under the radar.

    Surgeons have their conference fees and flights paid for by companies (nominally by asking everyone who attends to speak for 5 minutes, therefore making them faculty). Device manufacturers now run many of the workshops, and the focus of surgical education is on what device to use and how, with very little discussion of non-operative alternatives.

    Not to mention royalties, speakers fees, research funding, fellowship sponsorships, meeting sponsorships, educational dinners, promotional material, ‘badged’ patient information brochures etc.

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    • Excellent point about device makers. I’ve written about orthopedic surgeons here and about neurosurgeons here. And lots about stent-happy cardiologists of course . . . Thanks for your perspective.

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  2. Carolyn, have you investigated as to whether there’s any remotely viable means to get these articles – by you and cited by you – out to physicians? That must be impossible, from a money standpoint, for starters, but I had to ask anyway.

    I think about sharing them with my own physicians but amazingly, the first thought that comes to mine is “What will that do to my relationship with that doctor?” If there were only a way to have them mass delivered……

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    • Hi Bev – everything here is in the public domain and easily accessible to all physicians! When former journal editors themselves start publishing these facts in other journals, it’s all right out there for all to read.

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