Monday, March 17, 2008

Who's Bankrolling Your "Trusted" Medical Journals?

Note: This is a guest post from Susan Jacobs (see byline at bottom of post)

It is easy to point our fingers at greedy pharmaceutical companies when it comes to the rising costs of our prescription meds. However, the average citizen probably isn't aware of just how much these companies control our lives.

A perfect example of this control can be found on every other page in a leading medical journal. I'm speaking, of course, about the copious amounts of ad space.

It is easy for people to presume that the scientific evidence presented in various medical journals is based on unbiased information. Nothing could be further from the truth, unfortunately. Just as a network television channel strives to please their sponsors at the expense of a program's content, a medical journal that is filled with ads will always be at the mercy of its financial backers.

In his article "Under the Influence: Drug Companies, Medical Journals, and Money," Kent Sepkowitz writes:

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.

So, just how much money is the integrity of a medical journal (not to mention, the mental and physical well-being of its readers) worth a year? According to The Social Policy Research Institute, the New England Journal of Medicine receives approximately $18 million a year from pharmaceutical companies, while JAMA, the Journal of the American Medical Association receives around $27 million.

It was the New England Journal of Medicine that brought the most attention to this problem in recent years, after publishing a favorable study of the "safe" drug, Vioxx. Of course, we now know just how wrong they were. (It is worth noting that 2 of the 13 people involved with that study were actually employees of Merck.)

When Boston Magazine's Karen Donovan questioned the Journal's editor about the Vioxx scandal, he replied, “I am not a person who wants to make more rules. I just want people to behave.” It is particularly frightening to think that this increasingly corrupt industry is being held to an honor system of sorts, particularly one that is so indelibly damaged.


Susan Jacobs is a teacher, a freelance writer as well as a regular contributor for NOEDb, a site helping students obtain an online nursing degree. Susan invites your questions, comments and freelancing job inquiries at her email address

If you have feedback for Susan, please post a comment and/or send her an email.

1 comment:

Anonymous said...

The Human Injury of Lost Objectivity

If I were to rate the corruptive tactics performed by big pharmaceutical companies, the intentional corruption of implementing fabricated and unreliable results of clinical trials would be at the top of the list. Pharmaceutical companies manipulate the trials they sponsor because of their power to control others involved in the process largely absent of regulation. This is a matter of requiring authenticity and, more importantly, assuring the safety of the public health.

Decades ago, clinical trials were conducted in academic settings that focused on the acquisition of knowledge and the completely objective discovery of novel medicine. Then, in 1980, the Bayh-Dole Act was created, which allowed for such places to profit off of their discoveries that were performed for pharmaceutical companies in the past. This resulted in the creation of for-profit sites, called Contract Research Organizations (CROs), which are composed of community research sites with questionable investigators void of necessary experience or quality regarding their research purpose and ability. Since they are for-profit, the trials conducted at CROs are sponsored by pharmaceutical companies that control and manipulate all aspects of the trial. This coercion is done by various methods of deception in subtle and tacit methods. As a result, research in this manner has been transformed into a method of marketing, which includes altered results of the trial to favor the sponsor’s medication. Their activities are absent of true or applied regulation, and therefore have the autonomy to create whatever they want to benefit the collusive relationship between the site and the sponsor.

Further disturbing is that once the trials are completed, the medical articles are then written by ghostwriters, who are not identified and acknowledged by the sponsor, and are not trained in clinical research overall, as they are simply freelance writers. How often ghostwriters are utilized by pharmaceutical companies remains a mystery. This activity removes accountability and authenticity of the fabricated clinical trial even further. The corruptive act is finally completed by the sponsor hiring an author to be placed on the trial that likely had no involvement with the trial, and, along with others, was paid by the sponsor. To have the trial published, the sponsor pays a journal, along with the promise of purchasing thousands of reprints of the study from the journal. Again, how often this process is performed is unknown, yet frequent enough to create hundreds of such false writers and research sites to support the industry. So benefits of medicine studied in such a malicious way can potentially harm patients and their treatment options. The purchased reprints are distributed to the sponsor’s sales force to share the content with prescribers — your doctor.

Such misconduct impedes research and the scientific method with frightening ethical and harmful concerns. Our health care treatment with medications is now undetermined in large part in such situations, as well as the objectivity that has been intentionally eliminated regarding the trust in the scientific method in this type of activity illustrated in this article. More now than ever, meds that are removed from the market are given black box warnings. Now I understand why this is occurring.

The pharmaceutical industry needs transparency and disclosure in order to correct what we have historically relied upon for conclusive proof — the scientific method. More importantly, research should not be conducted in a manner that the sponsor can interfere in the ways I described in this article. We should call for independent sites with absolutely no involvement with the drug maker. And clearly, regulation has to be enforced not selectively, but in a complete fashion. Public awareness would be a catalyst for this to occur, after initially experiencing a state of total disbelief that such operations actually are conducted by such people, of course. We can no longer be dependent on others for our optimal health. Knowledge is power, and is also possibly a lifesaver.

Ethics and Science need to shake hands.
– Richard Cabot

Dan Abshear