Journals are a `marketing tool'

Pharma companies use medical journals as a marketing channel

Medical journals are nothing more than an extension of pharmaceutical companies' marketing activities, according to former editor of the British Medical Journal (BMJ) for some 13 years, Dr Richard Smith.

The today CEO of UnitedHealth Europe, Dr Smith said that journals were undermined by relying on pharma-funded clinical trials and industry advertising.

Writing in Public Library of Science he said that advertising was the most conspicuous example of medical journals' reliance on the pharmaceutical industry, yet `the least corrupting form of dependence'.

`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 the advertiser.'

A much bigger problem, according to Dr Smith, lies in industry-funded clinical trials published by journals.

`For a drug company, a favourable trial is worth thousands of pages of advertising, which is why a company will sometimes spend upwards of $1m on reprints of the trial for worldwide distribution,' he stated.

His argument is that company-backed trials seldom, if ever, produce unfavourable results and that this calls into question the credibility of the publishing journal.

There is little wrong with the technical quality of the studies carried out, Dr Smith noted, pointing to a systematic review conducted in 2003 which found that trials funded by the industry are as good as, if not better than, those funded from other sources. However, he criticised the way in which the results are presented.

Pharma gets the outputs it wants `not by fiddling the results, which would be far too crude and possibly detectable by peer-review, but rather by asking the ìrightî questionsÖ' he asserted, adding that there are many ways to achieve this.

In his essay, Smith talks of the numerous publishing strategies at pharma companies' disposal to ensure the maximum exposure of positive results, and makes more than a passing reference to the pressure that is applied to editors to publish positive outcomes; not so much by industry, as was the claim in the Health Select Committee inquiry, but by a need to gain greater profits.

`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.'

While Dr Smith believes that increased publishing of randomised trials - `a superior form of evidence' - would alleviate some of the dependency issues, a fundamental change is what is required. He suggests that there should be more public funding of trials, in particular large head-to-head studies and asks whether journals should continue publishing trial data.

`Nonsense details'

Separately, editor-in-chief of the New England Journal of Medicine, Dr Jeffrey Drazen, said that pharmaceutical companies' efforts to have their studies published in leading medical publications could be hindered by a reluctance to provide sufficient meaningful information about their trials on a government clinical trial registry.

Indeed late last year, a number of top journal editors made a stand that they would not publish any studies that are not registered in a public database at the time of launch. The International Committee of Medical Journal Editors (ICMJE) have called for 20 points of useful information to be made available by companies, including the main aims of a trial, the number of patients recruited and the source of funding for the study.

Drazen's opinions were based around a review by Dr Deborah Zarin, of the National Institutes of Health (NIH), who was asked by the ICMJE to look at information posted on www.clinicaltrials.gov by Pfizer, Merck & Co and Lilly.

ìThey are trying to hide what they are doing,î Drazen noted in an interview. ìThey are giving nonsense details.î

The firms that responded to his comments made clear their difference of opinion, noting that the information was accurate and worked to enhanced transparency.