Major Medical Journals Lead Us Astray by Publishing Studies Designed to Help Sell Product for the Drug Company
Today, Richard Smith is Chief Executive of UnitedHealth Europe, in London. Previously, Mr. Smith was an editor for the British Medical Journal ("BMJ") for 25 years, serving 13 years as the lead editor and chief executive of the BMJ Publishing Group. He stopped working for the BMJ in July 2004.
Given his experience, Mr. Smith is well-qualified to give the speech he did at the Medical Society of London in October 2004 when receiving the HealthWatch Award for 2004. That provocative speech lead to a subsequent article, entitled "Medical Journals Are an Extension of the Marketing Arm of Pharmaceutical Companies", which appeared in the May 17, 2005 edition of PLoS Medicine.
To put things into context for us, Mr. Smith starts by providing some recent remarks:
Journals have devolved into information laundering operations for the pharmaceutical industry”, wrote Richard Horton, editor of the Lancet, in March 2004. In the same year, Marcia Angell, former editor of the New England Journal of Medicine, lambasted the industry for becoming “primarily a marketing machine” and co-opting “every institution that might stand in its way”. Medical journals were conspicuously absent from her list of co-opted institutions, but she and Horton are not the only editors who have become increasingly queasy about the power and influence of the industry. Jerry Kassirer, another former editor of the New England Journal of Medicine, argues that the industry has deflected the moral compasses of many physicians....
The essence of Mr. Smith's article is that "artificial" drug-safety studies sponsored by the pharmaceutical companies is the primary evil which confronts doctors and patients in this age of so-called "blockbuster" prescription drug products. Mr. Smith seems rather confident that doctors and patients, as prescribers and consumers, can deflect the influence that the drug companies push on us by way of their multi-million dollar advertising campaigns. What concerns this former medical journal editor more is the seemingly sinister (mis-) use of medical journals when a drug company gets a sponsored, i.e., "their", clinical study report published in the likes of the Annals of Internal Medicine, the Journal of the American Medical Society ("JAMA"), the Lancet, and the New England Journal of Medicine.
Mr. Smith reveals that "between two-thirds and three-quarters of the trials published in the major journals -- Annals of Internal Medicine, JAMA, Lancet, and New England Journal of Medicine -- are funded by the industry." In his article, Mr. Smith shows how the drug companies arrange their clinical studies to get the efficacy or safety-profile results they desire -- "not by fiddling the results, which would be far too crude and possibly detectable by peer review, but rather by asking the 'right' questions—and there are many ways to do this." If for no other reason, Mr. Smith's listing of some of those methods used by drug companies for achieving their desired results makes his article recommended reading to anyone who has ever placed faith in a prescription drug based on a medical journal report they read.
To be sure, Richard Smith's PLoS Medicine article will certainly shake one from the complacent view that because it was printed in a major medical journal, it must be true.
(Posted by: Tom Lamb)