Medical journals & drug companies

Townsend Letter for Doctors and Patients,  August-Sept, 2005  by Jule Klotter

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Richard Smith, who edited the British Medical Journal (BMJ) for 25 years, wrote an essay that describes how pharmaceutical companies use medical journals to promote their products. Journals depend upon the advertising money received from drug companies, but Smith says that "this is, I suggest, the least corrupting form of dependence." Industry's ability to design clinical trials to increase the odds of a favorable result along with medical journals' tendency to print positive studies is more insidious. Industry-funded trials account for 66 to 75% of all the trials published in Annals of Internal Medicine, JAMA, Lancet, and New England Journal of Medicine. Companies pay these journals millions of dollars for reprints of favorable trials. They then send these reprints, emblazoned with the journal's name, to doctors. "The quality of the journal will bless the quality of the drug," writes Smith. "For a drug company, a favorable trial is worth thousands of pages of advertising."

Drug companies know how to design a technically good study; and they are continually working on new ways "to hugely increase the chance of producing favorable results." Smith lists seven ways that companies design studies to their advantage:

* "Conduct a trial of your drug against a treatment known to be inferior.

* Trial your drugs against too low a dose of a competitor drug.

* Conduct a trial of your drug against too high a dose of a competitor drug (making your drug seem less toxic).

* Conduct trials that are too small to show differences from competitor drugs.

* Use multiple endpoints in the trial and select for publication those that give favourable results.

* Do multicentre trials and select for publication results from centres that are favourable.

* Conduct subgroup analyses and select for publication those that are favourable.

* Present results that are most likely to impress--for example, reduction in relative rather than absolute risk."

When all else fails, companies have suppressed or, at least, significantly delayed the release of negative studies.

Multicenter trials have the added advantage of providing material for several articles that can be submitted to different journals. Instead of having results published once, drug companies combine results from centers in multiple ways, making it look as if they have several independent studies supporting their product. Smith says that determining whether a trial is independent or part of a bigger study requires tracking down the authors and looking at the data to see if individual patients show up more than once.

Smith offers two possible remedies for industry's de facto appropriation of medical journals. Instead of relying on industry to produce the trials that form the basis for medical decisions, he urges public funding for large head-to-head trials that compare all treatments for a single condition. In addition, he suggests that medical journals critique studies instead of publishing them. Protocols and results could be published on regulated web sites.

Smith R (2005) Medical journals are an extension of the marketing arm of pharmaceutical companies. PLoS Med 2(5):e138 (accessed at http://medicine.plosjournals.org, 18 May 2005)

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