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

[admin]

[edit add 11-12-23] "When the New England Journal of Medicine (NEJM) published 73 studies of new drugs over the course of a single year, they found that a staggering 82% of them had been funded by the pharmaceutical company selling the product, 68% had authors who were employees of that company, and 50% had lead researchers who accepted money from a drug company."
much more
https://www.covid-19forum.org/index.php?topic=1647.0 [end edit]

Please read directly on this link that has many links and also great comments on the article.
https://ethicalnag.org/2012/09/26/medical-journals-information-laundering-big-pharma/

"The Ethical Nag
Marketing Ethics for the Easily Swayed

Medical journals: “information-laundering for Big Pharma”?
Posted on September 26, 2012 by Carolyn Thomas   

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 editor-in-chief of The 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:

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

* 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

l

See also:

    Who’s running the show in industry-sponsored drug trials?
    How are hockey-playing goons the same as “puzzled” medical journal editors?
    Why doctors who pretend to write journal articles should be punished
    Putting a positive spin on negative medical research results
    The haunting of medical journals: how ghostwriting sold hormone replacement therapy
    When you use bad science to sell drugs
    Warning: clinical trials funded by drug companies may appear more truthful than they actually are
    The Lucky Stockbroker Syndrome and other ways to skew medical study results

For those interesting subjects and much more including the enlightening comments posted to that article please click here:
https://ethicalnag.org/2012/09/26/medical-journals-information-laundering-big-pharma/

[admin]

When did this all begin?

More on Big Pharma/Big Government/Medical Journal corruption/media & consequence

[admin]

"All the major journals are completely captured. They are captured by Big Pharma. The New England Journal of Medicine has an estimated income in excess of a hundred million dollars with a profit margin of about 30%. So they are no different from Big Pharma."
"They're all paid off." Dr. Paul Marik
https://twitter.com/i/status/1665283946274275330

RK Jr. on justice
https://twitter.com/i/status/1665694525505822722

https://twitter.com/FreeWCH

[admin]

Pharmaceutical Corruption News Articles
Excerpts of key news articles on pharmaceutical corruption
https://www.wanttoknow.info/pharmaceuticalcorruptionnewsarticles-0-10000

[admin]

Always best read at the link:
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020138

"Medical Journals Are an Extension of the Marketing Arm of Pharmaceutical Companies"

“Journals have devolved into information laundering operations for the pharmaceutical industry”, wrote Richard Horton, editor of the Lancet, in March 2004 [1]. 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” [2]. 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 [3], and the editors of PLoS Medicine have declared that they will not become “part of the cycle of dependency…between journals and the pharmaceutical industry” [4]. Something is clearly up.
The Problem: Less to Do with Advertising, More to Do with Sponsored Trials

The most conspicuous example of medical journals' dependence on the pharmaceutical industry is the substantial income from advertising, but this is, I suggest, the least corrupting form of dependence. The advertisements may often be misleading [5,6] and the profits worth millions, but the advertisements are there for all to see and criticise. 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 advertisers.

The much bigger problem lies with the original studies, particularly the clinical trials, published by journals. Far from discounting these, readers see randomised controlled trials as one of the highest forms of evidence. A large trial published in a major journal has the journal's stamp of approval (unlike the advertising), will be distributed around the world, and may well receive global media coverage, particularly if promoted simultaneously by press releases from both the journal and the expensive public-relations firm hired by the pharmaceutical company that sponsored the trial. For a drug company, a favourable trial is worth thousands of pages of advertising, which is why a company will sometimes spend upwards of a million dollars on reprints of the trial for worldwide distribution. The doctors receiving the reprints may not read them, but they will be impressed by the name of the journal from which they come. The quality of the journal will bless the quality of the drug.

https://doi.org/10.1371/journal.pmed.0020138.g001

Fortunately from the point of view of the companies funding these trials—but unfortunately for the credibility of the journals who publish them—these trials rarely produce results that are unfavourable to the companies' products [7,8]. Paula Rochon and others examined in 1994 all the trials funded by manufacturers of nonsteroidal anti-inflammatory drugs for arthritis that they could find [7]. They found 56 trials, and not one of the published trials presented results that were unfavourable to the company that sponsored the trial. Every trial showed the company's drug to be as good as or better than the comparison treatment.

By 2003 it was possible to do a systematic review of 30 studies comparing the outcomes of studies funded by the pharmaceutical industry with those of studies funded from other sources [8]. Some 16 of the studies looked at clinical trials or meta-analyses, and 13 had outcomes favourable to the sponsoring companies. Overall, studies funded by a company were four times more likely to have results favourable to the company than studies funded from other sources. In the case of the five studies that looked at economic evaluations, the results were favourable to the sponsoring company in every case.

The evidence is strong that companies are getting the results they want, and this is especially worrisome because 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 [9]. For the BMJ, it's only one-third—partly, perhaps, because the journal has less influence than the others in North America, which is responsible for half of all the revenue of drug companies, and partly because the journal publishes more cluster-randomised trials (which are usually not drug trials) [9].

Why Do Pharmaceutical Companies Get the Results They Want?

Why are pharmaceutical companies getting the results they want? Why are the peer-review systems of journals not noticing what seem to be biased results? The systematic review of 2003 looked at the technical quality of the studies funded by the industry and found that it was as good—and often better—than that of studies funded by others [8]. This is not surprising as the companies have huge resources and are very familiar with conducting trials to the highest standards.

The companies seem to get the results they want 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 [10]. Some of the methods for achieving favourable results are listed in the Sidebar, but there are many ways to hugely increase the chance of producing favourable results, and there are many hired guns who will think up new ways and stay one jump ahead of peer reviewers.

Then, various publishing strategies are available to ensure maximum exposure of positive results. Companies have resorted to trying to suppress negative studies [11,12], but this is a crude strategy—and one that should rarely be necessary if the company is asking the “right” questions. A much better strategy is to publish positive results more than once, often in supplements to journals, which are highly profitable to the publishers and shown to be of dubious quality [13,14]. Companies will usually conduct multicentre trials, and there is huge scope for publishing different results from different centres at different times in different journals. It's also possible to combine the results from different centres in multiple combinations.

These strategies have been exposed in the cases of risperidone [15] and odansetron [16], but it's a huge amount of work to discover how many trials are truly independent and how many are simply the same results being published more than once. And usually it's impossible to tell from the published studies: it's necessary to go back to the authors and get data on individual patients.

Peer Review Doesn't Solve the Problem

Journal editors are becoming increasingly aware of how they are being manipulated and are fighting back [17,18], but I must confess that it took me almost a quarter of a century editing for the BMJ to wake up to what was happening. Editors work by considering the studies submitted to them. They ask the authors to send them any related studies, but editors have no other mechanism to know what other unpublished studies exist. It's hard even to know about related studies that are published, and it may be impossible to tell that studies are describing results from some of the same patients. Editors may thus be peer reviewing one piece of a gigantic and clever marketing jigsaw—and the piece they have is likely to be of high technical quality. It will probably pass peer review, a process that research has anyway shown to be an ineffective lottery prone to bias and abuse [19].

Furthermore, the editors are likely to favour randomised trials. Many journals publish few such trials and would like to publish more: they are, as I've said, a superior form of evidence. The trials are also likely to be clinically interesting. Other reasons for publishing are less worthy. Publishers know that pharmaceutical companies will often purchase thousands of dollars' worth of reprints, and the profit margin on reprints is likely to be 70%. Editors, too, know that publishing such studies is highly profitable, and editors are increasingly responsible for the budgets of their journals and for producing a profit for the owners. Many owners—including academic societies—depend on profits from their journals. An editor may thus face a frighteningly stark conflict of interest: publish a trial that will bring US$100 000 of profit or meet the end-of-year budget by firing an editor.
Journals Should Critique Trials, Not Publish Them

How might we prevent journals from being an extension of the marketing arm of pharmaceutical companies in publishing trials that favour their products? Editors can review protocols, insist on trials being registered, demand that the role of sponsors be made transparent, and decline to publish trials unless researchers control the decision to publish [17,18]. I doubt, however, that these steps will make much difference. Something more fundamental is needed.

Firstly, we need more public funding of trials, particularly of large head-to-head trials of all the treatments available for treating a condition. Secondly, journals should perhaps stop publishing trials. Instead, the protocols and results should be made available on regulated Web sites. Only such a radical step, I think, will stop journals from being beholden to companies. Instead of publishing trials, journals could concentrate on critically describing them.

Examples of Methods for Pharmaceutical Companies to Get the Results They Want from Clinical Trials

    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.

Acknowledgments

This article is based on a talk that Richard Smith gave at the Medical Society of London in October 2004 when receiving the HealthWatch Award for 2004. The speech is reported in the January 2005 HealthWatch newsletter [20]. The article overlaps to a small extent with an article published in the BMJ [21].
References

    1. Horton R (2004) The dawn of McScience. New York Rev Books 51(4): 7–9.
        View Article
        Google Scholar
    2. Angell M (2005) The truth about drug companies: How they deceive us and what to do about it. New York: Random House. 336 p.
    3. Kassirer JP (2004) On the take: How medicine's complicity with big business can endanger your health. New York: Oxford University Press. 251 p.
    4. Barbour V, Butcher J, Cohen B, Yamey G (2004) Prescription for a healthy journal. PLoS Med 1: e22.
        View Article
        Google Scholar
    5. Wilkes MS, Doblin BH, Shapiro MF (1992) Pharmaceutical advertisements in leading medical journals: Experts' assessments. Ann Intern Med 116: 912–919.
        View Article
        Google Scholar
    6. Villanueva P, Peiro S, Librero J, Pereiro I (2003) Accuracy of pharmaceutical advertisements in medical journals. Lancet 361: 27–32.
        View Article
        Google Scholar
    7. Rochon PA, Gurwitz JH, Simms RW, Fortin PR, Felson DT, et al. (1994) A study of manufacturer-supported trials of nonsteroidal anti-inflammatory drugs in the treatment of arthritis. Arch Intern Med 154: 157–163.
        View Article
        Google Scholar
    8. Lexchin J, Bero LA, Djulbegovic B, Clark O (2003) Pharmaceutical industry sponsorship and research outcome and quality. BMJ 326: 1167–1170.
        View Article
        Google Scholar
    9. Egger M, Bartlett C, Juni P (2001) Are randomised controlled trials in the BMJ different? BMJ 323: 1253.
        View Article
        Google Scholar
    10. Sackett DL, Oxman AD (2003) HARLOT plc: An amalgamation of the world's two oldest professions. BMJ 327: 1442–1445.
        View Article
        Google Scholar
    11. Thompson J, Baird P, Downie J (2001) The complete text of the independent inquiry commissioned by the Canadian Association of University Teachers. The Olivieri report. Toronto: Lorimer. 584 p.
    12. Rennie D (1997) Thyroid storm. JAMA 277: 1238–1243.
        View Article
        Google Scholar
    13. Rochon PA, Gurwitz JH, Cheung M, Hayes JA, Chalmers TC (1994) Evaluating the quality of articles published in journal supplements compared with the quality of those published in the parent journal. JAMA 272: 108–113.
        View Article
        Google Scholar
    14. Cho MK, Bero LA (1996) The quality of drug studies published in symposium proceedings. Ann Intern Med 124: 485–489.
        View Article
        Google Scholar
    15. Huston P, Moher D (1996) Redundancy, disaggregation, and the integrity of medical research. Lancet 347: 1024–1026.
        View Article
        Google Scholar
    16. Tramèr MR, Reynolds DJM, Moore RA, McQuay HJ (1997) Impact of covert duplicate publication on meta-analysis: A case study. BMJ 315: 635–640.
        View Article
        Google Scholar
    17. Davidoff F, DeAngelis CD, Drazen JM, Hoey J, Hojgaard L, et al. (2001) Sponsorship, authorship, and accountability. Lancet 358: 854–856.
        View Article
        Google Scholar
    18. De Angelis C, Drazen JM, Frizelle FA, Haug C, Hoey J, et al. (2004) Clinical trial registration: A statement from the International Committee of Medical Journal Editors. Lancet 364: 911–912.
        View Article
        Google Scholar
    19. Godlee F, Jefferson T (2003) Peer review in health sciences, 2nd ed. London: BMJ Publishing Group. 367 p.
    20. Garrow J (2005 January) HealthWatch Award winner. HealthWatch 56: 4–5.
        View Article
        Google Scholar
    21. Smith R (2003) Medical journals and pharmaceutical companies: Uneasy bedfellows. BMJ 326: 1202–1205.