Commercial Influence and Medical Journals

Information Filters and the Challenge of Discernment

As we navigate the medical and nutrition science landscape together I find myself thinking that to be an effective practitioner of any type you truly need to develop your skills as an investigative journalist, sharpen your critical thinking skills and understand that the flow of information is not simply point A to point B. There are a variety of tangents information can and does take prior to reaching you through multiple filters like the media for example. So in order to have more control of your life, discernment is a skill you must learn as if you life depends on it…because it does.

This is why if you have been here reading my work for any length of time you will see deep articles on biochemistry but also covering topics like censorship, conflicts of interest and more. These, in my opinion are not side topics. I like to think of Sundays as op ed days so that I can give you a window into why I do what I do and the thought process that goes into my daily thinking and how I break down information.

Let’s look at a BMJ paper from 2006 from which I borrowed the title for this article  – “Authors of articles in medical journals may be affected by commercial bias…Government organizations and societies of health professionals can also influence journal content. A former editor of JAMA was fired by the AMA because of political sensitivity over an article on oral sex that he published at the time of President Clinton's impeachment.”(1)

So you see science the method is not pure when money or power are on the line. Amazing isn’t it? Capital S Science masquerades as pure but is very often just a political tool. Insert pretty much all information surrounding COVID1984 here.

This paper further explored whether financial conflicts of interest affect decisions made by journal editors? Do journals have policies on authors' conflicts of interest, and how well do editors enforce those policies? Do financial considerations affect the content of medical journals?

“Because journal editors have a great deal of control over original scientific articles, commentaries, and editorials, any commercial bias due to their own conflict of interest would affect the content of their journals.”

In 1992, the Annals of Internal Medicine published an article that critically examined the scientific accuracy of advertisements for drugs in 10 leading medical journals. The journal lost an estimated $1-1.5 million in advertising revenue by publishing the study after the reviewers in the paper, who were doctors, found that 28% of the ads should never have been published.(2) Other notable findings:

·        In 30% of cases, two or more reviewers disagreed with the advertisers' claim that the drug was the "drug of choice."

·        Headlines in 32% of the advertisements containing headlines misled the reader about efficacy.

·        In 44% of cases, reviewers felt that the advertisement would lead to improper prescribing if a physician had no other information about the drug other than that contained in the advertisement.

·        57% of advertisements were judged by two or more reviewers to have little or no educational value.

·        In the opinion of the reviewers, many advertisements contained deficiencies in areas in which the FDA has established explicit standards of quality.

The editor said, “The episode revealed the true colors of the pharmaceutical industry, which was willing to flex its considerable muscles when it felt its interests were threatened.”

Authors of a paper going back to 1999 noted, “potential financial conflicts of interest arising from pharmaceutical advertisements in medical journals may be substantial.”(3) They estimated pharmaceutical advertising revenue ranged from $715,000 to $18,630,000. “Five organizations raised more than 10% of their gross income (range 2% to 30%) from a single journal's pharmaceutical advertising. Four organizations raised as much or more from pharmaceutical advertising as from members (range 17% to 790%)…The impact on professional societies' financial independence and behavior is unknown.”

Companies may even go as far as to refuse to advertise in journals that publish articles that are critical of the drugs industry. So you see this is similar to the way consent in manufactured. If there are no journals free of pharmaceutical advertising dollars, what relative comparison does one have? You may be led to believe it is a perfectly healthy and normal relationship. Even worse, a busy doctor who does not take the time to fully vet a drug for its mechanism of action, potential side effects, etc…may air on the side of trusting an advertisement in a reputable journal over doing his/her own research.

The Journal of Law, Medicine and Ethics in 2012 wrote, “Medical journals should manage and eliminate conflicts, not just improve the disclosure of financial relationships.”(4)

Clearly we have a lot of work to do as a society to climb out of this mess but currently this is simply the cost of doing business and unlikely to change any time soon. The real problem is, you and I pay the steepest price with our health. Being informed is the only way to survive the minefield that science has become.

An informed consumer is a shock to the system. That is exactly what we need!

References

1.      Lexchin J, Light DW. Commercial influence and the content of medical journals. BMJ. 2006;332(7555):1444-1447. doi:10.1136/bmj.332.7555.1444

2.      Wilkes MS, Doblin BH, Shapiro MF. Pharmaceutical advertisements in leading medical journals: experts' assessments. Ann Intern Med. 1992;116(11):912-919. doi:10.7326/0003-4819-116-11-912

3.      Glassman PA, Hunter-Hayes J, Nakamura T. Pharmaceutical advertising revenue and physician organizations: how much is too much?. West J Med. 1999;171(4):234-238.

4.      Steinbrook R, Lo B. Medical journals and conflicts of interest. J Law Med Ethics. 2012;40(3):488-499. doi:10.1111/j.1748-720X.2012.00681.x