"Medical journals are an extension of the marketing arm of pharmaceutical companies".

The article with this title, published in the May 2005 PLoS Medicine, is particularly interesting because the author was an editor of the British Medical Journal for 25 year--and for 13 of them was editor and chief executive of the BMJ Publishing Group, responsible for the profits of the BMJ and 25 other journals. Some of his observations are different from what the public thinks.

He found that advertising was not the big problem, but "the least corrupting form of dependence. The advertisements may often be misleading and the profits worth millions, but the advertisements are there for all to see and criticise"--and people learn to discount advertising anyway. The big problem is clinical trials--which readers see as one of the highest forms of evidence, which have the journal's stamp of approval, and which are distributed around the world, often with global media coverage. "For a drug company, a favourable trial is worth thousands of pages of advertising," which is why companies sometimes pay more than a million dollars just to buy reprints to distribute to doctors and others. And studies have found that these published articles on trials rarely produce results unfavorable to the company that funded them. "The evidence is strong that companies are getting the results they want"--in large part by asking the right questions, which can be done in many ways, which much of the rest of the article describes.

Why doesn't the system peer review (accepting, rejecting, or improving the articles based on reviews by scientific colleagues) catch this? The author said he "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 They ask the authors to send them any related studies, but editors have no other mechanism to know what other unpublished studies exist.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." Many journals very much want to publish randomly controlled trials (because they believe they are the best). And such articles are highly profitable for the journals.

To address the problem, "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." The journals would then publish articles critically describing them--but the reporting of the results themselves would be less subject to manipulation.

Reference: Smith, R. Medical journals are an extension of the marketing arm of pharmaceutical companies. PLoS Medicine. May 2005; volume 2, issue 5: e138. All PLoS articles are freely available to anyone online; for this and other publications in PLoS Medicine, see http://medicine.plosjournals.org/.