Medical journals are no more than “an extension of the marketing arm of pharmaceutical companies” because a large proportion of their revenue comes from drug advertisements and reprints of company funded trials, claims former BMJ editor, Richard Smith.
Dr Smith argues that although medical journals make a sizeable income from drug advertisements this is the least of their “corrupting form of dependence” on the industry since the advertisements are “there for all to see and criticize” (PLoS Medicine 2005;2:e138; www.plosmedicine.org, doi: 10.1371/journal.pmed.0020138). Dr Smith's strongest criticism is levelled at the fact that journals publish clinical trials that are funded by the industry. Unlike advertisements, trials are seen by readers as the highest form of evidence, he says. Trials funded by drug companies rarely produce unfavourable results and make up between two thirds and three quarters of the trials published in key journals.
The potential profits from reprints of such a trial can run to $1m (£0.5m; €0.8m), says Dr Smith. And it is this potential income that can have the biggest corrupting influence on a journal because many editors are charged with ensuring their journal makes a profit. Editors may be confronted by “a frighteningly stark conflict of interest”, writes Dr Smith They may be forced to choose between publishing a trial that will bring $100 000 of profit or meet their end of year budget by making a member of staff redundant. Dr Smith, who is now chief executive of UnitedHealth Europe, offers a two pronged solution to what he sees as a 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 the results should be made available on regulated websites,” he writes. “Only such a radical step would, I think, stop journals being beholden to companies. Instead of publishing trials journals could concentrate on critically describing them.” Commenting on the article, Fiona Godlee, editor of the BMJ said, “Richard Smith led this important debate when he was editor, and the BMJ continues to be at the forefront of efforts to ensure that research findings are reported with honesty and integrity. We welcome this further contribution. “The BMJ takes the issues of transparency and accountability very seriously. We continue to call for public registration of all clinical trials and full disclosure of results, regardless of outcome. We have no objection to articles being authored by people employed or paid by a drug company provided that relationship is declared. We ask the authors to vouch for its intellectual honesty and to state that they accept full responsibility for the conduct of the study, had access to the data, and controlled the decision to publish. We also require all authors to disclose any financial competing interests.