Perhaps the most striking thing about this article is the refusal of the American publishers, all of which are doctors' organisations, to provide any data. Inevitably readers will wonder what they are hiding. The answer, I suspect, is the massive profits that they are making from selling reprints of pharmaceutically funded research.

We know that something like 50% of all drug sales are in North America, and reprints are a major device for promoting drugs. Cynically, I suggest that the point of reprints is not to provide doctors with scientific data but rather to link the drug company's product to the prestigious brand of the journal. My bet is that well over 80% of reprints are never read.

The second striking figure from this paper is the Lancet sale of a reprint for more than £1.55m. What the authors don't say (and perhaps don't know) is that the profit margin on reprints is something like 80%. Reprints are particularly attractive to publishers less for the revenue and more for the profit. Paper subscriptions are nothing like as profitable. So Elsevier, the owners of the Lancet, made a profit of well over a million pounds from the Lancet publishing this one study. That's one of the reasons why Elsevier manages to make a profit margin over 30%, which is far higher than in most industries.

The conflict of interest is clearly huge. If Elsevier had to maintain its profit margin by cutting costs rather than publishing that one article it would have to fire about 25 editors (assuming an average salary plus oncosts of about £40 000).

Because the American market is so huge and important the American journals, and particularly the New England Journal of Medicine, may well be making more from reprints than the Lancet. I suggest that doctors who belong to the organisations that publish the journals ask to see the budgets of their journals.

This rapid response overlaps to some degree with a blog that I hope the BMJ will be willing to post.

Competing interests: RS was the editor of the BMJ and the Chief Executive of the BMJ Publishing Group. He is a zealot for open access and was from 2004 to 2011 a member of the board of the Public Library of Science.