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Medical journals with advertising are more likely than subscription journals to recommend drugs

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1335 (Published 01 March 2011) Cite this as: BMJ 2011;342:d1335

In response to John Stone

Dear John Stone,

Thank you for giving me an opportunity to respond to Vera Hassner
Sharav's comment, [1] which for those of you who haven't seen it is
reproduced below.

Although Vera's claims may seem far fetched on this occasion, she is
right that we should have declared the BMJ Group's income from Merck as a
competing interest to the editorial (and the two editor's choice articles)
that accompanied Brian Deer's series on the Secrets of the MMR scare.[2]
[3] [4] We should also, as you say, have declared the group's income from
GSK as a competing interest in relation to these articles. We will publish
clarifications.

We didn't declare these competing interests because it didn't occur
to us to do so. We saw this series not as pro-MMR vaccine or pro-
vaccination in general, but as against fraud and corruption in medical
research. Having said this, the last line in the editorial is indeed
explicitly supportive of MMR vaccination. This is in line with the BMJ's
coverage since the MMR scare began and is in line with the evidence.[5]
As declared on its website (http://group.bmj.com/group/about

/revenue-sources#
The%20BMJ%27s%20sources%20of%20revenue) the BMJ Group receives
revenues from a range of sources. The contract with Merck's not-for-profit
arm, univadis, is for the distribution of BMJ Learning to doctors outside
the UK. GSK is the sponsor for the BMJ Group's Research of the Year Award.
The BMJ's own direct sources of revenue are also declared in general terms
on bmj.com. They consist of a combination of classified, pharmaceutical
and non-pharmaceutical advertising, subscriptions to the journal, the sale
of reprints, and sponsorship.

The journal's sources of revenue have remained largely unchanged over
the years, but the BMJ Group has grown and diversified, creating a more
complex commercial environment for the BMJ. Within this, the editors of
the BMJ and our commercial colleagues are acutely aware of the potential
for perceived and actual conflicts of interest, and all of us remain
fiercely protective of the journal's independence. Clear rules and
structures to prevent commercial influence from affecting editorial
decisions are in place and are rigorously upheld by both editorial and
commercial staff.

No one who is a regular reader of the BMJ or who has heard me speak,
could be left with the impression that we are uncritically supportive of
the pharmaceutical industry. Articles directly relevant to the activities
of Merck and GSK are referenced below,[6] [7] [8] and a recent lecture
I have given on the state of the medical literature is available online:
the annual Sense About Science lecture in London in June 2010

(http://www.senseaboutscience.org.uk/
index.php

/site/other/297/)

All three articles by Brian Deer were made freely available on line
in keeping with our policy of freeing up articles of high global
importance.

Fiona Godlee

1. http://www.ahrp.org/cms/content/view/766/9/

2. BMJ 2011; 342:c7452 doi: 10.1136/bmj.c7452 (Published 5 January
2011)

3. BMJ 2011; 342:d22 doi: 10.1136/bmj.d22 (Published 6 January 2011)

4. BMJ 2011; 342:d378 doi: 10.1136/bmj.d378 (Published 19 January
2011)

5.
http://onlinelibrary.wiley.com/o/cochrane/

clsysrev/articles/CD004407/frame.html

6. Krumholz H, Ross JS, Presler AH, Egilman DS. What have we learnt
from Vioxx?
BMJ 2007;334:120-123 doi:10.1136/bmj.39024.487720.68 (Published 18 January
2007)

7. BMJ 2010; 341:c4848 doi: 10.1136/bmj.c4848 (Published 6 September
2010)

8. BMJ 2010; 341:c6985 doi: 10.1136/bmj.c6985 (Published 7 December
2010)
From AHRP.org [1]

BMJ & Lancet Wedded to Merck CME Partnership

Monday, 14 February 2011

Why did the BMJ fail to disclose its partnership agreement with
Merck, major vaccine manufacturer--13 vaccines, including the
controversial MMR vaccine ?

Is it just conceivably possible, that the BMJ's decision to
commission and publish Brian Deer's series of articles attacking Dr.
Andrew Wakefield's personal and scientific integrity--and lend its
unwavering editorial endorsement--without giving him an opportunity to
defend himself--might be influenced by a SIGNIFICANT financial conflict of
interest?

The discovery that a psychiatry textbook penned by two influential
academics who gained notoriety, was actually ghostwritten shocked Dr. Dad
Kessler, former commissioner of the FDA, who called it "a new level of
chutzpah [that] takes your breath away."

How about the discovery that in 2008, the pharmaceutical giant, Merck
--using its tradename, MSD signed a partnership agreement with the BMJ
Group that effectively gave the company control of 350 interactive
continuing medical education courses in over 20 medical therapy areas?

"This unique partnership will change the face of medical education in
Europe and beyond, allowing users access to most of BMJ Learning's library
of 'Continuing Medical Education' (CME) and 'Continuing Professional
Development' (CPD) content. The agreement between MSD and BMJ Group
comprises about 350 interactive learning courses in over 20 medical
therapy areas."

Why did the BMJ fail to disclose its partnership agreement with
Merck?

Why did the BMJ conceal from readers-- of the Brian Deer series of
articles and the BMJ editorial excoriating Dr. Andrew Wakefield, charging
him with deliberate fraud and financial conflict of interest-- the fact
that the BMJ had a partnership with Merck, a major manufacturer of
vaccines--including the MMR vaccine, which is at the center of the
Wakefield controversy?

In 2009, Univadis, a Merck trademark, entered into a partnership with
The Lancet providing "medical education and an information website."

"Through a unique global medical literature service called Just
Published, clinical specialists registered on Univadis ?will receive free
access to the full text of recently published articles from The Lancet.
This new service will be available on www.univadis.com

I don't think it a stretch to suggest--as for Martin Walker does
(below) that:
"Linking Univadis ? /Merck with the BMJ and The Lancet inevitably links
them both to Merck's VIS (Vaccine Information Service) online -- 'a
comprehensive source of information, especially designed to provide
healthcare professionals with the answers to their questions on
vaccines.'"

The fact that BMJ and The Lancet-- two of the most prestigious
international medical journals would enter into a medical education
partnership with the drug manufacturer whose staff drew up a "doctor hit
list" to intimidate doctors who dared to discuss the lethal cardiac risks
linked to Vioxx--is in itself a betrayal of trust of the worst sort.

The stated purpose of the Merck / BMJ/ Lancet partnerships that
remained hidden from readers' view, is to "change the face of medical
education in Europe and beyond."

The BMJ editorial accompanying Deer's articles, did its best to lend
authority to the vaccine industry (Merck's) perspective. In an
introductory sound bite the editors declare:

"Clear evidence of falsification of data should now close the door on
this damaging vaccine scare."

Finally, the Statement about Competing Interests at the end of the
BMJ Editorial claims compliance with conflict of interest disclosure
requirements of the International Committee of Medical Journal Editors.
But the BMJ editor in chief and two deputy editors conceal rather than
disclose the most relevant financial conflict of interest:

"Competing interests: All authors have completed the Unified
Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on
request from the corresponding author) and declare: no support from any
organisation for the submitted work; no financial relationships with any
organisations that might have an interest in the submitted work in the
previous three years

Competing interests: I am the editor of the BMJ and responsible for all it contains.

11 March 2011
Fiona Godlee
editor
BMJ
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