The BMJ, spin, and the stockmarketBMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7251.1737 (Published 24 June 2000) Cite this as: BMJ 2000;320:1737
One of the many anxieties of medical editors is that we have little measurable impact on anything. Systematic reviews have shown that written information is ineffective in changing doctors' practice. “All we do,” claimed my predecessor as editor, “is take in other people's washing.” I thus read with mixed feelings the Independent headline “BMJ admits ‘lapses’ after article wiped £30m off Scotia shares” (10 June). Could a BMJ mistake really have such dramatic consequences? Unsurprisingly, the story is much more complex than the headline suggests and provides yet another example of the story being spun to meet a commercial agenda.
The story begins with us publishing a drug point that suggested that a new anticancer drug in phase I trials might cause skin burns in 40% of patients (6 May, p 1245). The drug—temoporfin (Foscan)—is a photosensitiser that accumulates in malignant tissues and then is activated by light to destroy the tissue. We published the drug point to alert readers to this possible side effect. Medical journals face a difficult problem with such reports, which are usually based on a single case or a small series of patients. We know that we don't get it right every time. Sometimes we publish reports of effects that turn out not to be “real” and sometimes we reject reports that do turn out to be “real” In other words, we have false positives and false negatives. We do know, however, that anecdotal case reports in journals are an important source of alerting information on adverse drug effects.
The central medical and scientific question in this case is how common are serious burns. Another important question is whether it is the drug itself that has caused the high incidence of burns, the way it was given, or some other explanation. But the major question for the shareholders of Scotia, the company that manufactures the drug, is whether the drug will get to market and produce a return on their investment.
The medical and scientific questions are not of great interest to general journalists because the drug is not even on the market. This is not a major public health issue. The financial journalists on the newspapers (not regular readers of the BMJ) could, however, be prompted to take an interest, and this is what happened. Credit Suisse First Boston, market analysts, put out a release on 5 May describing the drug point and wondering “what this report means for the approval, partnering, and commercialization of Foscan.” “First impression,” it continued, “is that this is highly negative.” The release also said: “We have long been skeptical about the commercial value of Foscan.” The share price of Scotia fell from 150p to 120p. Its highest price in the past year was 230p, although it reached 800p in 1996 and dipped below 100p in early 1999. Share prices in biotech companies fluctuate greatly. Crucially the share price needs to reach 340p by March 2002 for a £50m bond issue to convert into shares.
Scotia responded by pointing out that the burns seemed to be much commoner in this series of patients than in other series. It questioned how the drug had been given and threatened to sue the authors. The story was covered on the financial pages in seven newspapers.
The BMJ has not been blameless in all this. As I describe on the letters pages (p 1732), we failed to require the authors to include in the drug point the manufacturer's data on the frequency of the side effect. We did, however, post the information on our website on 5 May, and we have published both electronically (10 May) and on paper (p 1731) a letter from the company. The drug point did not include any statement on competing interests from the authors. We failed to send them our competing interest form—but the BMJ is almost alone among journals in asking all authors to sign a competing interest statement.
Despite various contrary reports in the media, Scotia has never threatened to sue the BMJ. Nevertheless, the company was anxious for us to explain our failures. It's our policy to do that anyway, and I posted a letter on our website on 7 June. Publication in the paper edition of the journal has been delayed until today by one of the authors of the original drug point informing us that his lawyers advised that my letter was defamatory of him. This author and one other, who stand by the professionalism of their methods, work for Charterhouse Clinical Research Unit, and their business is potentially threatened if the problem is not with the drug but with how it was given. The BMJ is thus caught between two commercial interests which favour contraryinterpretations of the meaning of the drug point.
Despite the comments from Scotia and the material posted on bmj.com the share price of Scotia did not rise materially. The company put out another press release on 9 June and gained widespread coverage in the newspapers. Unfortunately this coverage emphasises the BMJ's mistakes, giving the impression that the problem is how theBMJ has reported the information rather than with the drug, how it was given, or some other unidentified explanation. “Scotia Holdings staged a recovery yesterday after the BMJ admitted to shortcomings in its report that sent shares in the pharmaceutical group crashing last month” (Times 10 June). A “senior City biotech analyst” was quoted as saying: “This statement is a complete victory for Scotia and has basically vindicated the drug” (Daily Telegraph, 10 June).
The BMJ has been caught in a whirlpool of spin created mostly for the benefit of the stockmarket. Nobody has challenged the facts of the original drug point. We still don't know the answers to the medical questions of how commonly temoporfin causes serious burns and whether the high incidence in the drug point was a result of the drug, the way it was given, or something else—although the letter we publish today from two of the authors suggests that the cause may well be that a new solvent was added to the drug (p 1732).