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
All rapid responses
In his response, John Stone linked to an October 2010 article by
Harvey Marcovitch, freelance associate editor for the BMJ, on the subject
of editors under pressure and the possibility of competing interests
corrupting the editorial process. [1] At the end of this article, Dr
Marcovitch naively referred to the present dismal scenario described by
Marcia Angell, an editor not normally known for her naivety, who said,
"The problems I've discussed are not limited to psychiatry, although
they reach their most florid form there. Similar conflicts of interest and
biases exist in virtually every field of medicine, particularly those that
rely heavily on drugs or devices. It is simply no longer possible to
believe much of the clinical research that is published, or to rely on the
judgment of trusted physicians or authoritative medical guidelines. I take
no pleasure in this conclusion, which I reached slowly and reluctantly
over my two decades as an editor of The New England Journal of Medicine."
[2]
[1] Editors, Publishers, Impact Factors, and Reprint Income. Harvey
Marcovitch Public Library of Science. Published: October 26, 2010.
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed....
[2] Drug Companies & Doctors: A Story of Corruption. Marcia
Angell. The New York Review of Books. January 15, 2009
http://www.nybooks.com/articles/archives/2009/jan/15/drug-companies-
doctorsa-story-of-corruption/?page=2
Competing interests: No competing interests
Andrew Wakefield has been subjected to extraordinary criticism and
condemnation from a heavily conflicted profession since he first
questioned the safety of the MMR vaccine. In his book, Dr Wakefield begins
his account on matters of disclosure with the words,
"I have been accused and ultimately found guilty of professional
misconduct for not disclosing in The Lancet paper that I was a medical
expert involved in assessing the merits of litigation against the
manufacturers of MMR on behalf of plaintiff children possibly damaged by
this vaccine."
Andrew Wakefield had faithfully followed the rules on disclosure at
the time the paper was submitted to the journal. Dr Wakefield finishes his
account on those matters of disclosure, then and now, with the words ...
... "this essay is about what amounts to, in my opinion, hypocrisy,
double-standards, and professional retribution dressed in sanctimonious
piety." [1]
[1] 'Callous Disregard: Autism and Vaccines - the Truth behind a
Tragedy' by Andrew Wakefield 2010. Chapter Eleven: Disclosure.
Competing interests: No competing interests
"It is a paradox that the professional medical association that owns
JAMA was less than open and transparent with Lundh and colleagues about
potential financial conflicts (such as their income from industry sources)
as they expect their authors to be."
Harvey Marcovitch
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed....
Competing interests: No competing interests
Fiona Godlee acknowledges that AHRP was right to criticize the BMJ
and its editor-in-chief for failing to disclose to its readership, the BMJ
financial ties to Merck--manufacturer of 13 vaccines. She also
acknowledges income from GSK--manufacturer of several vaccines as well.
She reproduced our critical comments originally posted at:
http://www.ahrp.org/cms/content/view/766/9/ stating:
"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."
However, her statement, "We didn't declare these competing interests
because it didn't occur to us to do so " is startling. How seriously are
we to take her strongly articulated stance against researchers who fail to
disclose their financial conflicts of interest--if she doesn't recognize
her journal's blatant conflict of interest?
Either she is being disingenuous or downright cynical about the BMJs
declared stand against financial conflicts of interest that are
undermining the integrity of medical research reports, and its own
clandestine partnerships with industry.
Let's be clear: financial conflicts of interest ALWAYS influence the
position one defends-- human nature does not distinguish between
politicians whose campaign chests are filled by vested interests,
government officials, or academics who have grown dependent on financial
support from special interests. Each delivers the service for which he/she
is paid.
Vera Hassner Sharav
President, Alliance for Human Research Protection
Competing interests: No competing interests
Dear Sir,
Fiona Godlee says, "We didn't declare these competing interests
because it didn't occur to us to do so."
This raises a very important question:
If the editors of the BMJ fail to declare very pertinent conflicts of
interests, even when they place considerable importance on the issue, how
many other authors routine have brain fade when it comes to blatanlty
obvious disclosures which should be made?
Hilary Butler.
Competing interests: No competing interests
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.
BMJ is a part free journal. In view of the recent renewed attacks on
Andrew Wakefield (which were all free of access) what are we to make of
the fact that BMJ Learning is in partnership with Merck under the alias of
Univadis [1,2], or that MSD and GSK sponsor BMJ awards [3]? Should not
these competing interests be openly declared?
[1] Vera Hassner Sharav 'BMJ & Lancet Wedded to Merck CME
Partnership' (including Martin J Walker 'Merck's Medical Media Empire'),
http://www.ahrp.org/cms/content/view/766/9/
[2] Univadis log-in page, http://www.univadis.com/RH/UK_loginpage/
Competing interests: No competing interests
The report covered by Roehr [1] is truly astounding to all readers of
medical journals. When it comes to the question of publication preference,
I think free journals are bound to be confined within certain economical
restrictions. However, I have several points that need to be discussed:
First, can this kind of differential reporting also be classified as
"Publication bias"? As the publication bias denotes preferential
publication of study results in a certain direction (either clinically
significant or insignificant), a recently updated technological report [2]
points out that this phenomenon has not changed obviously for decades,
ever since the first inception of this term in 1960s. There have been several
ways created to discover publication bias (such as Funnel plotting,
inclusion of unpublished studies, etc.). In this case, I am wondering
whether we can detect the difference between the style of free and
subscription-only journals in a similar way?
Second, I think no matter how frequently positive findings appear in
a free medical journal pertaining to new drugs, we should all
apply our strenuous effort to scrutinize the methodology, analytic
technique, and statistical results. The editorial board can be in some way
or not biased against or in support of the result, but readers are not.
The option of free or subscription-only journal should not interfere in
our thinking about the strength of a study. Rather, the emphasis should be
placed upon the evidence level and the robustness that supports it.
References
1. Roehr B. Medical journals with advertising are more likely than
subscription journals to recommend drugs. BMJ 2011;342:d1335
2. Song F, Parekh S, Hooper L, et al. Dissemination and publication
of research findings: an updated review of related biases. Health Technol
Assess 2010;14:1-193
Competing interests: No competing interests
Re:In response to John Stone
We have been asked by two readers to extend the correction about the
BMJ's conflicts of interest in relation to its MMR coverage [1] to Brian
Deer's articles. We have no plans to do this. The conflict of interest
statements attached to Brian Deer's articles were correct. The conflicts
of interest listed in the correction apply to the BMJ Group and not to
authors who write in our journals.
[1] BMJ 2011; 342: d1678
Competing interests: I am the editor of the BMJ and responsible for all that it contains