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Medical Journals Hooked on Drug Money

Eleven leading medical journals tried this week to extricate themselves from an embarrassing dependence on the pharmaceutical industry. The journals adopted new policies supposedly intended to prevent studies financed by pharmaceutical companies from being inappropriately influenced by the funders.

Despite the apparent reasonableness of this action, it's little more than an effort to distract attention from the journals' unseemly addiction to drug money.

The "need" for the action arises out of several recent controversies involving research funded by drug companies.

One of the more notable incidents involved an effort by Boots Pharmaceuticals to block publication of a study in the Journal of the American Medical Association unfavorable to one of its products. The study reported several generic drugs for hypothyroidism worked as well as Boot's more expensive Synthroid. Although Boots ultimately was not successful, the study was not published until almost seven years after it was completed.

Another notable controversy involved a study published in the New England Journal of Medicine reporting the diet-drug Redux increased the risk of pulmonary hypertension, a life-threatening lung condition. An accompanying editorial by Harvard University and University of Pennsylvania researchers downplayed the study, saying the risk might not even exist at all.

Embarrassed by "revelations" that the editorial's authors had been paid consultants to Redux's manufacturer, the Journal publicly rebuked the authors – even though the authors fully complied with the Journal's usual request for information about potential conflicts of interest.

There is no question Boots acted wrongly in trying to block publication of results because they might harm sales of its product. But in the case of the editorial about the Redux study, the worst that can be said is its authors failed to disclose every possible – however remote – conflict of interest. There was no indication that the editorial was substantively wrong or inappropriately influenced.

Yes, some pharmaceutical companies have acted inappropriately in the past and others may do so again in the future. But not all the bad press has been, or will, be warranted.

Pharmaceutical companies have an agenda – selling drugs for profit – that can inappropriately influence the research they fund. But this is not a sufficient reason for the medical journals to attack the companies.

The other major funder of medical and scientific research in the U.S. is the federal government, which agencies often have agendas that bias research they fund.

The U.S. Environmental Protection Agency often funds research published in major medical journals – much of it obvious junk science – that attempts to justify calls for more EPA regulation and larger agency budgets.

The National Heart, Lung and Blood Institute is blindly committed to slashing the level of salt in our diets. Studies funded by the NHLBI always seem to support this goal – even when their data don't.

The National Cancer Institute is chock-full of pockets of researchers with special agendas. Some NCI researchers are bent on linking well-done meat with increased cancer risk. Others are committed to linking pesticides with increased cancer risk. Much data has been tortured to confess to those pre-determined conclusions.

Any research funder may have an agenda that might inappropriately influence research. So what? The solution to this problem is not – as the medical journals have done – to take a cheap shot at politically incorrect research funders.

If medical journals were truly concerned about the quality of the research published, they would improve peer review, the process in which independent experts review the research before publication. If the science is good, the identity of its funder is irrelevant.

The medical journals are making pharmaceutical companies into "whipping boys" because the journals are feeling pressure to demonstrate independence from the pharmaceutical industry.

The problem, though, is the journals more addicted to drug company money than sound science. In fact, medical journals tend to have more pages of drug company advertising than medical studies.

As pointed out in the 1998 New York Times Magazine story, "Hippocratic Wars," medical journals are businesses beholden to drug makers for their economic viability. The New England Journal and Journal of the American Medical Association each have display advertising revenues on the order of $20 million annually, the vast majority of it from drug companies.

The medical journals tend to publish drug company-sponsored studies that are positive for the drugs involved. The journals use the media to make these findings public. Publicity generates readership which, in turn, generates revenue from advertising and from reprints of articles that drug companies buy in bulk for distribution to doctors worldwide.

It's big business that the medical journals are willing to do. But they don't want to be seen as being too cozy with their business partners – hence this cosmetic attack.

If medical journals had real concern about drug company influence, the journals would take steps to transform themselves more into science journals than brochures for pharmaceutical products.

Steven Milloy is the publisher of JunkScience.com, an adjunct scholar at the Cato Institute and the author of the upcoming book Junk Science Judo: Self-defense Against Health Scares and Scams (Cato Institute, 2001). Mr. Milloy may be reached at milloy@cais.com.

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