Medical
journals are an extension of the marketing arms of drug firms,
says an ex-British Medical Journal editor.
Dr Richard
Smith, who edited the BMJ for 13 years, criticised the journals'
reliance on drug company advertising.
Writing in Public Library of Science Medicine, he also said
journals were undermined by relying on clinical trials funded
by the drugs industry.
The BMJ said a debate was needed, but drug industry representatives
rejected the criticisms.
Dr Smith, who is now chief executive of healthcare firm UnitedHealth
Europe, said the most conspicuous example of the dependence
was reliance on advertising, but he added it was "the least
corrupting form of dependence" since it was there for all to
see.
Dr Smith said the publication of industry-funded trials was
a much bigger problem.
"There
is certainly a need for more transparency, it is something
we are working on" --- Dr. Fiona Godlee, of the
British Medical Journal
He said: "For a drug company a favourable trial is worth thousands
of pages of advertising, which is why a company will sometimes
spend upwards of a million dollars on reprints of the trial
for worldwide distribution."
And Dr Smith argued, unlike ads, these trials were seen as the
highest form of evidence.
"Fortunately from the point of view of the companies which fund
these trials - but unfortunately for the credibility of the
journals who publish them - they rarely produce results that
are unfavourable to the companies' products."
He said editors are put under further pressure by the demands
of producing a profit.
"An editor may thus face a frighteningly stark conflict of interest
- publish a trial that will bring in $100,000 (£54,000) of profit,
or meet the end of year budget by firing an editor."
Publicly-funded trials
He said there needed to be more publicly-funded trials - about
two thirds are currently paid for by the industry - or journals
should stop publishing such trials.
BMJ editor Dr Fiona Godlee said she agreed with much of what
Mr Smith said.
"There is certainly a need for more transparency, it is something
we are working on.
"The whole issue about advertising is something journals are
uncomfortable about.
"On the one hand we are saying clean up your act, while we are
fairly dependent on the advertising for our survival.
"What we need now is a debate about the issue."
But Richard Ley, of the Association of the British Pharmaceutical
Industry, said his criticisms were unfounded.
"There would be an outcry if a pharmaceutical company tried
to put pressure on.
"And we must also remember these trials are peer reviewed."
He also added it was not realistic to think trials could be
funded form public money.
