‘Medische tijdschriften zijn verlengde arm van farma marketing’

Niemand minder dan de ex-hoofdredacteur van het British Medical Journal, Richard Smith, schrijft in een artikel op de site PLoS Medicine dat de strijd van de ‘vooraanstaande medische tijdschriften’ tegen de invloed van de farmaceuten zo goed als verloren is.

Het zijn niet de advertentieinkomsten die belangrijk zijn, zegt hij, maar de door de farmaceuten en haar ghost-writers gepubliceerde studies die eigenlijk per definitie nooit iets negatiefs zullen zeggen over bijvoorbeeld een nieuw getest geneesmiddel of ‘wetenschappelijk’ geconstateerd verband tussen een oorzaak en een voor de marketing van een middel gunstig gevolg. De zo gepubliceerde artikelen worden door de lezers, in tegenstelling tot de advertenties, serieus genomen en zijn daardoor voor de farmaceuten honderd keer meer waard dan een advertentie.

“Journals have devolved into information laundering operations for the pharmaceutical industry”, wrote Richard Horton, editor of the Lancet, in March 2004 [1]. In the same year, Marcia Angell, former editor of the New England Journal of Medicine, lambasted the industry for becoming “primarily a marketing machine” and co-opting “every institution that might stand in its way” [2]. Medical journals were conspicuously absent from her list of co-opted institutions, but she and Horton are not the only editors who have become increasingly queasy about the power and influence of the industry. Jerry Kassirer, another former editor of the New England Journal of Medicine, argues that the industry has deflected the moral compasses of many physicians [3], and the editors of PLoS Medicine have declared that they will not become “part of the cycle of dependency…between journals and the pharmaceutical industry” [4]. Something is clearly up.

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Why Do Pharmaceutical Companies Get the Results They Want?

Why are pharmaceutical companies getting the results they want? Why are the peer-review systems of journals not noticing what seem to be biased results? The systematic review of 2003 looked at the technical quality of the studies funded by the industry and found that it was as good—and often better—than that of studies funded by others [8]. This is not surprising as the companies have huge resources and are very familiar with conducting trials to the highest standards.

The companies seem to get the results they want not by fiddling the results, which would be far too crude and possibly detectable by peer review, but rather by asking the “right” questions—and there are many ways to do this [10]. Some of the methods for achieving favourable results are listed in the Sidebar, but there are many ways to hugely increase the chance of producing favourable results, and there are many hired guns who will think up new ways and stay one jump ahead of peer reviewers.

Then, various publishing strategies are available to ensure maximum exposure of positive results. Companies have resorted to trying to suppress negative studies [11,12], but this is a crude strategy—and one that should rarely be necessary if the company is asking the “right” questions. A much better strategy is to publish positive results more than once, often in supplements to journals, which are highly profitable to the publishers and shown to be of dubious quality [13,14]. Companies will usually conduct multicentre trials, and there is huge scope for publishing different results from different centres at different times in different journals. It’s also possible to combine the results from different centres in multiple combinations.

PLoS Medicine: Medical Journals Are an Extension of the Marketing Arm of Pharmaceutical Companies