Culture

The Journals’ Sins Are The Editors’ Sins — Guest Post by Robert Yoho

If you don’t read the newspaper, you’re uninformed. If you read the newspaper, you’re misinformed.

Mark Twain

Corporate funding has made medical journals wealthy. When I trained 35 years ago, they were everywhere, but with the cash injection you will read about below, they have become a blizzard of paper on every surface of a doctor’s house and office. To scan the primary care articles alone would take hundreds of hours a month. Over 5,000 journal articles get published every day.

Physicians get their information from journals, and the editors are responsible for everything that gets printed. They are the most sophisticated people in healthcare, and they understand what is happening as it occurs. But they only speak up after they retire because they do not want to lose their prestigious, lucrative jobs (I am guilty of this, too).

The following are two of their confessionals. There are similar statements published about NEJM, JAMA, and others.

Journals have devolved into information laundering operations for the pharmaceutical industry. The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness.

Richard Horton, Lancet editor

Medical journals are an extension of the marketing arm of pharmaceutical companies.… between two-thirds and three-quarters of the trials published in the major journals—Annals of Internal Medicine, JAMA, Lancet, and New England Journal of Medicine—are funded by the industry.

Richard Smith, editor, British Medical Journal and author, The Trouble with Medical Journals (2006)

About half of journal revenue comes directly from drug companies. Perhaps 90 percent of the articles and research are industry-funded, and the industry’s contractors ghostwrite the majority. Marcia Angell, the NEJM editor for 20 years, told how they do it in The Truth About the Drug Companies (2004), “I saw companies begin to exercise a level of control over the way research is done that was unheard of when I first came to the journal… 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.”

A review of 370 drug studies in 2003 showed that industry-sponsored trials were much more likely to have positive results than when funding was from other sources. A single positive trial may be printed and reprinted in hundreds of different venues and forms. The core of science is unfavorable reports, but these are frequently concealed. For example, during the approval process for the influenza treatment Tamiflu, the drug company withheld the Australian studies that suggested the drug was worthless.

If a journal publishes something their industry sponsors dislike, they will threaten them with loss of advertising or worse. Annals of Internal Medicine (June 1992) made the mistake of publishing Michael Wilkes’ study about drug advertising harms. The NEJM and JAMA had turned down the article.

In punishment, the big corporations withdrew advertising from the Annals, and they lost over a million dollars in revenue. Two respected editors lost their jobs. After this, US journals allowed pharmaceutical companies to print written rebuttals of any study they did not like in the same issue as the study. Neither big tobacco nor big food has ever received a concession like this.

Journals make startling amounts of money. Profit margins at scientific publishing companies average a sensational 35 percent. Other successful publishers worldwide average 10 percent, and industries without subsidies are successful at 10 percent. Reed Elsevier, the largest medical publisher, is stunningly profitable:

YEAR: REVENUE: NET: PROFIT:

2016 3.28 b 1.22 b 37%

2010 2.58 b 933 m 36%

How do they do it? Journals’ expenses are modest. Industry, federal grants, and academia pay for studies, so these are free. Review editors and members of editorial boards are mostly unpaid volunteers. Revenues are huge, however. A single journal subscription may cost several thousand dollars a year. Reprinted articles from a journal often cost $50 each. Comprehensive literature searches can cost tens of thousands of dollars to get the full texts.

Journals were billing Harvard’s library $3.5 million a year for subscriptions. It had to cut some journals from their list because of these ever-increasing costs. In 2019, the University of Southern California ended its subscription to Elsevier’s journals because of the exorbitant prices.

Reprints make money for the journals because they sell them right back to the study sponsors. These companies typically pay for the entire charade, from study design to research grants to ghostwriting. Salespeople gift purchased articles to doctors to prove that the drugs work. This is a page from the corporate sales and influence playbook. Dr. Deepak Malhotra described the way it works in the BMJ: “As a medical director of a pharmaceutical company, I learnt how to get articles published in journals, with one journal promising publication if we purchased 2000 reprints at $10 each.”

The NEJM’s publisher gets 23% of its income from reprints. The Lancet?—?41%. JAMA receives 53%. In a 2012 study, reprint income per article for the Lancet was a median of £287,353 ($363,946), with the most profitable one £1,551,794. Industry funding was ten times more likely in the most reprinted articles. Journal volumes labeled “special editions” are advertising vehicles. They look like the others but usually describe only a single therapy, and the journal editors do not expect them to have high scientific standards. One drug company typically supplies nearly the entire budget.

Occasionally, industry fabricates entire journals, and they look legitimate. Merck created the Australasian Journal of Bone and Joint Medicine to advertise Fosamax. Recall the Disease-Mongering chapter; this drug’s utility is doubtful. The Medline database did not index this journal, and it had no website. Elsevier published the magazine for several months, then it vanished.

The industry pays journal editors directly, and they get their salaries in addition. Jeanne Lenzer describes how the device companies use this power:

A medical journal editor who received millions of dollars from a medical device manufacturer wrote and edited articles favourable to the manufacturer without stating his conflict of interests to readers. Thomas Zdeblick, a University of Wisconsin orthopaedic surgeon… editor-in-chief of the Journal of Spinal Disorders & Techniques in 2002, received more than $20m… in patent royalties, and $2m in consulting fees from Medtronic for spinal implants sold by the company during his tenure as editor.

BMJ (2010)

Jason Fung, a Canadian academic nephrologist, summarizes these payouts in a blog:

Of all journal editors that could be assessed, 50.6% were on the take. The average payment in 2014 was $27,564. Each. This does not include an average $37,330 given for ‘research’ payments… Each editor of the Journal of the American College of Cardiology received, on average, $475,072 personally and another $119,407 for research. With 35 editors, that’s about $15 million in money for editors. No wonder the JACC loves drugs and devices.

Medium.com (2018)

The massive advertising revenues, the reprint deals, and the payoffs to the editors create near-complete corporate control of the only physician information source. We support the drugmakers and device manufacturers with insurance and government dollars, and they pay the journals and editors. The “big five” most respected medical journals, Lancet, JAMA, BMJ, NEJM, and Annals of Internal Medicine, are all contaminated with this commercial bias. The BMJ has the most integrity, at least by one measure. Only three percent of its revenues come from reprints.

Business corrupts science when it pays for research. Nortin Hadler wrote in The Citizen Patient (2013): “It turns out that the vast majority of the clinical literature is so lacking in methodological quality as to offer no contribution of substance to clinical decision making. For most clinical questions, one is fortunate to find a dozen studies that can be deemed informative.” Gøtzsche is franker: “The pervasive scientific misconduct has led to a research literature where one has to dig deeply to find the few gems among all the garbage.”

The following is excerpted from Butchered by Healthcare, by Robert Yoho, MD. For more information, see dryohoauthor.com.

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Categories: Culture

9 replies »

  1. No surprise, it’s like this with many professional journals.

    I can remember reading a book written by a physician who said, “yes, Big Pharma showers us with gifts, but we doctors are SO ethical, moral, and principled that we’d NEVER be influenced by them.”

    By the end of the book, my eyes had almost rolled back permanently.

  2. Just imagine all the new reprints, soon to be available, of the ‘science’ behind coronavirus testing, transmission and therapy medicine. The fortunes to be made. It might make you think that the blessed pharma industry was behind the coronavirus crisis, the whole time.

  3. I would add the corruption corrupts science. If someone is willing to rig studies to push drugs that may hurt, maim, or kill people for money, the corruption has already reached a pretty extreme point.

    I sometimes think we’re too cynical, this isn’t actually normal, even among hardened criminals, murderers are in a special class. Bad drugs absolutely do kill and if someone’s basically fine with that and if the journal’s basically fine with that, this isn’t just normal corruption.

  4. A 2020 article on reconceiving the peer-review-journal system: Beyond journals and peer review: towards a more flexible ecosystem for scholarly communication || Michael Wood, University of Portsmouth, UK|| Be forewarned – it is pre-print – t/f – not duly PEER REVIEWED. The author dwells on troublesome statistical issues and problems related to incomplete disclosure of data (among other points): https://www.preprints.org/manuscript/202012.0612/v1
    {~ apprecation to Dr. Yolo}

  5. My family doctor for decades (he met my mother when she was a child), recently deceased at age 103, was an exceptional one.

    Although well mannered, he was an old school, no nonsense guy (the 1936-1939 Spanish Civil War surprised him as a School of Medicine student, and he had to survive it while self-teaching him until classes resumed, so you could perceive that tough quality most lack), and tremendously gifted as a doctor. He had that “House” instinct to foresee what the hell was going on with a person while others (specialists included) struggled, because he lived many things and understood the nuances of health as a whole. Besides, he acted and looked like an incorruptible man, and he still had that dignified bearing when he walked along the city at more than one hundred years of age…

    My mother used to make him health-related questions after his retirement, when we bumped into him in the street. He always answered kindly (he was basically in love with her, ha…), but one day he opened his heart about his personal remorse and medicine shortcomings. He said he burnt all his career files after retirement (!), told her that he did not want to be involved with medicine anymore, said he was astonished at the poor level of modern doctors, and gave her an advice, which I remember as very close to this: “Do you want to stay healthy? Just get away from us. We´ll get you for one reason or another. We basically don´t know what the hell we are talking about most of the time.” And, to our huge surprise, he said that he (even he!) had been receiving money from the pharmaceutical industry, who paid his holidays twice, and that this is just how things work. It was a bitter confession from somebody who I know was a really extraordinary man and doctor. Although I am sure he did not do anything that could risk anybody´s health in a hard way, and he certainly helped hundreds along his way, it certainly gave me perspective on this world.

    Although this is only a tiny-sized example, to have such a close testimony of industry and the reality of modern medicine dangers impacted me more than the huge-sized cases we all know regarding general corruption in published science, or the shades behind the rather cocky confidence behind modern diagnosis that we see today.

  6. Every time I see a new commercial on TV I swear the side effects are just getting worse. I used to joke when I saw the commercials that “sudden death might occur” but then one of them basically said exactly that!
    I was appalled that there was a medicine that I don’t even remember being for anything that was life threatening like cancer that was saying something like this. Then I started to hear things like “terminal cancer has been reported” and several “swelling of the throat & tongue has been reported to occur.” I can tell you from my personal experience anaphylaxis is no joke and to just mention it as a possible side effect is frankly insane to me. I have come very close to dying from it and to treat it the same as your eyes might get red or something fairly innocuous like that is criminal.

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