One of our pet subjects at Medlatest is “vested interest”. Whether writing about sunshine act, disclosures, anti-tax campaigns, sponsorhip of congresses, there’s danger lurking in the form of potential bias which can send the ethical compass off course. In a thought-provoking rapid response to a similarly thought-provoking piece of research, ex-British Medical Journal(BMJ) editor Richard Smith has made us aware of a different form of potential for unhealthy goings-on in the world of published clinical work. In his commentary, here, on the original piece, he points an accusing finger at American publishers, suggesting that their unwillingness to provide the authors with data about how many reprints of how many articles they are selling lies in the “massive profits that they are making from selling reprints of pharmaceutically funded research.”
According to Richard Smith, who is a “zealot for open access” and a past editor and Chief Executive of the BMJ, something like 50% of all drug sales are in North America, and reprints are a major device for promoting drugs, in Smith’s view because of the halo effect for pharma co’s of being associated with prestigious brands. That’s step one of his argument.
Step two is a worked example in which he discusses a Lancet paper, sold as reprint, which netted Elsevier, the publisher “more than £1.55M”. At an estimated 80% gross margin, (Smith quotes Elsevier of making a bottom line of 30%, which is consistent with this) one can see why a publisher might consider pharmaco friendly articles quite attractive, with the clear potential conflict of interest that implies.
So Smith’s opinion of the pharmaceutical industry’s closeness to the publications is pretty clear, but what about medical devices? Do we see the same phenomenon Smith alleges exists in Pharma?
Well, to be honest, we don’t know because we don’t have any information. Admittedly we’ve never picked up the whiff of vested interest, which might evidence itself as papers being published that elicit surprise. But at the same time the potential is there, and that’s maybe the point. Clinical papers are hugely influential, whether read or simply weighed, when the sales rep comes a-knocking, so clearly companies will walk over hot coals to get their names in print in the right place.
Whether journals similarly really lick their lips at the potential for lucrative reprints when deciding what’s in and what’s out, is an unknown. Surely that is never a consideration. Indeed if it were ever found to be the case that a particular publication had favoured a money spinner over a worthy but less lucrative piece one might imagine that would spell the end for that journal’s credibility.
Richard Smith suggests that “doctors who belong to the organisations that publish the journals ask to see the budgets of their journals.”
And he’s right in essence. Transparency would, as usual, add a significant degree of comfort.