Can Doctors Trust Medical Journals?

For the past few years, Samme the snake has maintained that studies published in respected medical journals are often tainted by payments made by the drug manufacturers to the researchers themselves.

It now appears Samme was right. Further, it appears the drug companies have gotten in as deep as the respected New England Journal of Medicine and even the FDA.

The Wall Street Journal recently detailed that a top spine surgeon at UCLA – Jeffrey Lang, MD, – failed to disclose almost $500,000 in payments from medical companies for whom he conducted research. Both UCLA representatives and Dr. Lang declined to comment on the records, which were obtained by commercial investigators.

In February of this year, Pfizer announced it would begin to disclose “most payments” made to doctors for “consulting” on phase I to phase IV clinical trials. Pfizer representatives stated that they collaborated with nearly 8,000 researchers involved in almost 300 studies. Unfortunately, Pfizer refused to disclose payments made to researchers who do not prescribe medicine, yet may be heavily involved in the research project and the results presented. Critical observers (such as our own Samme) have complained for years that many important medical journal articles are written by “ghost writers,” who make strong conclusions about the effectiveness of a drug and its safety.

These articles then impress doctors and boost sales, yet the authors do not disclose that they are actually on the payrolls of the drug manufacturers. Other large drug makers including Eli Lilly, GlaxoSmithKline, and Merck have disclosed varying levels of financial support to their doctors, however, most such fees are categorized as speaking fees, and not for doing research or “ghost writing.”

Of greater concern is that several “financially compromised” physicians were appointed to the FDA’s Psychopharmacologic Drug Advisory Committee, which approves psychiatric drugs. It was found that these same physicians were on the payroll of AstraZeneca, maker of the psychiatric drug Seroquel, a drug which represents a major portion of AstraZeneca’s drug portfolio. These physicians were removed from the committee when Philadelphia attorney Steve Sheller filed a suit regarding conflict of interest. Sheller stated, “The industries affected have agreed: you can’t trust the approvals, you can’t trust the studies, and now you can’t trust the FDA.”

If the FDA has not been playing clean, then medical journals cannot be far behind. It is both telling and troubling that the respected New England Journal of Medicine is relaxing its long-standing rules around conflict of interest to publish evaluations of new drugs, conducted by researchers with financial ties to the drug companies, because it cannot find enough experts without financial ties to drug companies.

NEJM editors conceded that there is a risk that objectivity may be compromised, but retort that limiting evaluations to physicians with no financial ties to drug companies would result in physicians having to rely on only information from the manufacturers for information on new drugs.

It isn’t just the NEJM; the respected journal CANCER is also under fire for not reporting conflicts of interest. In a study published May 11, 2009, Reshma Jaagsi, MD, University of Michigan, analyzed 124 cancer clinical trials. He determined that studies showing almost twice the improved patient survival rate for a specific cancer drug were conducted by physicians with a financial conflict of interest. Unfortunately, CANCER comes in as the lowest conflict-of-interest journal when researchers analyzed similar data. The highest conflict-of-interest percentage, indeed, belongs to NEJM.

Even something as mainstream as the common flu shot is not immune: a recent study published by the British Medical Journal shows the reported effectiveness of a flu vaccine was much higher when the study was sponsored by the manufacturing drug company versus the results of a study sponsored by the government.

Who would have guessed?