Medical journals urged to publish positive drug studies — Quartz
Studies published in medical journals are an important way to provide evidence of the effectiveness of pharmaceuticals. Respected in the industry, journals like the Lancet or the New England Journal of Medicine (NEJM) are written for a scientific audience, peer-reviewed and provide information on the conflicts of interest of the authors of the article.
But there is one conflict of interest that medical journals often don’t disclose: their own. Journals often do not provide information on their revenue streams, so it is difficult, for example, to tell how much of their revenue comes from advertising, subscriptions and other sources.
While some of the influences – for example, drug manufacturer advertisements or sponsorships – are more visible, there are indirect ways in which journals are incentivized to publish studies that show the positive impact of drugs. Income from study reprints is particularly complicated.
Reprints make money
A reprint is a reproduction of a study or article published in a journal, often purchased in bulk. When a study shows positive results associated with a drug, the pharmaceutical company that manufactured it often purchases reprints for distribution to industry, often to promote the use of the drug to physicians and other prescribers.
Sales of copies of a study may not seem like a gateway to wealth, but purchases of reprints can be up to over $2 million each. This is a significant income, especially for large journals. The total annual revenue of Lancet is estimated at about 40 million dollars one year, while NEJM generates about $100 million-of which about a third is profit. Reprints are also more profitable than advertising because production costs are much lower, after Richard Smithformer editor of the British Medical Journal and long-time advocate for greater transparency in how the pharmaceutical industry influences journal publications.
Medical journals are published by medical societies (for example, the Massachusetts Medical Society owns NEJM) or specialty societies that own one or more publications, such as the Dutch company Elsevier, which owns The Lancet and other medical and scientific publications. They are edited and managed by expert researchers in the field, who evaluate papers submitted by scientists and decide which ones are worth accepting for publication. These papers are then sent to other scientists for peer review and then work on feedback with the authors. Peer reviews can lead to changes (although they often don’t), and sometimes cause documents to be withdrawn.
This, Smith explains, puts journal editors in a complicated position when it comes to publishing studies that assess a drug’s benefits through trials sponsored exclusively or in part by the drugmaker. If publishing a hypothetical industry-funded paper could offer a return of $700,000 in reprints, refuse to publish it — or even request more data with the risk that another publication might publish the study instead. – means giving up a large part of the income.
“It is an important income for the magazines. Seems like a small addition, but in 2011, 41% of The Lancet’s revenue came from the sale of reprints, so it’s not a minor issue,” says Harvard Medical Professor John Abramson. School and author of Disgustinga book about the profit-seeking role of big pharma in American health care.
The 2011 lancet revenue analysis is one of the few that was able to obtain reprint revenue data, and it is likely that many journals earned even more from reprints but did not disclose their data. But while the conflict of interest linked to the sale of reprints has been well known for a long time, there has been no improvement in the transparency of journals.
“I think what this indicates is the complete lack of transparency,” says Ivan Oransky, founder of Retraction Watch and professor of medical journalism at New York University. “Here are those journals that universally demand – and that’s a good thing – significant transparency and disclosure from their authors…but are in no way transparent themselves.”
The Lancet, the Journal of the American Medical Association (JAMA), and the International Committee of Medical Journal Editors did not respond to Quartz’s request for data and comment. The NEJM said it does not share revenue from individual Massachusetts Medical Society publications.
Quotes create impact
Further complicating the issue is that drug efficacy studies based exclusively on industry-supported trials are more likely to be published, representing up to 32% of the total number of published studies. And because they are often positive, they are cited more often, as they should be mentioned in subsequent studies based on their findings.
Journals benefit from being widely cited. Their relevance is quantified by the so-called impact factor, which reflects the volume of citations of articles from a specific journal. Thus, the more a study is likely to be cited, the more a publication has an interest in publishing it because it will raise its impact factor.
This makes industry-sponsored studies all the more attractive to journals. “It creates a conflict of interest in the medical journal industry, because then they have a financial incentive not to demand all the data, not to review it as critically as they would if they didn’t had no possibility of financial gain,” Abramson said.