Health Sciences Institute e-Alert
June 20, 2002
There was a seismic shift in medical journalism last week, and the Chicago Tribune headline said it all: "Top Medical Journal Eases Ethics Policy."
For those of us who look to the journals for reliable medical reporting, this is not good news. But there really isn't much we can do about it at this point other than marvel at the absurd statements that are being offered to defend this astounding lapse of judgment.
Standards going South
The "top medical journal" in question is the New England Journal of Medicine, once a paragon of virtue with the strictest conflict-of-interest standards among medical research publications. But all of that went South when editor Jeffrey M. Drazen and executive editor Gregory D. Curfman co-signed an editorial that conceded defeat to the blizzard of drug company bucks. They certainly tried to put a good face on it, which brings us to Absurd Statement #1: "With these modifications in policy, we can prevent financial interests from infringing on the editorial content of the Journal."
Nice try, guys! But what's really happening here is the exact opposite: financial interests have deeply infringed on the editorial content of the NEJM. Drazen and Curfman are trying to make it sound like they're fighting the good fight when they're actually lying down and throwing in the towel.
The fact is, the Journal is completely reversing the rules regarding conflict-of-interest for authors of review articles and editorials. The old NEJM policy stated that authors may not have ANY financial interest in a company (or its competitor) discussed in an article. That seems reasonable. After all, if Doctor Smith is singing the praises of Brand X, and if the makers of Brand X have written Doc Smith a fat check, you would have to consider his "expert" opinion to be little more than a paid advertisement.
The new policy adds just one word. But what a big word it turns out to be. Between "any" and "financial" now insert "significant." And what's the going rate of "any significant financial interest?" Any amount of gifts or money that exceeds $10,000. So, for instance, a set of the finest golf clubs, two first class airline tickets to Palm Springs, a week in an Executive Suite of a four-star hotel, and a couple thousand dollars in spending money for meals and greens fees would not be considered significant.
Did someone change the definition of "significant" when I wasn't looking?
Payday for influence
For a moment, let's pretend we were born yesterday and ask, "Why would they do this?" Which brings us to Absurd Statement #2: Editor Drazen claims that without this policy change NEJM won't be able to find any experts to contribute reviews or editorials who have not accepted money or gifts from pharmaceutical companies because "there are not enough of them around."
So what Drazen would have us believe is that nearly every doctor and researcher who is qualified to offer an expert opinion has accepted gifts, stipends or cold cash from major drug companies — but not more than $10,000. More amazing is that he would also have us believe that $9,999 would not influence an author to bias an article to benefit his benefactor.
Is anyone buying ANY of this?
At least one person is: Dr. Catherine DeAngelis, editor of the Journal of the American Medical Association, who gives us Absurd Statement #3: "I really think this is much ado about nothing. The New England Journal joined the rest of us by adding the word, 'significant.' That's all that's new."
Put another way, anyone who is surprised by this is, supposedly, naive. DeAngelis and Drazen are saying they've seen the flood of drug money pouring over the dam and can't do a thing about it. Then they try to shrug it off as if they're innocent bystanders with no power and no responsibility.
I really don't know which situation is worse here: the editors who are willing to compromise the integrity of their once venerable journals, or the belief that drug money has stuffed the pockets of just about every qualified author.
Looking ahead, it's easy to see the clear message that this relaxed journalistic integrity will send to young medical authors just starting out: it's fine to accept some money, even a lot of money, but just don't exceed the "significant" limit.
I'll let Dr. DeAngelis have the final Absurd Statement – #4: "What matters is the quality of their opinions. Is the article balanced? Is it fair? Is it true? Bias has a distinct odor, and it's up to us to smell it before publication."
And after publication, what's that distinct odor that lingers? Drug company money. Lots of it. And plenty more where that came from.
To Your Good Health,
Health Sciences Institute
"Financial Associations of Authors" The New England Journal of Medicine, 346:1901-1902
"New England Journal Loosens Rules on Authors' Ties to Firms" The Wall Street Journal
"Top Medical Journal Eases Ethics Policy" The Chicago Tribune