Wednesday, April 17

A flawed system: why scientific journals tend to publish positive articles about new drugs

They serve to disseminate, confront ideas and keep the complex machinery of medical research oiled, but often the studies on drugs published by specialized journals are also a valuable weapon of promotion. Nothing better to sell the virtues of a medicine to a doctor than to put a positive scientific article on his table. One also endorsed by control mechanisms, peer review and, incidentally, the publisher’s own seal. For years, however, there have been voices warning of the possible risks of this practice.

Your fears can be summed up in a very simple question. Given that journals charge for reprints, can they be incentivized to publish positive studies on drugs, articles that they know, or can at least intuit, that the companies that own the drugs will then reprint in large numbers for distribution to doctors and the rest of the industry? ?

What are reprints? Broadly speaking, a reprint can be defined as the reproduction of a magazine article. If a study on a drug shows positive results, it is not uncommon for its manufacturer to hire a few copies to send to prescribers. “Physicians frequently read reprints as a useful way to keep abreast of the latest developments in their field,” says Elsevier, the publisher responsible, among other journals, for The Lacent: “They are a reliable and attractive way to inform health professionals, giving pharmaceutical companies the opportunity to engage their audiences and build trust in their products.”

According to the percentages published by Elsevier itself in the section of its website dedicated to reprints, in 2015, 79% of health professionals read reprints, a proportion that two years later had risen to 88%. “Next to peer-reviewed journals, reprints are the most trusted source of information for clinicians: 90% find them useful to their practice, 84% say they are a reliable source of information, and 82% say reprints allow them to stay up-to-date”, adds the publishing house, one of the most important in the sector at an international level and which offers both paper and electronic copies.

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How much do they cost for publications? A study published in 2010 in PLoS Medicine concluded that reprints accounted for 23% of the income of the Massachusetts Medical Society, 41% of The Lacent and 53% from the American Medical Association. Another report, released in 2012 in BMJProvides some other interesting information. For example, it is not strange that orders are made wholesale, in quantity. 62% of reprint orders for The Lacent in fact exceeded 100,000 copies. As for its cost, in the cases analyzed for the study, the average ranged between 4,000 pounds for the cheapest orders and 287,300 for the most expensive ones.

Quarz points out that the purchase of reprints can exceed two million dollars, a significant amount that has an extra attraction: they are more profitable than advertising because their production costs are lower. “The profit margin on reprint sales is high, around 80% […]. Reprint sales have been and continue to be a major source of profit for many medical journals,” Richard Smith, former editor of Precisely, commented on his blog in 2018. British Medical Journal (BMJ).

A matter of promotion… and imageThe reprints they are such a lucrative source of income that Smith associates them with many journals’ misgivings that commercially funded studies are published under an open, CC-BY license, which would undermine their business. Basically, he adds, the key is in the image. “Most of these big reprint sales are to pharmaceutical companies. Companies use reprints for promotion. We might like to think that doctors will be grateful to receive high-quality scientific information from journals, but I suspect that few read reprints. The objective is simply to associate your medicine with a prestigious brand such as New England Journal of Medicine“.

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impact factor. The investigations that have approached the subject leave two other interesting ideas. For example, studies sponsored by the pharmaceutical industry are more likely to be published in journals with a higher impact factor (IF) than studies without industry funding. Another is that company-backed trials are cited more often. “Omitting them from the IF calculation decreased those of the journals,” concludes another analysis.

“Journals want to be read. So everyone is trying to get a high impact factor. To do this, you need to be cited by other authors. And nothing boosts ratings like a Big Pharma-produced blockbuster. They have the contacts and the sales force to make any study a milestone,” says nephrologist and essayist Jason Fung on Medium.

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What is the suspicion of the critics? Although Smith points out that sales of reprints have probably fallen, at least in the UK, with the Sunshine Medical Payments Act, and that in the case of the The MBJ They are no longer a prominent source, he points out that they still are for many magazines. The question is, could that incentivize them to publish positive drug studies? In 2012, a group of researchers asked themselves the same question and wrote an article that was published in MBJ. After their analysis, they concluded that the most reprinted articles were more likely to be financed by the pharmaceutical industry and also recognize that the business sometimes moves considerable amounts of money for publishers.

Does this mean that medical journals are actually more inclined to those studies that, they suspect, will result in large commissions? reprints? In their study they draw a link, but they recognize that with the data on the table they cannot go that far. “Reprint requests could potentially be a source of publication bias, although our study was not designed with this in mind. There was no evidence of an overall study association with reprint requests, although this may differ by journal,” they conclude. .

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The lack of transparency, key. One of the great handicaps when studying the possible effect of reprints is the lack of transparency in the sector, a criticism shared by those who have dealt with the subject, such as Smith or the professor of medical journalism at the University of New York Ivan Oransky . “Magazines are much less transparent than publicly traded for-profit companies,” laments Smith, who even acknowledges that “when there is a balance between transparency and their financial interest, they go for the money.” The published analyzes have been largely achieved thanks to the information he has contributed The Lancet or the MBJ itself.

Reprints are not the only sore point. Reprints are not, in any case, the only point in which the relationship between the companies or societies in charge of publishing magazines and the pharmaceutical industry is complicated. Fung points to other factors that, he emphasizes, can threaten evidence-based medicine itself, such as advertorials, financial conflicts of interest, or “bribes” of publishers. A 2017 article from the British Medical Journal concluded that 50.6% of the editors of the medical journals they were able to analyze received money from the industry.

Images | Myriam Zilles (Unsplash) and National Cancer Institute (Unsplash)

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