Today in Medicine: Judges or Defendants: Should the Journals be the Judges on Conflict of Interest?

July 2nd, 2007 By Alexandra Almonacid [mailto:aalmonacid@partners.org]

The American Medical Association, publisher of the Journal of the American Medical Association (JAMA), collected $40.6 million dollars in advertising revenue in 2005 (1), the large majority from the pharmaceutical industry (2). Yet according to the editor of JAMA, Catherine DeAngelis, MD, in a recent Wall Street Journal (WSJ) article (3), physicians should not accept fees from pharmaceutical companies for speaking engagements. “No doctor should be on a speakers bureau – none, zero.” She went on in the Wall Street Journal article to liken a physician who does such work to prostitutes.

According to the article on the WSJ.com health blog section, written by Jacob Goldstein, "she once said to a doctor who dodged a tough question during an industry-funded speech, 'Do you understand what prostituting yourself is? That’s what you just did.'”

There appears to be a growing backlash against the criticism from top-tier journal editors that physicians who are paid for speaking engagements, often at continuing medical education symposiums, are biased, but that journals who accept advertising revenue from the same companies do not have a conflict of interest. Evidence for the discontent can be found on the comments section following the WSJ article. "While no one thinks that conflicts don't exist or there are never problems with physician speakers, no one is looking at the elephant in the room—the journals, whose editors are pointing the fingers but whose advertising departments are accepting millions of dollars. A physician might get paid $500 to give a talk, but the journal is getting paid several hundreds of thousands of dollars for ads each week when it publishes a new issue. That sounds like a pretty big conflict. Maybe it's time JAMA took a look in the mirror."

Another contributor, referencing a quote from Dr. DeAngelis that “A couple weeks ago, the ad people came down and said, ‘You know, you’ve cost us $750,000 this year because you’ve turned down ads.’ I said, ‘Is that all?’”, responded in the comments section "This leads me to ask, How much money does JAMA and other medical journals make from pharma advertising if Catherine can shrug off $750,000 per offhand remark?"

Another contributor wrote that "DeAngelis’ opinion that she must protect the world from the evil companies only sheds more light that we all should wonder what the editors motives are. Maybe the goal is to end innovation through their own multi-pronged approach? Oh, and by the way, I wonder what interests each of the editors might have, or if we will ever uncover them? I doubt it, but I never doubt they have some".

And finally from another contributor "Having seen both sides (pharma and academia) in action, I am surprised by the hyperbolic attacks on Pharma and the sanctimonious treatment of Academia. Non-pharma articles in NEJM should be read with equal care if not more skeptically, since the authors are in my view, essentially selling their laboratories, theories, etc, to promote themselves, and receive grants from their peers who sit on review boards. I believe there are numerous documented examples in academia of skewed writing, data cherry-picking, and sometimes, fraud. While clearly Pharma is in the business to sell its products, I have found them to be more rigorous in the treatment of scientific data compared with academia, and am not aware of a paid physician or expert who did not present supported facts, or make statements that they did not believe were aligned with appropriate care of patients. I would appreciate a more fair and balanced approach to privately-funded research from people such as Ms. DeAngelis."

You can read more comments regarding the viewpoint of DeAngelis [|here]

In an opposing view, pharmaceutical companies argue that they have a mission to keep health care professionals well informed, and advertisement is just a way to provide the most accurate and updated information available regarding prescription medicines. According to the WSJ article, Dr. DeAngelis defended the Journal's acceptance of advertising money from the pharmaceutical industry by not placing the advertisements in the same section as research articles and requiring editorial approval on the content of the ads.

http://www.ama-assn.org/ama1/pub/upload/mm/37/2006annual-cfs.pdf (31 Dec. 2005).
 * 1) ref1 American Medical Association. (2005).  ama.org.

http://medicine.plosjournals.org/perlsev/?request=get-document&doi=10.1371/journal.pmed.0030130
 * 1) ref2 Fugh-Berman A, Alladin K, Chow J (2006) Advertising in Medical Journals: Should Current Practices Change? PLoS Med 3(6): e130.


 * 1) ref3 Goldstein, Jacob. (2007, June 27).  How to Rile Up the Editor of JAMA. wsj.com   http://blogs.wsj.com/health/  (27 June. 2007).