July 11, 2006
A Major Failure at JAMA
Two years ago, in my role as director of the Integrity in Science project at the Center for Science in the Public Interest, I conducted a study that warned the editors of the Journal of the American Medical Association and other leading scientific journals that there was a persistent pattern of non-disclosure of conflicts of interest by physicians and scientists publishing original articles within their pages. At that time, CSPI said a voluntary disclosure policy needed teeth – a ban on publishing if an author failed to disclose – if it was going to work. The advice was ignored.
Today’s Wall Street Journal documented a major failure to disclose relevant conflicts by seven authors of a JAMA article involving the safety of anti-depressant use by pregnant women. At least two of those authors, including lead author Lee S. Cohen, a Harvard Medical School professor and director of the perinatal and reproductive psychiatry research program at Massachusetts General Hospital, had their conflicts of interest documented in the Integrity in Science Database at www.integrityinscience.org prior to publication of the article.
It’s clear now that the editors of the Journal of the American Medical Association take no steps to evaluate conflict of interest disclosures when articles are submitted. As a result, physician-authors with numerous conflicts of interest feel they can ignore the journal’s policy with impunity.
The only solution is to adopt strong penalties for authors who fail to disclose – a three-year ban from publishing in the pages in the journal. The International Committee of Medical Journal Editors should also make any ban by any of its member reciprocal.
Addressing this issue in his book, "Too Profitable to Cure," Brent Hoadley said: (reprinted with permission)
Manipulating medical journal articles
Doctors, regardless of what they would have you believe, are not gods. They may truthfully be unaware of the dichotomy of pharmaceutical research techniques. Nevertheless, from the articles and editorials that appear in medical journals, doctors should know that the once-revered publications have been cannibalized by the pharmaceutical corporations. If a doctor bases his treatment recommendations on material from suspect sources, isn’t he compromising more than his integrity? How about his patients’ lives?
In a 2003 article in The Observer, Antony Burnett, the public affairs editor, claims that many medical journal articles supposedly written by well-known academics or doctors, have in fact been “ghostwritten” by pharmaceutical companies. Although appearing in highly-respected publications, like The New England Journal of Medicine, the British Medical Journal, and The Lancet, these articles are actually nothing more than commercials—targeted at doctors and other health care professionals. Direct advertising to doctors, presented in the guise of scientific reference, is no more credible than Madison Avenue’s provocative images that entice patients to “ask your doctor about (insert name of drug).” E.R. Shell’s article titled “The Hippocratic wars” appeared in the June 28, 1998 edition of the New York Times Magazine. The article states that both NEJM and JAMA “are beholden to drug makers for their economic viability”; each takes in about $20 million annually from drug company advertising.9,10
This perverted view of science and education, sanctified by a professional association that represents practicing physicians amounts to little more than a mob-controlled workplace. If pharmaceutical corporations can be likened to the Godfather of a crime family, then the upper echelon of the AMA could be considered consigliores.