Unspiked But Defanged

This is a jaw dropper. The latest issue of the New England Journal of Medicine includes a version of the Robert Steinbrook article on the overuse of Amgen's erythropoietin. Last week, the Wall Street Journal reported that the original story had been spiked. Steinbrook, who is a national correspondent for the NEJM, then submitted the original piece to the Lancet, which ran it on December 23.

Is it possible that the editors of NEJM were so ashamed by the Journal article that they decided to run the story? If so, they haven't done themselves any favors. I won't be the only reader who will compare the two versions. Every mention of corporate conflicts of interest, which was the major subtext of the Lancet article, is missing from the NEJM version. Specifically, this information about the relationship between the drug companies and the National Kidney Foundation, which issued the guidelines leading to greater use of Amgen's drug (and is responsible for higher mortality from increased heart attacks and strokes) is gone:

The National Kidney Foundation guidelines . . . have been questioned for their reliance on expert opinion and because of the close relations between the Foundation, the Kidney Disease Outcomes Quality Initiative (KDOQI) that formulates its recommendations, and the drug industry. In fiscal year 2005, according to its annual report, the Foundation received $19·7 million—57% of its total support—from various “corporate and organizational partners”. In calendar year 2005, it received $4·1 million from Amgen and $3·6 million from Ortho Biotech, a subsidiary of Johnson & Johnson, the current marketers of epoetin products in the USA. Amgen supported the development of the anaemia guidelines and is acknowledged as “the founding and principal sponsor of KDOQI”. Of the 18 members of the workgroup, two-thirds disclosed financial associations with Amgen or other epoetin manufacturers or marketers.

Are the financial relationships between the drug industry and physician-led, industry-dominated "patient advocacy" groups like NKF now subject non-grata at the NEJM?