Healthy Skepticism Library item: 19292

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Publication type: news

Widely read free medical journals hype drugs: study
Reuters 2011 Feb 28
http://wtaq.com/news/articles/2011/feb/28/widely-read-free-medical-journals-hype-drugs-study/

Full text:

Free medical journals crammed with glossy ads could be swaying doctors to prescribe new expensive drugs with unknown long-term risks, German researchers said Monday.

They found the journals, which are financed by pharmaceutical company advertisements, are much more likely to recommend new medications than journals paid for by subscribers.

“In the journals you get for free, there were almost only positive recommendations,” said study author Dr. Norbert Donner-Banzhoff, of the University of Marburg. “But in the journals you have to pay for, in most instances the articles were critical.”

And that’s a problem, Donner-Banzhoff said, because free journals are an important timesaver for physicians who don’t have time to keep up with the more technical peer-reviewed journals.

That shortcut may end up leading to questionable treatment decisions, however.

“There is no free information,” said Donner-Banzhoff. “We have to pay, either with money or by getting biased information.”

The researchers, whose findings appear in the Canadian Medical Association Journal, mined several German journals for articles on a range of heavily promoted newer drugs, such as Merck’s cholesterol drug Zetia.

Among five free journals, there were 253 articles encouraging use of the new drugs in 2007, while only one article was negative and two were neutral.

In two of those publications, the chances of finding a positive drug recommendation more than doubled when an ad for that drug appeared in the same issue.

Journals with subscription fees offered far less advice on the new drugs, however, with three positive recommendations, three neutral ones and 28 negative.

Sometimes called “throwaway” journals, the free publications mostly contain boiled-down research summaries and opinion pieces. They also offer continuing medical education, which many doctors need to maintain their medical license. They are not the same as open access, peer-reviewed journals, which are also free to read but are made available online and contain original research.

“I have long been concerned about the effects of drug company advertising, sometimes quite covertly, masquerading as education, on the prescribing habits of doctors,” Dr. George A. Jelinek, of the University of Melbourne in Australia, told Reuters Health in an email.

It’s estimated that drugmakers generate $2 to $5 for each dollar spent on advertising in medical journals.

Jelinek is past editor of Emergency Medicine Australasia, a peer-reviewed journal that decided earlier this year to no longer publish ads for drugmakers.

Although the journal’s price rose slightly after the unusual move, Jelinek said he suspects the number of subscribers will actually increase, because of the clear stance against ads.

“The evidence suggests strongly that doctors’ prescribing habits are influenced by these practices, leading to the widespread prescription of drugs of dubious benefit,” he said.

New medicines are far more expensive than older generic ones, and doctors have less experience with how people react to them.

“That presents a risk for patients,” Donner-Banzhoff said, “because they get a new drug with unknown long-term effects.”

A commentary published with the new findings noted that direct-to-physician pharmaceutical promotion has led to “widespread inappropriate use of drugs,” including Merck’s withdrawn painkiller Vioxx.

Vioxx has been linked heart disease, and researchers estimate it caused nearly 40,000 deaths before it was taken off the market.

“Doctors need to be aware of the degree to which their clinical practice is influenced by the drug industry, and actively take steps to distance themselves from this commercial bias,” Jelinek said.

Advanstar Communications, which publishes free medical journals in the U.S., could not be reached immediately for comment.