Healthy Skepticism Library item: 19940

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Magazine

Hansen K
Are medical publications selling out?
Australian Medicine 1999 July 1910-11

Abstract:

Pharmaceutical advertising makes up a considerable bulk of the medical magazines sent to doctors and, in many cases, these advertising dollars are the lifeblood of the publication. So what effects does this have on the editorial content of the journal?

Full text:

Long legged beauties lolling about in swimming pools sell the message of the ‘calming influence’ of antidepressants, while advertisements in the shape of a steering wheel, urge that a hypertension drug, like an air bag, will ‘protect your patients’ vital parts’.

Numerous studies show pharmaceutical advertising influences doctors’ prescribing habits, but how much sway does it have in driving the publication’s editorial agenda?

Australian Medical Writers Association President, Dr Amanda Caswell, said as a former features editor at the weekly tabloid, Australian Doctor, she found the writers were ‘blissfully ignorant of which companies made which drugs’.

‘It never crossed my mind to think oh – they’ve been advertising a lot I better do a nice story about them’.

However she believes there are examples, although uncommon, of unethical journalists who write article purported to be independent.
‘I suspect there are cases where pharmaceutical companies, through PR companies, deliberately try to influence journalists through offering rewards.

‘At the more insidious extreme [rumours suggest] these rewards are… cold hard cash’, Ms Caswell said.

Head of the Department of Pharmacology at the University of Melbourne, Professor James Angus, said he had an ‘horrific’ first hand experience of an international pharmaceutical company interfering with the editorial independence of an eminent British journal. Professor Angus had documented evidence showing that the drug company – which would be adversely affected were the study to be published – obtained information about his study whilst it was being reviewed by the journal’s editorial board.

‘It became apparent from letters of complaint [written by the drug company] that confidential editorial board comments must have been passed on’, Professor Angus said.

‘Scientists within the pharmaceutical industry are often members of editorial boards, it is always assumed that they will act impartially.
‘I am appalled to contemplate that [the pharmaceutical company] is privy to confidential correspondence regarding the reviewing process.
‘It’s very, very distributing… that publication could be delayed for commercial reasons’.

Professor Angus’s study was eventually published but only after an unusually lengthy delay. Deputy Editor of Modern Medicine, Josephine Inge, acknowledges the realities of advertisers being ‘the bread and butter’ of publications.

We seek to provide objective and accurate information to readers at all times, whilst being sensitive to advertisers’.

This meant being tuned in to advertising possibilities. ‘If there are important new drugs coming out, we will try to give it coverage… and we will be aware of the advertising opportunities’.

This could mean contacting relevant advertisers to let them know an article on a particular topic was likely to be run, she said. However, they were never permitted to read the article prior to publication.

Australian Pharmaceutical Manufacturers Association (APMA) chief executive, Pat Clear, said he expected it was not unusual for publications to target drug companies when they knew an article of interest to the company was coming up.

Ms Inge points out that Modern Medicine is in a unique position to ensure editorial independence because of the review process of the journal. Studies must be scrutinised by two specialists and a GP before they are considered for publication.

However, she said it was naive to think that publications did not develop relationships with advertisers.

Former editor of the Medical Journal of Australia (MJA), Dr Laurel Thomas, admitted that financial constraints had forced the journal to permit advertisement to be placed near editorial on related topics. ‘We all hope that an economic upturn will allow us to return to the purity of former days’, she wrote in response to letters of complaint from doctors at the time.

Current MJA editor, Dr Martin Van Der Weyden, said running editorial and advertising material on the same subject next to each other would now only occur if by accident. As stipulated by the MJA’s policy regarding advertising, it should be avoided.

The MJA’s code also states: advertising must not be allowed to influence editorial decisions; readers should be able to distinguish readily between advertising and editorial material; advertising should not be sole on the condition that it will appear in the same issue as a particular article; and journals should not be dominated by advertising.

While the MJA complied with these particular guidelines, the tabloids were under no obligation to subscribe to them, nor were they subject to peer review, Dr Van Der Weyden said.
‘There are laws for the geese and laws for the ganders’.

Australian Medicine editor and former Australian Doctor news editor, Anne Messenger, said that in six years as a medical writer she has seen little to suggest the dollars drug companies pour into advertising influenced editorial outcomes in specialist publications.

‘It’s quite the opposite. I’ve seen examples of journalists resigning, or putting their jobs on the line, rather than being directed to pull stories because of pressure from a pharmaceutical company’.

Despite being aware of the publication’s ethical guidelines, drug companies do try to have stories changed or made favourable to them, occasionally withdrawn, Ms Messenger said.

‘That’s part of their business, but it can make it quite stressful for an editor’.
Australian Doctor editor, Kellie Bisset, said medical publication were far from being in the pocket of the drug companies.

‘It makes me quite cross when you hear [those kinds of accusations]… because nothing could be further from the truth.

‘It’s drummed into everybody who works here that editorial independence is paramount’.

More concerning is the mainstream press’ reliance on media releases, Ms Bisset said.

‘It’s very press release driven… You’ll see stories straight from a press release that obviously haven’t had any balancing comment sought, and almost amount to a free ad’.

The pharmaceutical industry is vital to the funding of medical research and as Professor Terry Campbell, Chair of the Therapeutic Advisory Committee of the Royal Australasian College of Physicians points out, advertising provides a valuable source of information for doctors.

‘Unfortunately doctors don’t have time to read original sources of studies of new developments in drugs… so advertisements and drug reps become their main source of education’, he said.

‘In an ideal world this information should come from an independent source, but that’s not how it works, so you need to be pragmatic’, Professor Campbell said.
There’s no gain in ‘killing the goose that lays the golden egg’.