Publishers are speaking out against a recent study that calls for a ban on advertising by pharmaceutical companies and device makers in medical journals to avoid potential conflicts of interest.
“The primary obligation of industry is to make money for its stockholders. The primary obligation of journals should be to physicians and their patients, who depend on the accuracy of information within these publications,” the study, appearing in this month’s issue of the nonprofit Public Library of Science (PLoS) journal PLoS Medicine, concluded. “Medical journals should not accept advertisements from pharmaceutical companies, medical device companies, or other industries relative to medicine.”
The study’s lead author, Dr. Adrianne Fugh-Berman of the Georgetown University School of Medicine in Washington, D.C., and associates analyzed ads in nine multispecialty medical journals and found the majority were for drugs and devices. For example, in the past 10 years, the percentage of pharmaceutical ads appearing in the Journal of the American Medical Association (JAMA) has not dipped below 95%, the authors contend.
The study also proposes that medical journals solicit drug ads by touting their low prices in comparison to consumer publications. The study claimed The New England Journal of Medicine (NEJM) charges drug advertisers $51 per 1,000 readers, compared with $86 to $110 per 1,000 readers charged by consumer magazines.
“It is disturbing that medical journals appear to have exclusive, largely undeclared arrangements with pharmaceutical companies,” the authors wrote. “It could even be argued that it is poor business practice to forego more lucrative advertisements in order to provide cut-rate advertising to manufacturers of drugs and devices.”
The study’s results have met with sharp criticism from publishers and industry advocates who argued the suggested ban, if ever enacted, would threaten the communication of vital information to physicians.
“The members of the Association of Medical Publications (AMP) feel that there is a strong relationship between editorial subject matter and the categories of products advertised,” Charlie Hunt, EVP of AMP, told MM&M. “As publishers, we do take issue with Dr. Fugh-Berman's suggestion that advertising introduces a potential conflict of interest. Not only are the publications that she specifically cites peer-reviewed at high standards, there is a well-structured division of ‘church and state’ between editorial and marketing. It may be worthwhile for Dr. Fugh-Berman to ask the editors of JAMA and NEJM , her journal examples, what types of firewalls have been put in place to protect that which she is most concerned about. … We encourage the open and free exchange of ideas and opinions.”
John Kamp, executive director of the Coalition for Healthcare Communication, called the study’s proposed ban on advertising a “goofy” idea, stating the study’s authors should instead thank drug companies for supporting robust medical journal independence.
“PLoS Medicine needs to take a basic course in the First Amendment and the history of American journalism,” he said. “Journals advance the science of medicine and play a critical role in the diffusion of innovation in clinical treatment, mostly at the expense of the drug industry. What the drug industry gets in the bargain is access to prescribers and the opportunity to be kicked around routinely by fiercely independent journal editors. For all its perceived faults, it's a great system that benefits doctors and their patients.”
Jim Dougherty, group VP, healthcare information, The McGraw-Hill Companies, and past AMP president, added, “In the decades that I have reviewed, traditional clinical journals have run ads for financial services, computer systems, office supplies, automobiles, etc., but readers have responded negatively to those ads. Readers expect to have advertising related to clinical practice in clinical journals. Most journals have a statement about the kinds of ads that they will accept in their rate cards. Advertisers have also balked. Do you want a glossy ad for your luxury automobile next to a clinical article featuring a photo of an oozing sore? I don't think so, and neither do the advertisers that I have spoken to.”
Dougherty further added, “Generating revenue from individual subscribers is a very expensive business. The costs of generating all of the solicitations for subscriptions adds up very quickly. Do you have any idea how much money publishers waste on all of those reduced rate subscription postcards that fall out of a magazine each month? A publisher needs to generate about $5 of subscription revenue to generate the same margin as $1 of advertising revenue. We could take the authors’ suggestion a step further and ban advertising all together. But then, an annual subscription would cost more than $1,000 and every other page would be solicitations to have the reader renew their subscription. Academic libraries are already squawking about the increasing cost of subscriptions. I suspect that individual physician readers would squawk much louder.”