Wednesday, March 2, 2011

Drug Money and Scientific Objectivity

A study published in the Canadian Medical Association Journal (CMAJ) confirms what we all suspected.  Drug money sullies the objectivity of medical journals.

Medical journals run the gambit from purely funded by subscription to those that are funded solely by advertising.  Some journals have both kinds of revenue.  The ad-supported journals get most of their business from pharmaceutical manufacturers.  These drug money supported journals are typically sent free to doctors around the world and have much larger circulation than the subscription supported journals.  These free journals are also less likely to be peer reviewed.

The CMAJ study examined 11 medical journals with distributions in Germany in 2007.  In addition they surveyed Canadian general practitioners to find what journals they rely on for up-to-date data.  The write-up states, “Our study shows that the tendency to positively recommend the use of a drug depends on the source of a journal’s funding . . . Free journals almost exclusively endorse the use of the selected drugs, whereas journals that rely exclusively on subscription fees for their revenue are more likely to recommend against the use the same drugs. . . . More than half of the doctors surveyed had used free journals as a source of information during the previous months.”

This kind of bias can be critical when adverse reaction to prescription medication is the sixth leading cause of the death, at least in the US (reported in JAMA several years ago).  This study was not specific to psychiatric drugs but it certainly has salience in the psychiatric field where many medicinal treatments have questionable benefit.  If the risk-benefit calculation is skewed, then neither doctors nor patients are making truly informed decisions.

We now know that people with severe mental illness have life spans that are 20 years shorter than the general population.  How much of that is a result of our pharmaceutical treatments?

Reference: Becker, Anette; et al.  Canadian Medical Association Journal (2011, March 1).  The influence of advertising on drug recommendations.

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