Ads, reprints stoke concerns

(Reuters) - Medical journals and their publishers often take money from the companies whose products they write about.

Drugmakers order reams of reprints of articles that promote their medicines, for instance, which are then distributed to practicing physicians by drug representatives.

According to Barbour of PLoS Medicine, a company may order as many as 500,000 copies of an article about a blockbuster drugs. That can amount to a substantial income for the publisher, and might be seen as a competing interest for the journal, she said.

And drugmakers sometimes sponsor publications on specific topics. In testimony before the UK Parliament in May, that prompted Fiona Godlee, editor-in-chief of the journal BMJ, to call journals "the marketing arm of the pharma industry."

Many journals also keenly solicit ads from companies that wish to reach doctors and scientists.

The Journal of Investigative Dermatology, for example, writes on its website that its publisher, Nature Publishing Group, offers "a range of services to companies to support promotional and educational activities."

"Subscribers include researchers and members of numerous societies," it goes on, "as well as leading scientists and decision-makers from multinational companies."

Likewise, every issue of BJD sports a handful or so glossy full-page ads for skin products such as moisturizers and acne drugs.

And those ads work: For every dollar spent, companies generate between $2 and $7 in revenue, according to a 2006 report by Georgetown University researchers.

That, in turn, means drug marketing sways medical practice -- a fact that has some experts concerned.

Earlier this year, an Australian medical journal decided to pull the plug on drug ads.

"Essentially, our subscribers had to pay more for the journal," Dr. George Jelinek, past editor of Emergency Medicine Australasia, told Reuters Health in an e-mail.

"We believe that is perfectly reasonable," he added, "and far preferable to having a dependence on drug company revenue, a dependence which ultimately requires some repayment."

In an editorial from February, Jelinek and the journal's current editor, Dr. Anthony Brown, said doctors are clearly influenced by ads, although many deny it.

Because the claims made in ads are often not supported by quality evidence, they run counter to the purpose of medical journals.

"The duty of drug companies is to make profits for their shareholders," Jelinek and Brown write, "which is in conflict with the ethical duty of doctors to provide sound, unbiased advice for their patients."

Ad sales may account for as much as 10 percent of a journal's revenue, they add, which may explain why only very few medical journals, such as PLoS Medicine and now Emergency Medicine Australasia, don't carry them.

"We're very aware that things that we publish will have a direct effect on patients," said Barbour. "Our role is in the accurate dissemination of scientific and medical research. That is what we should be doing."