A stand against drug company advertising

Emergency Medicine Australasia (EMA) has taken a stand against drug company advertising in medical journals by making a decision to no longer publish such advertisements in the EMA journal. At the Editorial Meeting in Canberra last November 2010, and with the support of the Councils of the respective owners of the journal, the ACEM and the Australasian Society for Emergency Medicine, the Editors and Editorial Board of EMA unanimously upheld a motion to no longer accept drug advertisements. This followed extensive debate on the growing evidence about the detrimental effects of the drug industry in medicine. Among the issues discussed were that the industry, one of the most profitable in the world, distorts research findings, such that drug company sponsored research is approximately four times as likely to be favourable to its product than independently funded research; authors of company-sponsored research are far more likely to recommend a company’s drug than independent researchers, and researchers with industry connections are more likely to publish data favourable to a company’s product than those without; selective reporting of results by industry is likely to inflate our views of the efficacy of company products; the drug industry has been shown to engage in dubious and unethical publishing practices, including guest and ghost authorship, and to apply pressure to academics to withhold negative findings; and the industry spends enormous amounts of money on advertising, which has been shown to change the prescribing practices of doctors, increasing sales in a dose-related manner to the volume of advertising. Meanwhile doctors (and indeed journal editors) generally deny that they are influenced, yet clearly they are. The editor of the Australian and New Zealand Journal of Psychiatry reportedly said on an ABC Radio interview in 2002, when questioned about all the drug company advertisements in that journal, and in particular the glossy advertisement encasing the journal: ‘Our doctors are not stupid, and they will simply rip the wrap-around and dispose of it. . . . Nobody is gullible’. The authors who pointed this out were critical of the journal’s policy, and suggested that it might compromise the editorial independence of the journal, a point unfortunately disputed by the editor in reply. Drug companies value drug advertising in medical journals because it works. It is regarded as highly effective by pharmaceutical marketers, generating at least US$2-5 in revenue per dollar spent, with returns growing in the long term. But this works both ways. Medical journals have equally played a big a part in the problem. Large medical journals keenly solicit drug advertisements as evidenced by adverts they themselves place in publications such as Medical Marketing and Media (MMR), a publication aimed at drug companies. The New England Journal of Medicine (NEJM) for example, in the November 2003 edition of MMR highlighted its value to the drug industry in these terms: ‘Place your ad in the NEJM and make our relationship with the medical community yours’. Some large journals even tout their ability to reach particular target groups of high-prescribing physicians such as cardiologists and oncologists through flyers and inserts placed in subsets of their journal mail-outs. The NEJM has, for