Truth and Transparency

A while ago, I got into a verbal skirmish with an investment banker. His bank invited and then disinvited me to a reception they were holding in conjunction with a conference I was attending. When I commented on the gaucheness of the disinvitation, the banker made an appeal to our shared difficulty in managing lists. But I was having none of it. The Bernie Madoff scandal had just hit the news, and we were starting to learn the scale of our national economic crisis, precipitated in part by something called "credit default swaps," an invention of investment bankers. So, I replied that as an editor, my mistakes appeared in print, in public, and were acknowledged and corrected in the same way. And as a holier-than-thou cherry on my supercilious cake, I added that it would be nice if all businesses—say hedge funds and investment banks, for example—operated with that level of transparency.

Michelle Hoffman

But what happens when publications take advantage of that presumed transparency to dupe readers and boost advertising revenues? That's what seems to have happened at Elsevier. According to late April reports in The Scientist, the publisher issued in the early 2000s the Australasian Journal of Bone and Joint Medicine, an ersatz medical journal that purported to publish reports about the successful clinical use of particular drugs—all of which were manufactured by Merck (Whitehouse Station, NJ). According to allegations, the journal was actually publishing reports written by Merck. In short, Elsevier was publishing advertisements and passing them off as objective, peer-reviewed articles.

The president of Elsevier is quoted in The Scientist article, acknowledging the practice and noting that the company has "affirmed our business practices as they relate to what defines a journal and the proper use of disclosure language with our employees to ensure this does not happen again."

Interestingly, not all in the pharmaceutical community feels there was any wrongdoing. One response to a post in the blog, "ADventures in Ethics and Science," suggested that Elsevier's only transgression was that it did not make it clear enough that the journal was sponsored by Merck. Another comment writer says:

I know all the medical blogs are going after Merck, but I think a more reasoned discussion is necessary. Merck has to advertise, and it has to be creative to get a message across. I think that there is an urban myth that physicians should learn about new drugs or indications or whatever by some pure, academic, non-monetary format. It doesn't happen. Physicians are seeing hundreds of patients, trying to pay their bills in a managed care environment, and there are thousands of medical products companies trying to tell them they need this or that. Sometimes, you just have to do something innovative to get the message across.

I agree that physicians are busy with patients and paperwork, but that's why they rely on medical journals—and their expert peer-reviewers—to provide an objective, uninterested assessment of the clinical uses of medications. To publish ersatz journal articles is not a clever marketing ploy; it is a deliberate attempt to make physicians use a drug that they think has been fully and objectively determined to be the best treatment for a particular medical condition, when in fact it may not have been.

The journal's practice came to light during a civil suit against Merck by a patient who claimed to have suffered a heart attack while on Merck's drug Vioxx (rofecoxib), The Scientist reported. Was the patient's health compromised by Elsevier's deception? That's unknowable. But it might have been. And other patients may have received less than optimal care because their physicians were misled by articles they read in the fake journal.

For those of us involved in publishing, this incident should remind us that we are not impartial observers and chroniclers of the drug-making process, but very much a part of it. By subjecting the articles we publish to rigorous peer-review, we are trying to promote the best practices in the discovery, development, and manufacture of drugs and, thus, bear some responsibility for the public's safety.

Peer-review is a very important quality control. Journals that merely pretend to conduct peer-review pervert the enterprise as much as accountants who, by producing phony financial statements, enable money managers to perpetrate Ponzi schemes masquerading as hedge funds.

Michelle Hoffman is editor-in-chief of Pharmaceutical Technology. Send your thoughts and story ideas to mhoffman@advanstar.com