The Trouble with Medical Journals

Abstract

The Trouble with Medical Journals Richard Smith. London: Royal Society of Medicine Press, 2007. 292 pp. £19.95Very few laypersons read medical journals, especially the more pointed and esoteric variety, some of which deal with material of interest only to specialists in arcane areas such as neuropharmacology or forensic pathology or bizarre diseases such as kuru. But even if this were not the case and hundreds of millions of people who comprise the general public subscribed to BMG or JAMA, most of these readers would take little interest in the problems that beset these publications. Indeed, with only a handful of commonly articulated dilemmas (conflict of interest, the pharmaceutical industry's undue influence on research and patient choices, and misconduct), most readers are blithely unaware of the broad array of problems that Richard Smith discusses in this extraordinary and enticing study. As a former editor of BMG (originally, the British Medical Journal) and an articulate and incisively honest critic, Smith is the perfect person to offer these many often disturbing insights.The book is divided into seven sections (e.g., ethical accountability of researchers and journals) and 21 chapters (e.g., libel and medical journals). The trouble here is not always of an ethical nature, but even those problems that have to do, say, with leadership or the relationship between patients and journals are both intellectually stimulating and somehow ultimately do lead to an ethical subtext. But much of this study does concentrate on a plethora of ethical problems, most of which are not easily resolved. For example, editors were aware of researchers' conflicted interests decades ago, but only slowly have the major journals (BMG, The Lancet, JAMA, NEJM, The Annals of Internal Medicine) begun to stipulate that all financial conflicts must be articulated so that readers can immediately realize that what an author is discussing or advocating (even in the unsullied description of a randomized clinical trial) may be tainted. Since this has been going on for so long, one might have expected that by 2011, when every research article in JAMA, for example, offers a page of personal admissions, that the problem would have been resolved. But ongoing revealed conflicts indicate that authors are either naive, confused, or dishonest. On March 23 and again on March 28-29, 2009, David Armstrong, in The Wall Street Journal, reported that a university professor had failed to indicate, in a JAMA article, that he had received compensation from the company that produced the drug he had studied. The revelation by a third party produced a major brouhaha, because JAMA's editors were incensed by what they felt was a breach in confidentiality (although this appears to be untrue), and reacted badly.Medical journals publish both poor (soft) science, which biologists and chemists disrespect, as well as non-scientific materials in order to maintain interest among the broad array of readers whom publishers wish to attract, because the larger the readership, the greater the profit, and now even noncommercial (organizational) publishers are interested in generating monies; conflicts of interest run rampant; pharmaceutical companies and their research sponsorships as well as their advertisements (sometimes paired with studies of the marketed product) unduly and unfairly influence the dissemination and use of specific drugs; misconduct (falsification, fabrication, and plagiarism) continue to haunt the publication of scientific papers; peer review remains a tainted system; the concept of authorship is extremely confusing, even to the authors involved; and political maneuvering and advocacy are highly controversial for medical journal editors, who are forced to make difficult choices when it comes to national health care insurance or other touchy social subjects. …