医学期刊的麻烦

Q2 Arts and Humanities Journal of Information Ethics Pub Date : 2011-10-01 DOI:10.5860/choice.44-3908
R. Hauptman
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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. 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引用次数: 0

摘要

医学期刊的麻烦理查德·史密斯。伦敦:皇家医学学会出版社,2007。很少有外行阅读医学杂志,尤其是那些比较尖锐和深奥的杂志,其中一些只涉及深奥领域的专家感兴趣的材料,如神经药理学、法医病理学或奇怪的疾病,如库鲁病。但是,即使事实并非如此,数亿人组成的普通公众订阅了BMG或JAMA,这些读者中的大多数也不会对困扰这些出版物的问题感兴趣。事实上,只有少数几个常见的困境(利益冲突,制药行业对研究和患者选择的不当影响,以及不当行为),大多数读者都不知道理查德·史密斯在这本非凡而诱人的研究中讨论的广泛问题。作为《BMG》(原《英国医学杂志》)的前编辑和一位口齿伶俐、直言不讳的评论家,史密斯是提供这些经常令人不安的见解的最佳人选。这本书分为七个部分(例如,研究人员和期刊的道德责任)和21章(例如,诽谤和医学期刊)。这里的问题并不总是伦理性质的,但即使是那些与领导或患者与期刊之间的关系有关的问题,也都是智力上的刺激,并以某种方式最终导致道德潜台词。但这项研究的大部分确实集中在过多的伦理问题上,其中大多数都不容易解决。例如,编辑们在几十年前就意识到研究人员的利益冲突,但直到慢慢地,主要期刊(BMG、the Lancet、JAMA、NEJM、the Annals of Internal Medicine)才开始规定,所有的财务冲突都必须明确,这样读者才能立即意识到作者所讨论或倡导的内容(即使是在一项随机临床试验的干净描述中)可能受到了污染。由于这种情况已经持续了很长时间,人们可能会期望,到2011年,例如,当《美国医学会杂志》(JAMA)上的每篇研究文章都提供一页个人承认时,这个问题就会得到解决。但持续不断的冲突表明,作者要么天真,要么困惑,要么不诚实。2009年3月23日和3月28日至29日,《华尔街日报》的大卫·阿姆斯特朗(David Armstrong)报道,一位大学教授在《美国医学会杂志》(JAMA)的一篇文章中没有表明,他从生产他所研究的药物的公司那里获得了报酬。第三方的披露引起了轩然大波,因为《美国医学会杂志》的编辑们被他们认为违反了保密规定(尽管这似乎是不真实的)所激怒,并做出了糟糕的反应。医学期刊既发表生物学家和化学家不尊重的“软”科学,也发表非科学材料,以保持出版商希望吸引的广大读者的兴趣,因为读者越多,利润就越大,现在甚至非商业(组织)出版商也对赚钱感兴趣;利益冲突猖獗;制药公司及其研究赞助及其广告(有时与市场产品的研究相结合)不适当和不公平地影响特定药物的传播和使用;不端行为(伪造、捏造和抄袭)继续困扰着科学论文的发表;同行评议仍然是一个受污染的系统;作者身份的概念是非常混乱的,即使是作者;对于医学杂志的编辑来说,政治操纵和宣传是极具争议的,当涉及到国家医疗保险或其他敏感的社会话题时,他们被迫做出艰难的选择。…
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The Trouble with Medical Journals
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. …
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Journal of Information Ethics
Journal of Information Ethics Arts and Humanities-Philosophy
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