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Shaukat Ali Jawaid
 

 

Medical Journal Editors getting
payment from Pharma,
Medical Device industry?
 

ShaukatJawaid 

Academic Medicine is getting polluted with the every passing day. Previously it was researchers who were blamed to receive financial incentives to give positive results of research projects, clinical trials, suppress negative results.1 Now comes the shocking revelations that about half the editors of the most prestigious medical journals in United States receive payments from the Pharma or medical device industry. The study conducted at University of Toronto, Canada published in a recent issue of British Medical Journal reports that only 30% of these journals make it clear to their readers about their policies regarding such conflict of interest. This raises an important question regarding independence and objectivity of these medical journals which are considered as the primary source of information for healthcare professionals in particular and public at large.2

The BMJ study is reported to have looked at industry payment to editors which were reported to Open Payments as consulting fees, speaker’s bureaus, and meal and travel reimbursements. Another study conducted by University of Hawaii/UC-San Francisco looked at similar payments but also included payments to the home institution of the editor. Editors of medical journals, it must be mentioned here are the gatekeepers who determine which study should be published and which should be highlighted in the media. Hence, if these editors are influenced by industry payments, either through cash payments or research funding or financial assistance provided to their home institution, it raises concerns about their authenticity and credibility. According to Michael Joyce writer-producer at HealthNewsReview.org the researchers estimated payments by looking at 2014 data from Open Payments database and investigated fifty two highly influential medical journals related to twenty six specialties. Payments received by the editors ranged from three thousand US dollars but two editors are reported to have received over one Million US dollars. Editors affiliated with Endocrinology, Cardiology, Gastroenterology and Rheumatology Journals are reported to have received highest payments.2 In Pakistan too, these along with oncology and psychiatry (all related to chronic diseases) are the main specialties which has too many professional groups, societies and associations which all organize their academic activities all sponsored by the pharma, medical device industry and unfortunately all this is then paid by the poor patients.

The Hawaii and San Francisco study specially focused on industry payments to Physician Editors. Its major findings were that nearly two-thirds of physician editors from thirty five influential medical journals received industry payments over a forty one month study period. More than one in seven received over ten thousand US dollars directly, 44% of the cardiology editors received over US$ 10,000/- in 2015. Since both these studies were retrospective and observational in nature, neither of these studies can definitely claim that industry payments clearly affect editorial decisions.

It is felt that it is important that the Editors of Medical Journals should declare their actual and potential conflict of interest. BMJ has a practice wherein editors are required to fill out a Conflict of Interest Forms just like the authors and this is listed on the BMJ website. At every editorial board meeting, BMJ has a policy for the editors to reveal their financial and non-financial conflict of interest with the paper under discussion. If there are any such interests, that particular editor does not participate in the discussion or may not participate in that meeting.

Medical Journal Editors are considered to be Key Opinion Leaders within their specialty. Dr. Victoria Wrong the lead author of the University of Hawaii/UC San Francisco study feels that “some physician-industry relationships are beneficial and can result in novel therapeutics or other medical contributions”. However, at the same time these leaders are more likely to have multiple source of funding that could pose real or perceived conflicts of interests. In an interview with Retraction Watch, she further stated that “It would be ideal for most editors to have some significant research experience but not at the expense of losing objectivity and transparency. In case of more funds coming from industry, there is greater chance that it will affect the editorial decisions which may not be objective”.

If all this was not enough, the publishers of medical journals have also been added to this list and they are blamed that “Reprint and supplement payments to publishers could easily be a source of bias”. Leading medical journals make lot of money by selling Reprints which are then distributed among the healthcare professionals hence it could easily be a source of bias reports Dr. Michael Callahan co-author of UC-San Francisco study. Papers published in the sponsored “Supplements” it is alleged do not undergo the same rigorous peer review process. Various professional bodies of medical editors like International Committee of Medical Journal Editors (ICMJE), Committee on Publication Ethics (COPE) as well as World Association of Medical Editors (WAME) have published detailed Guidelines addressing the issue of Conflict of Interest but since they are not mandatory and compliance is voluntary, it has failed to achieve the desired objective.

In view of all this, integrity of research, Medical Journal Editors as well as Medical Journal Publishers have become very questionable. If this is the situation in a developed country with lot of checks and balances, accountability process in place, what would be the real situation in developing Third World countries where the accountability is non-existent is not difficult to imagine. Pakistan Association of Medical Editors (PAME) the registered body of medical editors in Pakistan should watch all such developments and caution its members to be extra careful. In order to ensure that their image, credibility is not eroded and they do not start losing public confidence and trust, all the stakeholders must uphold professional ethics, enforce transparency and must be prepared to offer themselves for accountability.

REFERENCES

  1. Ensuring integrity of research remains an uphill task http://www.pulsepakistan.com/index.php/off-the-records-oct-15-16
  2. Michael Joyce. Why we should care that many editors of top medical journals get healthcare industry payments. http://www.halthnewsreview.org/2017/11/158902 Accessed on November 16, 2017
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