Medical journals and industry ties

Shift in culture

Why are we doing this? The first reason is that making clinical decisions based on information biased by commercial interests can cause harm, as happened with cardiotoxicity from rosiglitazone and rofecoxib5 6 and continues to happen with hydroxyethyl starch.7 We also believe that the educational content we publish will have more impact if readers can trust it. We know that readers consider research papers written by authors with declared financial links to industry to be less important, relevant, rigorous, and believable8 9; they are also less willing to prescribe drugs evaluated in such papers.9 Finally, we want to encourage a shift in the culture of medicine. We think that we can help to do this by promoting authors without financial ties to industry and offering them appropriate prominence and visibility.

Financial competing interests are endemic to the culture of medicine and are rarely driven by malign motives or actions. The mechanisms of influence are diverse. An author of a review article might be an advisory board member for companies selling drugs for that condition, a commentator might have received honorariums from industry for lectures on the topic, or an editorialist on a disease might be a patent holder for one of its diagnostic tests. Psychological research suggests that biases may operate subconsciously.10 Our decisions not to proceed with an article or an author are not made lightly. Nor are they intended to pass judgment on an author’s integrity. However, we cannot ignore the mounting evidence of systematic attempts by commercial interests to corrupt the literature and influence clinical decisions. Internal company documents revealed during litigation expose practices aimed at influencing clinicians such as funding medical meetings, dinners, studies, and articles.10 Many clinical practice guidelines are little more than industry marketing tools because of the financial competing interests of their authors and sponsors.11

Making it work

Will our new policy mean we lose the expertise of those at the cutting edge of research? Are there enough experts free of industry ties to satisfy the needs of a weekly general medical journal? In some fields—for example, obesity medicine, genetics, and rheumatology—we may find it difficult to recruit authors free of relevant financial links with industry. It might even prove impossible. But we believe the ethical arguments are persuasive and that this approach will cause less harm. We will study progress and report back. We are tracking how long and how many approaches it takes to find authors who are free of financial links. We are willing to miss out on articles on a few topics in exchange for publishing more articles by authors with no relevant financial ties to industry. And things should become easier over time: if current trends continue then ties between academics and industry are on the wane.12 We will let you know about the topics we struggle with, which in itself will be educational. We realise that non-financial influences matter.13 However, our aim is not to eradicate all competing interests—that would be impossible. Nor do we want to be anti-business just for the sake of it. Rather we wish to focus on ties that are known to, and indeed are largely designed to, influence clinical decisions in favour of industry.

We can also learn from the experience of other journals. In 2002, the New England Journal of Medicine abandoned a strict policy on authors with industry ties. “Our ability to provide comprehensive, up-to-date information, especially on recent advances in therapeutics, has been constrained,” conceded its editors.14 However, an editor in chief of NEJM when that policy operated in the 1990s explains how it can be made to work: “Sometimes it required going down the list until we found someone who didn’t have a conflict, but we never had to compromise and accept someone without sufficient expertise to do a good job.”15 For over two decades the journal American Family Physician, which primarily publishes clinical reviews, has not considered articles by authors who have financial ties with industry.16

Please let us have your views on this change in The BMJ’s editorial policy. Our aims are to preserve and enhance readers’ trust in the journal’s content and to help to shape a new relationship between journals and industry, rather than perpetuate the perception of medical journals as the marketing arm of commercial interests.