PEER-REVIEWED journals keep doctors informed about cutting-edge research, but their credibility increasingly depends on ferreting out conflicts of interest that might call authors’ findings into doubt.
Despite loud calls from medical ethicists to clarify financial ties between industry and the doctors who publish in journals, a study that appeared this week on the Archives of Internal Medicine website found that, of 32 physicians who received consulting fees of $1 million or more in 2007 from orthopedic medical device companies, 25 published articles in orthopedic-related journals during 2008 without disclosing their financial ties to industry. These potential conflicts of interest were no more likely to be disclosed in journals with seemingly stringent policies than in other journals.
As coauthor David Rothman, director of Columbia University’s Center for Medicine as a Profession, said in an interview, “If we can’t follow $1 million in the system . . . the system is broken.’’ This should be a warning to consumers, who, in the Internet age, have unprecedented access to medical literature but generally lack the professional expertise to evaluate it.
Fortunately, the health care reform bill mandates that industry payments to physicians of $10 or more be posted online, starting in 2013. That surely will make authors fess up on their journal articles. But that is three years away — an eternity in a profession subject to other corruptions, such as industry-paid ghostwriting of medical journal articles.
For that reason, journals must question would-be authors more intensely — and can use existing data sources to verify some of the information they receive from researchers. Journals should spot-check physician payments on the websites that pharmaceutical and device companies have put up — either voluntarily or after settlements with the Justice Department over allegations of kickbacks to doctors. The five medical device manufacturers in the Columbia study alone made 1,654 direct payments to physicians and researchers in 2007, totaling $248 million.
The International Committee of Medical Journal Editors has proposed tighter reporting standards, against resistance from researchers who see their own financial dealings as a purely private matter and who trust in their own ability to remain objective despite industry ties. The sheer number of journals — a website run by the National Institutes of Health clearinghouse keeps tabs on nearly 5,000 of them — makes it unlikely that all will agree to precisely the same code. But the editors’ committee has developed a thorough common disclosure form that asks researchers to disclose grants, consulting fees, writing assistance, and other items that they or their institutions have received. Journals would be wise to adopt it, at least as a minimum requirement.
Just as journals have come to rely on peer review as a way to screen for the most rigorous and scientifically important research, best practices for disclosing conflicts of interest must evolve over time as well. But it’s clear that all journals must do more to shed light on industry payments to the researchers whose work they publish.
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