The
Canadian Journal of Psychiatry
|
| Volume
48 |
Ottawa,
Canada, June 2003 juin
|
Number
5
|
|
Editorial
Challenges at the Pharmaceutical–Physician Boundary
Quentin Rae-Grant, MB, ChB, FRCPsych, FRCPC
For many years, there has been a necessary but at times uneasy relationship between companies that produce medications and physicians who prescribe them. Often, research physicians develop information that the companies apply to commercial production of targeted products.
The price of such development is huge and leads to aggressive promotion of specific products, with various measures and inducements that range from the blatant to the subtle seeking to influence physicians. A larger and larger proportion of physicians have a major part of their research funded by pharmaceutical companies, so much so that some prestigious journals have recently stated that such funding will no longer disqualify individuals from being guest editors or reviewers. There are few if any prominent academics who would qualify unless this changed.
There have been several prominent cases—Dr Nancy Olivieri, for example—of corporate interference with the dissemination, with support for them, one may add, from major institutions.
In parallel, there has been development of the in-house editorial staff—“ghost writers” as they were labelled in an investigative report in a recent CBC program. They may work with articles after they have been submitted and massage them so that the authors, when they receive them after review and with comments, are clear that a significant change of content and emphasis has been made. The Journal has seen this on occasions, and the overall quality and balance of the manuscripts have been acceptable to reviewers. The report, however, suggested that some writers produce articles using information from the company about its products, and then the company seeks clinicians in practice to have their names used as the authors. Let us be clear that there is no problem with having help with the writing of articles—indeed some research institutions now openly employ people with these skills—as long as there is a clear declaration of such involvement in the acknowledgement section, but it is absolutely unacceptable to represent as one’s own scholarly work the prepared work of pharmaceutical companies’ contract writers.
With people ever more busy and the ever-present pressure to publicize “product,” whether as scientific papers for the academician–clinician or as the later R&D results from the pharmaceutical marketer, as a medical publisher we must be ever diligent to assure not only the appearance of boundaries but also to reaffirm their reality. The Journal has recently encountered the need for heightened clarity in this regard in the April edition. First, some background on the issue: the Journal has been publishing solicited review articles since 1997 to provide readers with information on the developments in specific areas of psychiatry prepared by experts in that field. The “In Review” series does carry a cost to the Journal and to the Canadian Psychiatric Association (CPA). At the outset, this was partially defrayed by an unrestricted educational grant from a pharmaceutical company but went without for a few years until the present sponsor. Acknowledgement in the form of a small “bootlug” advertisement (an acknowledgement of an unrestricted educational grant in support of the series from a pharmaceutical firm on the foot at the front of the first article) first appeared in the February issue. In March, the Journal went to press without the In Review series, so it was then necessary for the CPA as publisher to place the ad twice in April to fulfill the contractual arrangement. This was inserted after the authors had approved the articles for publication. They were understandably upset. Unfortunately, the wording of the acknowledgement was ambiguous and could well have been misinterpreted to suggest that the authors, rather than the publisher, were supported by the funding. A revised wording of the acknowledgment was approved at a meeting of Editorial Board members to make it clear that the funding was an unrestricted grant for the series, not the particular articles. The Editorial Board also requested that the advertisement be moved to foot of the Guest Editorial for the May and future editions; this has been done.
At this point, it is appropriate that, on behalf of the Journal and the CPA, I extend apologies publicly to the authors involved in the situation as well as to the company that provided the funding.
In addition, and recognizing some of the above issues, the Journal will now require individual disclosure by each author of their specific contribution and specific conflicts of interest.
In the reality of today’s world, the Journal cannot investigate each article. It can and will make the readers well informed about possible conflicts so that they, the readers, can make final judgement with regard to the weight to place on specific articles.
|
