Medical Publishing Needs Greater Transparency

Elyas Bakhtiari, for HealthLeaders Media, March 26, 2009

Trust is not easy to come by these days. Yet physicians, as a whole, still enjoy a level of trust and credibility that few authority figures can boast. Particularly when it comes to healthcare reform, voters view physicians as being on their side.

That can change and change quickly, however. It is becoming increasingly difficult to read the news these days without stumbling across a story about medical research tainted by drug industry ties, and if anything can tarnish physicians' public image, it is a few highly-publicized and ill-timed cases of corruption and fraudulent research.

A few weeks ago, it was Scott Reuben, a well-known anesthesiologist at Baystate Medical Center in Springfield, MA, who made headlines when allegations surfaced that he may have fabricated results—and even used fictitious patients—in at least 21 published papers over a 13-year period showing positive data for drugs produced by Pfizer, Inc. You may not be surprised to learn that Pfizer had given Reuben five research grants and made him a member of its speakers' bureau.

More recently Joseph Biederman, a Harvard child psychiatrist, has come under fire for allegedly telling Johnson & Johnson that studies of its drugs for children would yield positive results, before he administered the tests.

Perhaps the biggest story has been the spat between the Journal of the American Medial Association and Jonathan Leo, an associate professor of neuro-anatomy at Lincoln Memorial University in Tennessee. In October 2008, Leo uncovered an unreported financial conflict of interest, as well as questionable results, in a study of depression drug Lexpro that was published in JAMA.

Leo reportedly alerted JAMA to the conflict of interest, and after four months without a response, took his criticism public by publishing a letter about the study in the British Medical Journal. That got JAMA's attention. According to the Wall Street Journal, JAMA Editor-in-Chief Catherine DeAngelis called Leo a "nothing and a nobody," and told him, "You are banned from JAMA for life. You will be sorry. Your school will be sorry. Your students will be sorry."

JAMA claims the quotes were misreported, but their follow-up actions suggest a certain tone deafness to the real problem. The journal effectively implemented a gag order and has instructed anyone who unearths possible financial conflicts not to go public until editors have completed an investigation.

JAMA would have been better off going in the other direction and increasing transparency to avoid the impression of a cover-up, or perhaps advocating for much stricter restrictions on pharmaceutical gifts to physicians. Instead, they are responding as if this is only a public relations problem.

But the poison runs much deeper than that.

If you think the public seemed on the verge of taking up pitchforks and torches in outrage at AIG bonuses, imagine what would happen if one of these fraudulent studies led physicians to prescribe a drug with potential lethal consequences. Consider the media frenzy and public outcry in this zeitgeist if it were revealed that a physician ignored the potential warning signs after earning six figures from that same drugmaker.

The AIG debacle wasn't just about money—it was about a lack of accountability and a willingness to profit at the expense of the general public. When JAMA attempts to silence critics, it comes across unapologetic and unaccountable. Those elements also bubbled up in a revealing deposition in the Biederman case when a prosecutor asked who outranked him as a full professor at Harvard, and he responded simply: "God."

It's not just patients who should be angry at these shady relationships and the permissive environment that enables them. Physicians rely on this type of research to make treatment decisions, and hospitals and other institutions put their reputations on the line when something goes wrong.

Certainly, most physician researchers' hands are clean, and it is unfair to let a few cases soil the reputation of an entire industry. But as we saw in the financial sector, when people begin taking up torches and pitchforks and looking for justice, they don't tend to be very discriminating in their targets.

Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at
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