Medical journals should ban drug adverts, say researchers"By accepting only advertisements for drugs and medical devices, medical journals have accepted an exclusive and dependent relationship with pharmaceutical companies," says a team of researchers in an investigation published in PLoS Medicine.
Adriane Fugh-Berman and colleagues (Georgetown University School of Medicine) examined advertising in nine multi-specialty medical journals, chosen because they receive the most advertising revenue (in 2002, $221 million was spent on advertising in multi-specialty journals, almost ten times the amount spent on the runner-up, internal medicine journals).
In eight of these journals the advertisements were almost exclusively for drugs, rather than for cars, computers, vacations, or other products of potential interest to doctors (the exception was PLoS Medicine, which has a ban on publishing drug advertisements). A detailed analysis of the advertisements in the Journal of the American Medical Association (JAMA), for example, found that 99% (211 out of 214) of the advertisements in the year 2004 were for pharmaceuticals.
Drug companies place a high value on advertising in medical journals, say Fugh-Berman and colleagues, because research has shown that such advertising increases prescriptions for targeted drugs in a dose-related manner. Drug companies get a huge return on investment (ROI) from these adverts--one study found that the ROI (the average increase in revenues per incremental dollar spent in any give month) was $5.00.
It is clear why drug companies advertise in medical journals, but Fugh-Berman and colleagues wanted to understand why these journals exclude other types of advertisements. They hypothesized that perhaps it was only drug companies that could afford to buy journal advertising space. In fact, their investigation found that medical journal advertisements are cheaper than those in consumer magazines, and medical journals sometimes emphasize their cheap advertisement rates when reaching out to drug companies.
Medical journals, say the authors, sometimes argue that drug advertisements provide doctors with valuable information about drugs and diseases. "If medical journals accepted only advertisements for drugs proven superior in comparative trials," they say, "the argument that drug advertisements are educational could be rationalized. No journal, however, requires demonstration of product superiority as a condition for advertising."
The scholarly nature of journals confers credibility on both articles and advertisements within their pages, say Fugh-Berman and colleagues. "By exclusively featuring advertisements for drugs and devices, medical journals implicitly endorse corporate promotion of the most profitable drugs. Advertisements and other financial arrangements with pharmaceutical companies compromise the objectivity of journals."
The authors argue that the time has come for medical journals to eschew drug advertisements altogether and find sources of revenue that are less compromising. "Why not run ads for cars, computers or other consumer products that doctors would buy for themselves?" says Fugh-Berman, who also pointed out that pharmaceutical adverts in journals are third-party adverts--a doctor whose prescribing is swayed by a drug advert isn't paying for the product advertised.
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Citation: Fugh-Berman A, Alladin K, Chow J (2006) Advertising in medical journals: Should current practices change? PLoS Med 3(6): e130.
PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://dx.doi.org/10.1371/journal.pmed.0030130
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For an interview with Dr. Fugh-Berman please call (202) 687-5100.
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