By eCliniqua Staff
May 22, 2006 | For the second consecutive issue of this newsletter, we shamelessly lean on The Wall Street Journal. It has put a wicked dent in the gold-plated stretch limousine known as the New England Journal of Medicine.
The newspaper recently identified significant conflicts of interest for the NEJM editors and managers. These conflicts came to light during court testimony for the Vioxx mess. We trust young readers will not be shocked. But mundane commercial interests at the NEJM turn out to be as important in driving editorial policy as the advancement of medical knowledge. Public relations also played a role in what the NEJM told readers about Vioxx.
Who knew that the mundane article-reprint trade (with a single peer-reviewed article generating hundreds of thousands of dollars in sales) could loom so large? It's just an idea. But maybe the NEJM should offer an interactive bar graph on its website to tell readers how much reprint-oriented revenue has accrued from each article. You could let people right-click to see which sponsor had bought the articles in quantity.
The notion that the peer-reviewed journals are at odds with the pharmaceutical industry is partly true. There is simmering ill will. But industry-journal tension is partly myth. Pharma's dollars heavily underwrite the budgets of peer-reviewed publications. The journals depend on articles about important trials for editorial gravitas. The industry and the journals are inextricably connected, and forever will be. Who bought the reprints that seem to have impaired the NEJM's Vioxx publishing judgment? Merck.
It is against this background that, just last week, a new journal was born at the Public Library of Science (PLoS). A new PLoS journal for clinical trials will offer all its articles online, free.
PLoS Clinical Trials will publish "all randomized trials that are ethically and scientifically sound, registered, and reported accurately." Crucially, it will consider positive, negative, and ambiguous findings, addressing the "publication bias" allegation frequently hurled at journal editors and trial sponsors alike.
As many readers know, critics of the drug industry say many clinical trial results are never submitted for publication. The question is why. Do investigators believe they didn't find clinically significant results that are worthy of publication? Or are clinical trial sponsors hoping to hide anything that might negatively affect prescription trends?
For Nobelist Harold Varmus, an M.D. who ran the NIH and founded PLoS, both scenarios are untenable. Here's a quote from Varmus in the press release about PLoS Clinical Trials: "Members of the public participate in clinical trials, believing the results will increase knowledge. However, results are often hard to find or, worse still, are not reported at all because journals tend to be interested in positive outcomes." PLoS Clinical Trials is a timely and well-executed addition to the scientific literature that could become a spin-free, noncommercial outlet for clinical trial research.