Tag Archives: medical journals

Study: Good press releases contribute to good health journalism

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Thanks to Gary Schwitzer for drawing attention to a study, published in BMJ, which analyzes the impact medical journal press releases have on actual press coverage of studies.

The authors begin with a somewhat gratifying hypothesis, writing that “Although it is easy to blame journalists for poor quality reporting, problems with coverage could begin with the journalists’ sources,” and positing that difficult-to-decipher studies and misleading press releases could lead to low-caliber health reporting.

They looked at 100 studies from five major journals, as well as a sample of 348 news stories based on those studies. In general they found that higher-quality press releases led to higher-quality coverage. Unfortunately, they also found that the inverse was true. Here’s an excerpt from the “Discussion” subheading (also highlighted by Schwitzer).

…Higher quality press releases issued by medical journals were associated with higher quality reporting in subsequent newspaper stories. In fact, the influence of press releases on subsequent newspaper stories was generally stronger than that of journal abstracts. Fundamental information such as absolute risks, harms, and limitations was more likely to be reported in newspaper stories when this information appeared in a medical journal press release than when it was missing from the press release or if no press release was issued. Furthermore, our data suggest that poor quality press releases were worse than no press release being issued: fundamental information was less likely to be reported in newspaper stories when it was missing from the press release than where no press release was issued at all.

Reporters looking for a Health News Review-style “how do I ensure my story clears their quality bar?” checklist can just scroll down to the “Quality Assessment” subheading. For the record, the metrics found there apply equally well to the PR professionals who write the releases.

PLoS Medicine article advocates using legal system to stem ghostwriting

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

An essay published by PLoS Medicine makes the case that the “guest” authors of ghostwritten articles – typically academic researchers who provide little or no input – in medical journals should be held legally liable for damages or deaths caused by the drug or device that is the subject of articles they sign their names to.

The article points out that ghostwriting “openly infringes academic standards and … contributes to fraud” but that journal editors have been ineffective at putting a stop to it.

We argue that when an injured patient’s physician directly or indirectly relied upon a journal article containing false/manipulated safety and efficacy data, then pursuant to the legal authority outlined above, the authors of that article, including guest authors, are legally liable for patient injuries and could be named as defendants.

Xavier Bosch, Bijan Esfandiari and Leemon McHenry, authors of the PLoS Medicine piece, even endorse the theory that the Racketeer Influenced and Corrupt Organizations Act (RICO) could be used, something that was mentioned in an article last year. Other recourses the authors recommend include the False Claims Act and the Anti-Kickback Statute.

Ghost authorship waning in top journals

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

On the academic publishing blog The Scholarly Kitchen, Phil Davis writes about the recent BMJ study indicating that ghost authorship in top medical journals may be on the wane.

The paper’s authors reviewed data from 2008, then compared it to the results of a previous study conducted in 1996. Davis summarizes their findings.

In 2008, self-reports of ghost authorship was 7.9%, down from 11.5% in 1996. In comparison, rates of honorary authorship remained statistically similar over time (17.6% in 2008 versus 19.3% in 1996). Prevalence of honorary authorship in research articles was higher in 2008 than in 1996, but lower for review articles and editorials.

Surprisingly, journals that require authors to detail their contributions showed no difference from journals without such author requirements.

Honorary authorship is the practice of granting authorship to often-powerful individuals (deans and the like) who may not have had a direct role in the study.

While the results may appear encouraging, Davis does provide a cautionary note.

While this study was beautifully and rigorously executed — with a response rate of over 70% — the researchers acknowledge that respondents may not be forthright with reporting inappropriate authorship practices, especially considering the social stigma against ghost authorship. Indeed, a study of members of the American Medical Writers Association and European Medical Writers Association put the incidence of ghostwriting at 42% for 2008, down from 62% in 2005. If the incidence of ghost writing is truly declining, it still has a long way to go.

Australian journal says no to pharma ads

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Emergency Medicine Australasia, an Australia-based medical journal, has declared that it will no longer accept paid advertisements from pharmaceutical companies.

ozImage by acediscovery via Flickr

The journal’s editors announced their decision in an editorial, and we learned about it from Pharmalot’s Ed Silverman. In the editorial, the editors say they’re drawing a line in the sand and all but dare other publications to join them. Here’s Silverman with the how-and-why:

The ban followed discussions with other emergency medicine specialists, who worried aloud that advertised drugs were supported by evidence that was neither “of reasonable quality, nor independent.” There were cases of “dubious and unethical” research practices by pharma, including ghostwriting. And academics may face pressure to withhold negative research, which could “inflate views of the efficacy” of heavily promoted drugs.

For more, refer to this AAP story. In this case, the acronym refers to the Australian Associated Press, not the physician group. In Australia, medical journals are one of the only places where pharmaceutical advertising is legal.

Doctors tied to manufacturer report better outcomes, may influence spinal surgery

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

After using a FOIA request to obtain documents the Food and Drug Administration had labeled “confidential,” Milwaukee Journal Sentinel reporter John Fauber has found that conflicts of interest may have played a role in the outcomes of clinical trials for Medtronic’s much-debated spinal fusion product BMP-2.

In a review of the study’s summary data for the newspaper, researchers at Dartmouth-Hitchcock Medical Center found 91 of the 364 patients in the trial – 25% – were implanted by surgeons who had a financial connection with Medtronic. Those doctors reported an 80% overall success rate, compared with 63% for doctors with no ties to the company.

Fauber also notes Medtronic’s response, which was to simply point to comments the company had made for a previous Fauber story.

At the time, [Medtronic spokeswoman Marybeth Thorsgaard] said the company fully disclosed the success rates of the doctors with financial ties to the company to the FDA. She noted that those doctors also had better results with the patients in the trial who did not get BMP-2.

In a companion story Fauber writes that, much like in the clinical trials, the journal articles published to push BMP-2 (and its off-label use) were riddled with conflicts of interest. One of his sources even called one article “egregious” for “blowing off” complications.

Related

Bloomberg’s Peter Waldman and David Armstrong write about the “national boom in costly fusion surgeries” and how “surgeons have prospered from performing fusions, which studies have found to be no better for common back pain than physical therapy is – and a lot more dangerous.” The pair also look at Medtronic’s payments and other ties to doctors who perform the surgery, as well as some of the risks of the surgery.

Scary secrets about ghostwriting in journals

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

Just in time for Halloween, an anonymous medical ghostwriter spoke to Phil Davis over at the Scholarly Kitchen about the scary world of ghostwriting.

He reveals how much ghostwriters are paid, how the process works, where his work has been published, how to detect ghostwritten material and more.

The Scholarly Kitchen is a blog from the Society for Scholarly Publishing.

(Hat tip to Scott Hensley.)

Study considers role of impact factor, income in journal editors’ decisions

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

A newly published study looks at medical journals and whether the publication of industry-supported trials might cause a conflict of interest by improving the journals’ importance or income.

Researchers looked at “impact factor” – a measure of a journal’s importance based on how often its articles are cited – and they looked at income from the sale of reprints to drug companies.

While they found that the publication of industry-supported randomized controlled trials is associated with an increase in both the impact factor and income from reprints, they do not conclude that editors’ decisions are affected by those increases.

Importantly, these findings do not imply that the decisions of editors are affected by the possibility that the publication of an industry-supported trial might improve their journal’s impact factor or income.

Despite that conclusion, the researchers do suggest that journals routinely disclose information on the source and amount of income they receive.

In that spirit, PLoS Medicine discloses its sources of income for 2009 and the editors discuss the issue in an editorial.

Related

More about conflicts of interest in publishing

How ghostwriters sold hormone replacement

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Writing in PLoS Medicine, Adriane J. Fugh-Berman, M.D., demonstrates the cynical art of “publication planning” and the use of academic journals as an avenue for unregulated drug promotion by showing, with the help of documents from a major drug manufacturer, how ghostwriting was used to sell hormone replacement therapy.

The documents in question come from the lawsuits against Wyeth over the development of breast cancer during treatment with the hormone replacer Prempro, and were brought to light, according to Fugh-Berman, “when PLoS Medicine and The New York Times intervened in the litigation. Both intervenors successfully argued that ghostwriting undermines public health and that documents proving the practice should be unsealed.”

Fugh-Berman was a paid expert witness in the trial, and thus was familiar with the documents before their release. Her conclusion?

… the pharmaceutical company Wyeth used ghostwritten articles to mitigate the perceived risks of breast cancer associated with HT (menopausal hormone therapy), to defend the unsupported cardiovascular “benefits” of HT, and to promote off-label, unproven uses of HT such as the prevention of dementia, Parkinson’s disease, vision problems, and wrinkles.

According to Fugh-Berman, the effects of this careful campaign seem to have outweighed the preponderance of evidence, at least in the minds of some doctors.

Today, despite definitive scientific data to the contrary, many gynecologists still believe that the benefits of HT outweigh the risks in asymptomatic women. This non-evidence–based perception may be the result of decades of carefully orchestrated corporate influence on medical literature.

Through the course of the article, Fugh-Berman lays out the entire ghostwriting/marketing process, complete with instructive details and damning examples. There’s a lot to take in, but you’ll emerge with a far better understanding of the mundane mechanics that make ghostwriting work.

Related

Journal editor linked to spinal implant royalties

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

John Fauber of the Milwaukee Journal Sentinel continues his coverage of conflicts of interest in medical research and journals with a look at journal editors. First, Fauber lays out the case in question:

  • For seven years, a University of Wisconsin orthopedic surgeon (university bio | hospital bio) has been editor-in-chief of the Journal of Spinal Disorders & Techniques.
  • During that time, he’s received more than $20 million in patent royalties thanks to spinal implants sold by Medtronic.
  • Also during that time, an average of more than one Medtronic-related article appeared in each issue of the journal, most of them positive. Some were even co-authored by the editor/surgeon himself and related to the implant for which he gets royalties.
  • Despite these coincidences, the journal never disclosed the potential conflict of interest.

Fauber then goes on to explore why journal editors aren’t mentioned more often in conflict-of-interest scandals, and then to explain exactly why those editors hold the sort of power that makes these conflicts particularly distressing. As Fauber explains, editors of medical journals can accept or reject manuscripts of studies involving drugs or devices – something that can make or break the product.

They can send a study out to peer reviewers who may be sympathetic to a particular drug or device by virtue of their own financial relationships with the companies that make those products. They can give authors more leeway to say positive things about a drug. They can turn down studies that say bad things about the product of a company they get money from.

The author of “On The Take: How Medicine’s Complicity with Big Business Can Endanger Your Health,” Jerome Kassirer, says that “Once an editor makes a decision, there is no recourse; they are like a king.”

Earlier coverage:

Journal launches site for journalists covering studies

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

In an editorial in the Journal of the National Cancer Institute, “Promoting Healthy Skepticism in the News: Helping Journalists Get It Right,” Steven Woloshin, Lisa M. Schwartz and Barnett S. Kramer analyze some recent media coverage of journal articles and research findings and conclude that “When it comes to exaggeration of health hazards and medical breakthroughs, there is plenty of blame to go around.”

It would be easy to pin all the blame for exaggeration on journalists. After all, they have to grab their reader’s (or listener’s) attention. Screaming headlines and breathless reporting come in handy. And many health journalists lack the medical or statistical training needed to appraise research critically. Curiously, many fail to approach medical research with the same skepticism they routinely apply to political reporting. Nonetheless, blaming journalists for all exaggeration would be unfair. Many health journalists (and their editors) do a great job.

The writers also acknowledge that researchers’ passion can play a part, as well as the desire to get good media attention. They also point to journals’ failure to include or highlight some important elements that would help journalists accurately report on study findings.

In a move to help improve coverage of research, the JNCI has launched “a Web site for science and health journalists to help them ‘get it right.’” The first offering is “Reporting on Cancer Research,” a set of tip sheets designed to help reporters better understand oncology research and its results. It was developed for the writers’ book, Know Your Chances: Understanding Health Statistics, and adapted for journalists attending the annual Medicine in the Media workshop. Each PDF highlights a different aspect of interpreting cancer research (risk numbers, statistics, findings and outcomes, and cautions), and all four are succinct and easy to use, even on deadline.