Are medical Journals an extension of the marketing arm of pharmaceutical companies?

According to some people in the field modern medical journals are not more then a marketing machine for the pharmaceutical companies. In a recent essay by Richard Smith gives his view on this matter.

"The most conspicuous example of medical journals' dependence on the pharmaceutical industry is the substantial income from advertising, but this is, I suggest, the least corrupting form of dependence. The advertisements may often be misleading and the profits worth millions, but the advertisements are there for all to see and criticise."

Pharmaceutical companies trying to influence professionals in the medical field exposing their sponsored trials in highly respected medical journals.

"For a drug company, a favourable trial is worth thousands of pages of advertising, which is why a company will sometimes spend upwards of a million dollars on reprints of the trial for worldwide distribution. The doctors receiving the reprints may not read them, but they will be impressed by the name of the journal from which they come. The quality of the journal will bless the quality of the drug."

Although questionable, this still wouldn't be a problem. However these sponsored trials rarely show results that are unfavourable to the companies' products. Paula Rochon, analyzing the trial results funded by manufacturesr of nonsteroidal anti-inflammatory drugs for arhtritis. All the 56 trials published showed the company's drug to be as good as or better then the comparison treatment.

"The evidence is strong that companies are getting the results they want, and this is especially worrisome because between two-thirds and three-quarters of the trials published in the major journals—Annals of Internal Medicine, JAMA, Lancet, and New England Journal of Medicine—are funded by the industry"

How are companies able to get the results they want from clinical trials? Smith gives us some examples. Ofcourse, fiddling with the results would be far to obvious. The right results can however be obtained by asking the "right" questions. For example a trial can be conducted of your drug against a treatment known to be inferior, or to dose your drugs against a too low a dose of a competitor drug. etc. Some suggestions made to prevent the journals from being a marketing tool for the pharmaceutical industry:

"Editors can review protocols, insist on trials being registered, demand that the role of sponsors be made transparent, and decline to publish trials unless researchers control the decision to publish."

Smith, R. Medical Journals Are an Extension of the Marketing Arm of Pharmaceutical Companies. PLoS Medicine 2, e138 (2005).