NEJM, other journals: provide more transparency about conflicts of interest or don’t publish conflicted articles
Are medical journals reliable sources of objective information, or do they, at times, act as shills for the pharmaceutical industry and other interests? We believe the latter after reading a Perspective article on drug pricing in the New England Journal of Medicine (NEJM) that presented the perspective of the pharmaceutical industry on what drugs should cost without explicitly revealing the industry ties of its authors.
Editorial content in journals is expected to provide objective information about medical science, care, and health policy. That objectivity is threatened by authors of editorials, review articles, and other “perspective” pieces with critical conflicts of interest due to financial associations with the topics being discussed. To prevent this, or at least limit it, the International Committee of Medical Journal Editors advocates transparency about such conflicts.
Many journals, including NEJM, have adopted such policies, and collect information from authors on their conflicts. For research articles, they judge that to be sufficient. For editorials and reviews, they specify their level of tolerance for relationships to companies with financial interests in the topic. Many journals also publish perspective pieces that are more akin to editorials but that are not always explicitly mentioned in conflicts disclosure policies. A particularly good test of whether these policies solve the problem of conflicts of interest occurs when they publish articles on topics with major implications for corporate players in health care.
The NEJM Perspective that caught our attention was “Drug-Pricing Debate Redux — Should Cost-Effectiveness Analysis Be Used Now to Price Pharmaceuticals?” published in November 2021. It showed us that the journal’s policy about transparency is not particularly transparent, and its policy about limiting the level of conflict of interest for writers of editorials is not enforced for at least some Perspective pieces.