It seems to be getting more and more difficult for physicians to gain access to unbiased information about the medications they prescribe--especially when that information is provided for free.
The latest identified purveyor of financially swayed drug recommendations: Medical journals. According to Annette Becker, MD, MPH, of the University of Marburg, and colleagues, a cross-sectional study of 465 issues of 11 German journals published in 2007 found that free, ad-supported journals were more likely to recommend specific drugs advertised in the same issue than were those with revenue derived from a mix of subscriptions and advertising or from subscriptions alone.
In particular, the study, published in the Canadian Medical Association Journal, identified 592 advertisements for certain controversial, patent-protected (and more expensive) drugs in 312 of the issues reviewed, while free journals recommended for or against the chosen drug in 256 articles in 250 issues, after accounting for repeat ads and recommendations.
In addition, independent journal reviewers rated the strength of the recommendations on a five-point scale from negative-2 (recommending against) to plus-2 (recommending for). The free journals averaged a recommendation strength score of 1.9, while the mixed-revenue journals averaged 0.86 and the subscription-only journals averaged negative-1.03. Using this data, the team mathematically determined that recommendations for the drug increased when the drug was advertised in a particular issue.
The authors acknowledged a separate survey of Canadian physicians that found most healthcare professionals considered journals that did not have a peer review process, such as most free journals, as unreliable information sources. Nonetheless, more than half of those surveyed said they used free journals as a source of information in the past month.
"Physicians need to realize that the alternatives are to either pay for journals with objective information or rely on potentially biased information published in free journals," the authors concluded.
To learn more:
- read the article from MedPage Today
- see the abstract from the Canadian Medical Association Journal