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Medical Journal Changes Policy of Finding Independent Doctors to Write

By John McKenzie

The New England Journal of Medicine will announce Thursday that it has given up finding truly independent doctors to write and review articles and editorials for it, as a result of the financial ties physicians have with so many drug companies in the United States The Journal says the drug companies' reach is just too deep.

In 2000, the drug industry sponsored more than 314,000 events for physicians — everything from luncheons to getaway weekends — at a cost of almost $2 billion. On top of that, many doctors accept speaking and consulting fees that link them to drug companies.

No publication in this country influences the way your doctor treats an illness more than the New England Journal of Medicine. Since 1812, the Journal has scrutinized and published thousands of clinical studies.

These "review" articles on drug therapy that can be pivotal. They tell doctors the strengths and weaknesses of new medications for everything form high blood pressure to obesity to cancer.

Now, the Journal will allow these critical evaluations to be written by people with financial ties to drug companies.

"This change will allow us to recruit the best authors, the people who have experience with new treatments to write these editorials and review articles," said Dr. Jeffrey Drazen, the medical journal's editor-in-chief.

Under the new policy, doctors writing reviews in the Journal can accept up to $10,000 a year from each drug company in speaking fees and consulting fees.

Concerns About Possible Bias

Not everyone thinks this is such a good idea.

"So if a doctor is doing that kind of business with four or five companies, he or she can get as much [as] $40- to 50,000 a year and not violate the new New England Journal policy," said Dr. Sidney Wolfe, the director of the Public Citizen Health Research Group, one of the country's largest medical consumer groups.

"The bias introduced by drug companies paying writers of review articles a large amount of money can have the consequence of slanting articles and influencing physicians in a way that isn't really in the best interests of their patients," said Wolfe.

The Journal, in a letter to its readers, says the policy change is necessary because it simply could not find enough qualified authors who did not already have ties to drug companies.

"There are areas where we simply have not published anything because we didn't think we could get a person who was good to write in an area that had absolutely no interaction with a commercial entity," said Drazen.

But Jerome Kassirer, who was the Journal's editor between 1991 and 1999, says he had no problem finding independent authors.

"There's a lot of depth in academic medicine, sufficient depth, so that it's almost always possible to find a first-class person to write an editorial or review article in which they do not have a conflict of interest," said Kassirer, now a professor at the Tufts University School of Medicine.

Some doctors are concerned that by relaxing conflict-of-interest standards, the Journal is reducing the prestige and influence that it has taken 190 years to build.

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