One of my first experiences of the relation between medical journals and pharmaceutical companies occurred in the early 1980s after the BMJ had published papers suggesting that a new non-steroidal anti-inflammatory drug, benoxaprofen, might have serious side effects. We were visited by three stern men from Eli Lilly, the makers of the drug. Tony Smith, the deputy editor, conducted the meeting and asked me to join him. The men, whom I remember (probably wrongly) as having gold teeth, threatened us with legal action, at which point Tony said: “In that case we'll see you in court.” They backtracked hastily and asked simply to be able to publish a prompt response.
Those papers led eventually to benoxaprofen being banned, but the drug's rapid demise may well have been caused by its rapid ascent. The summer before the meeting with the men with gold teeth, I had visited Eli Lilly's headquarters in Indianapolis. I had won a prize from the Medical Journalists Association, and the money had to spent on a journalistic investigation. I was interested in compensation for drug injury and decided to visit the United States to look at its system. The prize money came from Lilly, and as Lilly had been involved in one of the biggest cases of drug injury—from diethylstilbestrol—it made sense to visit them. My wife and I were put up in a grand hotel at the company's expense and treated very well.
Lilly showed me films that were to be used to promote benoxaprofen when it was launched. I thought them wildly over the top: patients with severe arthritis were shown before they took the drug and then afterwards dancing. The message was that benoxaprofen didn't simply relieve the symptoms of the disease; it actually reversed the disease. I was sceptical of this claim, and even if it had some truth I thought the films excessive.
When the drug was later launched in Britain Eli Lilly made these extravagant claims. The Liverpool Echo carried a report of “a miracle drug.” Heavy marketing meant that the drug began rapidly to be widely prescribed. This meant—ironically—that reports of side effects also appeared rapidly, culminating in the papers in the BMJ. Research published later showed that benoxaprofen probably didn't cause any more side effects than similar drugs—but it didn't reverse the process. Benoxaprofen may have died from being overhyped.
This story had a formative influence on me and caused me to fret about the relationship between doctors and the pharmaceutical industry. Firstly, it taught me something about conflict of interest: your opinion may not be bought, but it seems rude to say critical things about people who have hosted you so well. Secondly, there's a tendency to see the industry as villains and doctors as innocent victims—but that's oversimplified. In doing their best for patients, doctors will need to use the products the pharmaceutical industry makes, and it's reasonable that the industry should be able to promote its products. But surely doctors should be looking also to independent sources of information, and how did we reach a point where so many doctors won't attend an educational meeting unless it's accompanied by free food and a bag of “goodies”? Something's wrong, and medical journals are part of what's wrong.
Free newspapers for doctors depend completely on income from pharmaceutical advertising, but many journals also depend heavily on such advertising
The advertising is often misleading
Editorial coverage is much more valuable to drug companies than advertising, and scientific studies can be manipulated in many ways to give results favourable to companies
Many medical journals have a substantial income from supplements and reprints paid for by drug companies