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Do drug advertisements (“adverts” in Britspeak) belong in medical journals? In a head to head debate in this week's issue, Richard Smith, former BMJ editor and long-time critic of big pharma, says yes (doi: 10.1136/bmj.39259.472998.AD). He maintains, perhaps paradoxically, that advertising allows journals to be independent and thus better. Major journals have advertising from many manufacturers and thus no one company can exert undue pressure or influence. Smith's big concern is one that most readers don't even think about: the lucrative article reprints that journals sell for hundreds of thousands of dollars a year, largely to the drug companies whose products are evaluated in clinical trials published in the very same journals. Conflict of interest? You betcha.
Gareth Williams, University of Bristol's medical dean, argues against journal advertising of pharmaceuticals (doi: 10.1136/bmj.39259.481134.AD). He wants drug ads at least vetted for inaccuracy and misleading claims, but he would prefer an outright advertising ban. Doctors are inevitably influenced by the clever words and images stuck throughout their medical reading, and it would be better if prescribing choices were based only on independent data and evaluations.
The big news in this issue is a trial that shows that an oral preparation of probiotic bacteria, marketed as DanActive in the US, can decrease antibiotic-associated diarrhea in hospitalized older patients (doi: 10.1136/bmj.39231.599815.55). Mary Hickson and colleagues randomized 135 patients with a mean age of 74 who were taking antibiotics and found that only five patients needed to be treated to prevent one case of diarrhea and six patients to prevent a case of diarrhea caused by C difficile. In a related editorial, Lynne McFarland points out that the trial had several limitations, including the fact that only a small proportion of hospitalized patients on antibiotics were enrolled in it (doi: 10.1136/bmj.39255.829120.47). Still, when combined with other evidence, this study argues for routine use of these inexpensive preparations, especially in patients with chronic infections who require repeated courses of antibiotics.
Other research includes a trial comparing surgery and compression dressings with compression alone in the treatment of chronic venous ulceration (doi: 10.1136/bmj.39216.542442.BE). The addition of surgery did not improve healing but did reduce ulcer recurrence over four years of follow up. And a systematic review of randomized controlled trials of drug treatments for painful diabetic neuropathy found that established preparations—tricyclic antidepressants and traditional anticonvulsants—were better for short term pain relief than newer anticonvulsants (doi: 10.1136/bmj.39213.565972.AE). Proof of long-term effectiveness is still lacking.