May 5, 2009

Merck Publishes A Fake Journal

Oh, The Last Psychiatrist wrote another conspiracy article.  That must mean it's wrong.  So I don't have to deal with it.  Phew.  Pass me the Blue Pill, I'm feeling anxious again, for no reason at all.

From The Scientist:

Merck paid an undisclosed sum to Elsevier to produce several volumes of a publication that had the look of a peer-reviewed medical journal, but contained only reprinted or summarized articles--most of which presented data favorable to Merck products--that appeared to act solely as marketing tools with no disclosure of company sponsorship.
The journal is called the Australasian Journal of Bone and Joint Medicine.  No, I'm not kidding.

Cue populist rage: "Pharma is tricking people!  There needs to be a separation between Pharma and medicine!   Don't let them in our medical schools to corrupt our impressionable 30 year old students!"  

Go to bed satisfied; no sex necessary.


I have a question: is anyone accusing Merck of faking the data?  Are the studies all lies?  No.  This journal contained research previously published (and I assume therefore peer reviewed) elsewhere, and review articles.  I'll grant that the review articles are hardly cutting edge, but no one can say they are false or incorrect.   Isn't it possible that Merck might have something useful to say on the subject of bone loss? 

"But they're misleading, in that you don't know Merck is sponsoring them."  I see.  So what you object to, actually, is not the content, but the impression.  What matters to you are appearances.


Any doctor who couldn't sense something is amiss with a journal called "Australasian" anything is an idiot.  And a danger to the public.  He is much better off doing exactly what Merck tells him to, and not thinking for himself.  I'm absolutely serious.  Do you really think such a doctor is in any position to critique the methodology of a clinical trial?  Make reasonable distinctions between treatments?  Of course not. You know what he'll do instead, as a shortcut?  Look for the financial disclosure. 


"I've seen no shortage of creativity emanating from the marketing departments of drug companies," Peter Lurie, deputy director of the public health research group at the consumer advocacy nonprofit Public Citizen, said, after reviewing two issues of the publication obtained by The Scientist. "But even for someone as jaded as me, this is a new wrinkle."
New?  Hey Ponce De Leon, what did you think the past fifteen years of throwaway journals were?


All together now: What does the author of this story want to be true?

The point of this story is to direct your outrage onto Merck publishing a biased journal, so that you are not conscious of the fact that all of the journals are even more biased.

I can, and have, published an entire journal by going to Kinko's at 3am, and I did it drunk.  And it was in physics.  So why would Merck need to partner with Elsevier to get a limited run of a fake journal?  Obviously it is because having the Elsevier imprint makes the journal appear more legitimate.  Fine.

So why would Elsevier partner with Merck?  You think it needs the money?  Elsevier can get the money for the journal this way, or it can get it from selling ad space, or it can get it via the study authors who are funded by Merck ("publication costs.")  It's the same money.  What's the difference to them?  Why do it this way?

Here's why: by publishing a fake journal, it can then apologize for making a fake journal, thereby reinforcing that its other journals are not fake: "sorry, this does not meet our otherwise high standards of integrity."  


Oh, the other journals aren't fake? Then, knowing nothing about osteoporosis and without looking,  I shouldn't be able to tell you that all the articles about Fosamax published in the past year will say it's good; except for any published in NEJM, which will say it's bad.  Wow, what do you know, I was right. (NEJM: 1 2 3 4)

Of course I don't want Merck publishing journals.  But they have been publishing the content of all the other journals for decades.  They control you practice, and you don't even know it, because you think, "I've never received anything from Pharma!"  Yes you have, you received their message.  Or did you prescribe Vioxx (and Depakote and blah blah) because you analyzed the data and you thought it was better/safer than the alternatives?

You think there's any difference at all to the patient between getting paid to prescribe Fosamax, and prescribing it in good faith based on hearing about the studies conducted by  academics who were paid by Merck, reviewed by three other idiots/academics also paid by Merck, and published in a journal with ads paid by Merck; and while medical students are taught in school that Fosamax is useful for X and Y, based on those journal articles?

Do you think the elderly are on 8 meds at a time because they're all necessary?

And at least I have a good idea of the bias Merck has on Fosamax, I know how to interpret their results.  Do you think I have any clue what to do with anything published in NEJM?  Do you think a layman has any chance when the regular media reports, "scientists have found that..." 

You're worried about Australasia?

The question isn't whether Merck should be able to publish a journal; the question is why no one is rioting.


So why don't most pr... (Below threshold)

May 5, 2009 6:47 PM | Posted by eddie sylvano: | Reply

So why don't most practitioners recognize this kind of shill? Are they stupid? Lazy? Indifferent? If they can't discriminate good from bad as is, what hope do we have for them in any context? They're the ones who are supposed to police this. They're the professionals.

I'm curious about your take on how lawyers fit into this. I imagine that a lot of what drives medical decisions has to do with liability. People aren't just inconvenienced by bad medicine, they can die. What wiggle room is there to buck failed convention if you could lose your job because your treatment isn't sanctioned? If, however, you can point to literature by Merk telling you what to do, you're not alone. You're not a renegade.

As for overprescription, I blame the patients, to some degree. When people go to the doctor with a problem, they want a solution. They don't want ambiguity, they want definition. It reminds me of politics: I don't care if the problem is intractable, I want action. Gimme. Resolution.

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Now, now Eddie. If the acc... (Below threshold)

May 5, 2009 9:03 PM | Posted by AndrewAtor: | Reply

Now, now Eddie. If the accident dies, then there's no more accident, is there? Isn't logic fun?

I don't see many problems as being intractable. I always hear people tell me that blah, blah, blah would just be awkward. I'm a fan of thinking things are as awkward as people choose to make them. Lawyers have made things awkward for everyone.

The problems I see with Pharma are not ones of evil, but government imposed incompetence. Really, I've worked for them for years in a variety of levels. Most people are lazy. That's why systems are in place for data to be cross-referenced. Or why certain jobs exist for no other reason than to give a body a job. What happens when, due to political agenda or personal bias, certain evidence is rendered inadmissible, freely dismissed and never put back into public consciousness? I think it cuts off avenues of discussion, though, some are critical of this conclusion.

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No one is rioting because n... (Below threshold)

May 5, 2009 10:46 PM | Posted by Anonymous: | Reply

No one is rioting because nobody cares. It's the 21st century baby.

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You write: "Any doctor who ... (Below threshold)

May 6, 2009 10:44 AM | Posted by Anonymous: | Reply

You write: "Any doctor who couldn't sense something is amiss with a journal called "Australasian" anything is an idiot." Is that because Australasia, a term coined in 1756, by the way, and includes New Zealand, Australia & Papua New Guinea is automatically suspect because ...? It's beneath us all?

I believe the relevant term is disclosure. That's all. It doesn't solve the problems of the world, it doesn't right all wrongs, it's just an ethically useful addition to the publication. You see it all the time in reviews and testing on software. Sometimes simple steps forward might prove more useful than bloviating about riots.

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"... because nobody cares".... (Below threshold)

May 7, 2009 12:09 AM | Posted by Ma Pe: | Reply

"... because nobody cares". It depends on what "cares" means.

I would think that some people do care in the sense that they are bothered by the lack of disclosure but don't care enough to take an action. And then there are some who don't care: those who did not notice it; those who are not bothered by it; and those who feel good about it because they will cite the AJ in their defense should they every be sued, they will claim that Merck misled them, they will try to forge an alliance with the victim and jointly they will sue Merck. If I can think of this strategy, thousands of lawyers can; they are trained to think this way.

It could also be a lesson in ethics: do something even slightly wrong and you may have to pay for it dearly. However, if you bucked the trend (you better know it! that is very wrong!! you offended the herding instinct) and your patient died, they will come after you with the AJ; you will defend yourself with the NEJM. Only the lawyers gain. It always has been risky to be a patient, but nowadays it is also risky to be a doctor and it does not matter whether you follow the trend or are a renegade. It's just bad luck.

"Life is what happens to you while you are busy making other plans" (John Lennon)

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Some more stuff from the Sc... (Below threshold)

May 7, 2009 1:20 PM | Posted by ATraveller: | Reply

Some more stuff from the Scientist:

"Elsevier published 7 fake journals
Posted by Bob Grant
[Entry posted at 7th May 2009 04:27 PM GMT]
Comment on this news story

Scientific publishing giant Elsevier put out a total of seven publications between 2000 and 2005 that were sponsored by unnamed pharmaceutical companies and looked like peer reviewed medical journals, but did not disclose sponsorship, the company has admitted.

Elsevier is conducting an "internal review" of its publishing practices after allegations came to light that the company produced a pharmaceutical company-funded publication in the early 2000s without disclosing that the "journal" was corporate sponsored. "

Full article is in the URL, although a free registration is required to read it.

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Now with URL:<a href... (Below threshold)

May 7, 2009 1:23 PM | Posted by ATraveller: | Reply

Now with URL:
Scientist: Elsevier published 7 fake journals.

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... and you're aware of the... (Below threshold)

May 7, 2009 6:24 PM | Posted by Les Posen: | Reply

... and you're aware of the matter presently being heard in the Australian Federal Court where Merck is facing a class action re Vioxx? Makes very interesting reading as the defense now mounts its case and deals with accusations of ghost writing of scientific articles...

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As an aside: Is Fosamax goo... (Below threshold)

May 9, 2009 12:40 AM | Posted by information addict: | Reply

As an aside: Is Fosamax good or bad? It supposedly increases bone density but what about strength? Don't you need vitamin D for that? What's a person to do when the doc says "take it" but the news reports are scary?

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