Fake medical journals.

John Lynch and Dr. Isis have already posted on the revelation that Elsevier published something, Australasian Journal of Bone and Joint Medicine, that looked and sounded like it was a medical journal but that turned out to have been fancy advertising for pharmaceuticals company Merck.

The Scientist has the details:

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 Australasian Journal of Bone and Joint Medicine, which was published by Exerpta Medica, a division of scientific publishing juggernaut Elsevier, is not indexed in the MEDLINE database, and has no website (not even a defunct one). The Scientist obtained two issues of the journal: Volume 2, Issues 1 and 2, both dated 2003. The issues contained little in the way of advertisements apart from ads for Fosamax, a Merck drug for osteoporosis, and Vioxx. (Click here and here to view PDFs of the two issues.) ...

In testimony provided at the trial last week, which was obtained by The Scientist, George Jelinek, an Australian physician and long-time member of the World Association of Medical Editors, reviewed four issues of the journal that were published from 2003-2004. An "average reader" (presumably a doctor) could easily mistake the publication for a "genuine" peer reviewed medical journal, he said in his testimony. "Only close inspection of the journals, along with knowledge of medical journals and publishing conventions, enabled me to determine that the Journal was not, in fact, a peer reviewed medical journal, but instead a marketing publication for MSD[A]."

He also stated that four of the 21 articles featured in the first issue he reviewed referred to Fosamax. In the second issue, nine of the 29 articles related to Vioxx, and another 12 to Fosamax. All of these articles presented positive conclusions regarding the MSDA drugs. "I can understand why a pharmaceutical company would collect a number of research papers with results favourable to their products and make these available to doctors," Jelinek said at the trial. "This is straightforward marketing."

Clearly putting together something that looked like a medical journal and that contained articles (and excerpts from articles) that had only good things to say about Merck products reflects an intent to deceive. A real medical journal, one would assume, contains articles that have been scrutinized by scientists who are concerned to uphold standards of evidence and sound scientific reasoning. Peer review by experts lets the consumer of the articles in the journal regard the articles as legitimate contributions to a body of scientific knowledge. Moreover, real medical journals consider manuscripts examining the safety and efficacy of drugs from a number of competing manufacturers, and, presumably, manuscripts reporting problems with drugs, not just successes with them.

Australasian Journal of Bone and Joint Medicine was a fake journal. But, because it was put together to look like a real one, it was intended to capitalize on the credibility that articles in a real medical journal would command.

Merck, obviously, crossed an ethical line here. So did publisher Elsevier. Again, from The Scientist:

In response to several questions about the publication posed by The Scientist, an MSDA spokesperson wrote in an email: "MSDA understood that Elsevier envisaged the complimentary publication would draw on the vast resources of Elsevier, publishers of many leading peer-reviewed journals including Lancet, Bone, Joint Bone Spine and others, to deliver novel and timely full text articles and abstracts to physicians." Many of the articles appearing in the Australasian Journal of Bone and Joint Medicine were in fact reprints or summaries of studies that originally appeared in other Elsevier journals.

A spokesperson for Elsevier, however, told The Scientist, "I wish there was greater disclosure that it was a sponsored journal." Disclosure of Merck's funding of the journal was not mentioned anywhere in the copies of issues obtained by The Scientist.

Elsevier acknowledged that Merck had sponsored the publication, but did not disclose the amount the drug company paid. In a statement emailed to The Scientist, Elsevier said that the company "does not today consider a compilation of reprinted articles a 'Journal'."

"Elsevier acknowledges the concern that the journals in question didn't have the appropriate disclosures," the statement continued. "It is worth noting that project in question was produced 6 years ago and disclosure protocols have evolved since 2003. Elsevier's current disclosure policies meet the rigor and requirements of the current publishing environment."

The Elsevier spokesperson said the company wasn't aware of how many copies of the Australasian Journal of Bone and Joint Medicine were produced or how the publication was distributed in Australia, but noted that "the common practice for sponsored journals is that doctors receive them complimentary." The spokesperson added that Elsevier had no plans to look further into the matter.

Myself, I'm not really moved by the claim that publishing standards were so different 6 years ago that Elsevier has clean hands here. It's pretty obvious from this response that Elsevier was happy to take money from Merck to make something journal-like, trading on Elsevier's reputation as a publisher of proper journals. And the "no plans to look further into the matter" comment does not really speak to an awareness by Elsevier that its reputation as a publisher of proper journals is damaged by shenanigans like this.

This is the kind of thing that makes you wonder if the model of journal publishing for profit ought to have a future, at least where scientific and medical journals are concerned.

There's a bit more blame to go around, according to The Scientist:

One of the members of Australasian Journal of Bone and Joint Medicine's "Honorary Editorial Board," Peter Brooks, a rheumatologist in Australia, said he didn't recall who asked him to serve on the board, but noted that he was on Merck's Asian Pacific and international advisory boards from the mid 1990s until about 2004, as well as the advisory boards of other pharmaceutical companies, including Pfizer and Amgen. "You get involved in a whole bunch of things at this level," Brooks said, adding that he had put his name on "a few advertorials" for pharmaceutical companies about 10 years ago.

As for the Australasian Journal of Bone and Joint Medicine, he said, "If it would have been put to me that [the journal] was just sort of a throwaway, then I would have said 'no'" to serving on its editorial board. He said he was never paid for his role, adding that he "didn't ever get [manuscripts] to review or anything like that," while on the board, because the journal did not accept original manuscripts for review.

An "Honorary Editorial Board" of physicians and scientists could only have been intended to add a further veneer of credibility to the articles in the fake journal. You'd think someone smart enough to earn an M.D., asked to be on such a board and then never asked to do anything for the "journal", might inquire further to see if someone was trading on his credibility.

That Dr. Brooks wasn't paid to have his name and credibility on the "Honorary Editorial Board" for the fake journal doesn't absolve him of responsibility. Maybe he was duped, but as a member of a Merck advisory board at the time, and as an author of pharmaceutical "advertorials", he had access to some clues that Merck wanted to sell its drugs and make money.

Not asking some fairly obvious questions doesn't just make you look dumb, but also risks making members of your profession as a group look dumb.

And here, there may be a smidgen of blame left for the physicians who were clearly targeted by the Merck-Elsevier fake journal. It's true that not all physicians are researchers, but if they're going to be turning to the medical literature for guidance, physicians probably need to tune up their critical faculties and evaluate the articles.

At a minimum, knowing what we know about what seems to drive the pharmaceutical industry, physicians should be especially cautious about drug company sponsored research. And now, being suspicious of articles published by Elsevier imprints might be a good idea, too.

More from blog.bioethics.net.

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This Brooks fellow sounds like so many academic physicians I know who are overeager to append their names to anything remotely resembling research. I can only assume that "at [that] level." you're automatically entered into some sort of contest with your peers to see whose CV can extend for the greatest number of pages. Nice to see one of them finally get bitten. Not nice for all those patients who suffered.

This is exactly what Science does NOT need right now. What a disgrace for Elsevier. What a shame for Merck. Without seeing the actual pages of the Journal, I'd venture to guess those involved tend to be MDs more than basic scientists. If so, lets add our medical education institutions to the 'Hall of Shame' as well.

By Denis Alexander (not verified) on 04 May 2009 #permalink

Shame for Merck? I don't think so. You're making the same points as the anti-vaccination, somehow there is an ethical issue here. I'm not seeing it, but then again, I'm a shill for Big Pharma. Oh that's right, I'm proud of my own ethics in this industry.

I think Elsevier has been sliding down the slippery slope of irrelevance for awhile. I'm sorry but Homeopathy does not exactly make me think that the publisher is "pro-science." They should be reviled for this activity, although in this world, trying to make money seems to appear poisonous, even if it isn't.

I know all the medical blogs are going after Merck, but I think a more reasoned discussion is necessary. Merck has to advertise, and it has to be creative to get a message across. I think that there is an urban myth that physicians should learn about new drugs or indications or whatever by some pure, academic, non-monetary format. It doesn't happen. Physicians are seeing hundreds of patients, trying to pay their bills in a managed care environment, and there are thousands of medical products companies trying to tell them they need this or that. Sometimes, you just have to do something innovative to get the message across.

Merck is a good, ethical company, made up of mostly ethical individuals. To assume otherwise is no different than the dumb arguments from the anti-vaccine woo-pushing nutjobs.

I asked my librarian to discontinue the subscription. He responded that he is aware and concerned but he is waiting to see before he acts.

Dammit!

They have bismirched my region of habitation!

By antipodean (not verified) on 04 May 2009 #permalink

"Sometimes, you just have to do something innovative to get the message across."

like lie. quack quack quack.

homeopath = drug pusher = pharma

no diff.

By know shame (not verified) on 04 May 2009 #permalink

This pay for coverage model took place all the time in the technology industry. Ultimately, the publishers that participated in it suffered so much reputational damage that they went out of business or were forced to reinvent themselves.

Elsevier is too big, and their real journal titles too diverse for this to happen today. Yet...

I didn't realize "innovative" was marketing-speak for "dishonest". I'll have to remember that.

I sort of figured that if you actually had effective drugs, that broadcasting the data would work. Pretending that research supporting the use of your drugs is peer-reviewed and reputable wouldn't have been on my list of ways to do that - it sounds more like something to do if your drug doesn't work all that well, and you need to sell it anyway. Something that Merck, once upon a time, wouldn't have stooped to do, and which might explain people's distrust of them (and of pharmaceutical companies - hence the massive woo outbreaks).

If you produce useful drugs, people will find them, and use them. If you sell drugs dishonestly and for conditions for which they may not be useful, people may not buy drugs from you even for things for which they are likely to be useful (unless they have no choice), because most of your customers aren't pharmacists, doctors, or drug chemists, and aren't going to understand what your drugs do, but do know that they may not be able to trust you. Once you barter your reputation for cash, you probably will not get it back, not in a form that you might want, anyway.

Time to take yet another look at that Lancet Iraq Body count item.

By vanderleun (not verified) on 05 May 2009 #permalink

Even worse is that Elsevier apparently requested and received an ISSN, presumably to promote the deception.

By Dana Roth (not verified) on 05 May 2009 #permalink

"Merck has to advertise, and it has to be creative to get a message across."

New definition of creative: Deception for the sake of objectivity and impartiality.

Can you imagine if a tobacco company did something like this today? Elsevier would never sell another issue and the company would probably be bankrupted several times over by government actions against it.

So are we going to see the same sort of actions in this case?

Of course not: Big Pharma has a "Get Out Of Jail Free!" card. Sure they have to occasionally pay off the small fry who get killed by their drugs, but in general they simply keep raking the money in.

The "real" medical journals aren't that much better in some ways though: they'll publish research that fits with the politically correct views and be very reluctant to publish that which does not. The "peer-review" process is a joke as submitters nominate their like-minded friends for reviewers and then those friends rubber-stamp the nonsensical parodies of research designed to support a political position or social engineering goal.

See http://www.acsh.org/factsfears/newsID.990/news_detail.asp

for an example of how research arriving at undesired conclusions gets treated.

Michael J. McFadden
Author of "Dissecting Antismokers' Brains"

If you've got another way to vet papers for accuracy, I'm sure a lot of people would like to hear it. Right now, peer review sounds better than the "this fits my political opinions so it must be right" mode lots of conservative people and journals (for example, JAPS - see two articles above) have taken - it's not even as good as what came before peer review. While its purveyors seem to be adept at self-promotion (anti-VAX, anti-AGW, anti-ant-smoking, etc.), they haven't been so good at providing actual data (well, at least, not before a few hundred tries or so), and seem to have a remarkable immunity to data. The "there must be a bias to peer review because they think my data sucks" only works when you have evidence - as in the H. pylori ulcer hypothesis, data will out. Of course, that would require data, and based on the choice of conspiracies of exclusion that require none (that actually use the absence of evidence as evidence), I'm guessing you don't have any. Sorry about that.

I would have figured the previous Presidential administration's experiences (or failures, but that's redundant) were an object lesson in what happens when you only hear what you want to hear and lack a mechanism for comparing what you hear to objective reality. I guess there's at least a few who haven't yet learned that lesson.

Michael Simpson:

If you can't tell the difference between ethical innovative marketing and deliberate deception, you are indeed a shill for Big Pharma. You ought to be ashamed.

Hap wrote,
If you've got another way to vet papers for accuracy, I'm sure a lot of people would like to hear it. Right now, peer review sounds better than the "this fits my political opinions so it must be right" mode lots of conservative people and journals (for example, JAPS - see two articles above) have taken - it's not even as good as what came before peer review.

Unfortunately I don't Hap. The problem isn't so much with peer-review itself but with the editorial boards of journals allowing their biases and political agendas to dictate the journals' contents. All peer-review actually consists of is having the editors of the journal, after their own preliminary examination determination that your work deserves serious consideration, passing it on to two or three "reviewers" who can partially or wholly suggested/selected by the author of the original article. Those "reviewers" are suppose to read the article, evaluate/criticize it, offer suggestions for improvement and recommendation to the journal editors as to whether to publish. It's then landed back in the lap of the main editors (who've basically just farmed out the work you would think THEY are supposed to be doing!) and they make a decision as to "Yes," "No," or "Needs more work and then send it in again." That's really all peer-review consists of.

In the case of our own submission, the BMJ got a critical, but not negative, evaluation from one reviewer and then dumped the paper on the primary ground that a paper contradicting the very highly publicized earlier work they'd published simply would not be "of general interest" to their readers. See the ACSH link in my earlier post for the full story.

Hap then went on to say, "While its purveyors seem to be adept at self-promotion (anti-VAX, anti-AGW, anti-ant-smoking, etc.), they haven't been so good at providing actual data (well, at least, not before a few hundred tries or so), and seem to have a remarkable immunity to data.

Actually Hap, our paper supplied plenty of data, all publicly verifiable, and all analyzed at least fairly well. See:

http://www.scribd.com/doc/9679507/bmjmanuscript

which is the original unedited, unimproved BMJ submission. You'll find that our work, over three years ago, reached and supported the same conclusion just recently reached by the RAND/Harvard study just last month at:

http://www.nber.org/papers/w14790.pdf

and discussed in detail at:

http://tobaccoanalysis.blogspot.com/2009/04/new-study-of-national-heart…

It will be interesting to see if the medical journals are as willing to refuse valid data, even if they don't like it, from the RAND Corporation and Harvard. It's just too bad that so many smoking bans got passed on the basis of bad data that the journals refused to correct. The fault didn't lie with the peer reviewers: it lay directly upon the shoulders of the editors of the BMJ, Circulation, and Tobacco Control.

Michael J. McFadden
Author of "Dissecting Antismokers' Brains"

There is an excellent discussion of this at
http://laikaspoetnik.wordpress.com/2009/05/08/mercks-ghostwriters-haunt…

And http://bibwild.wordpress.com/2009/05/05/shame-on-elsevier/ has links to two copies at
http://images.the-scientist.com/pdfs/blogs/MSD0503540001.pdf and http://images.the-scientist.com/pdfs/blogs/MSD0503540027.pdf

I see that Stanford is requesting its scientists to neither publish in Elsevier publications, nor to quote them. Not on account of this (yet), but because the journals are so very, very expensive.

By WiseWoman (not verified) on 09 May 2009 #permalink

The whole thing sounds like a mafia-style organised crime network with the use of academia especially by developed part of the world.

1) I'm sorry for the catty comments referred to in 17. I am being annoying lately more often than I would like.

I dont really know where to go without peer review though. Theoretically, with enough journals, something can get published anywhere, so the hope is that the biases of journal editors are canceled. (Of course, they're not supposed to have biases for or against opions, but well, neither are newspapers, exactly.) I don't know if that's true - there are a lot of journals, but you probably would actually like people to read your articles. After-action review of papers might help, but readers and commenters have biases, too - if we write commentary under our own names or a consistent name, then if we make stupid comments, we can be held accountable and the accuracy/honesty of our review can be factored into whether people should trust our input on specific articles, but that won't always be the case. Maybe nonanonymous peer-review would help (unless it's the editor, in which case you already do), but I don't know if that would create more problems than it solves. Publishing it yourself might work (Elsevier's already got one of those, effectively, by a math guy), but useful stuff (good data excluded for bad reasons) might get overwhelmed by bad data and logic excluded for good reasons.

2) One aspect that I didn't realize when I wrote the further above comments (e.g. 10) was that the work Merck published in the fake journal was originally peer-reviewed - it just wasn't a random cross-section and wasn't labeled as being intended to help advertise their drugs. It's still dishonest, but they aren't using it as a pipeline to push non-peer reviewed research on their drugs.

Hap, no problem! :) Catty comments make for good reading and response sometimes. :>

Re the multiplicity of journals: You're correct that with so many out there it's probably possible to get almost anything published eventually, but the problem is that unless you're a full time professional with a staff and grants it's difficult. Each journal has its own styles and hoops to jump through and it takes a lot of work and time for submissions. If your research is time sensitive at all then after a while you start running into the problem of editors wanting updated data.

The main point I was making is that the "peer-review" aspect of medical journals seems fairly worthless. All it means is that after the main editors determine your research is both important enough and of a quality that it can't simply be thrown right in the trash then they farm it out to two or three "peers" to look over and comment on. It then comes back to the editor to make a decision. It all hinges on the journal editors - not the "peers".

The appeals process appears to be broken as well. In the case of the BMJ Dave and I felt we had valid grounds for an appeal so we filed one. The main BMJ editor simply gave it to one of his co-workers who then agreed with him. End of appeal. I believe that's all discussed in the ACSH article:

http://www.acsh.org/factsfears/newsID.990/news_detail.asp

HOWEVER... the BMJ *does* have something in the area of peer review that I consider far more powerful and valuable: their Rapid Response section. They seem to run it fairly and they review submitted comments for accuracy. When I submitted my "Independently Reviewed?" or "Helena: 1,000 Days" comment that included reference to data being removed from the public eye because its content contradicted the public statements of the researchers the RR editor contacted me to verify the link (the original link evidently had a problem because it needed to dredge the data page up from an archival engine.)
The Helena authors have continued to display a disgraceful lack of responsibility in responding to those Rapid Responses, but at least the questions and criticisms of the research are out there in the public and medical record for anyone responsible enough to go look.

http://bmj.bmjjournals.com/cgi/eletters/bmj.38055.715683.55v1

Michael J. McFadden
Author of "Dissecting Antismokers' Brains"

Even top peer-reviewed medical journals such as Nature Medicine sometimes published results with huge experimental errors. When one of the readers found out the obvious errors and wrote to the Editor, the original authors and the original reviewers found all kinds of baseless excuses to confuse the scientific concepts and then used their power to deny the opportunity to make corrections by saying "reviewers felt the points raised were not of sufficient importance to challenge the main conclusions". No matter the main conclusions are challenged or not, errors in the published article need to be corrected based on basic scientific ethics.

When more and more unreliable results and unqualified papers are published in top peer-reviewed journals, it will be more difficult for readers to know which journals are responsible and can be trusted. One of the papers published recently in Nature Medicine with huge experimental errors was mentioned in the ScientificBlogging:

http://www.scientificblogging.com/truth_finder/blog/any_opinions_whethe…