Medical journals: Gone cold turkey

2. December 2013

One of the major medical journals finally distances itself from the cigarette industry. The risk of the deadly products being abused is said to be too great.

The British Medical Journal (BMJ) has drawn a line. It will no longer publish studies that were funded by the tobacco industry. In one of the newspaper’s editorials the editors make it clear that they will not stand by and watch as the industry uses “journals to maintain one of the deadliest epidemics of our time”. In addition to the mother journal, the periodicals Heart, Thorax and BMJ Open have undersigned the agreement.

After much hesitation

Thus the BMJ follows the example of those magazines that have already taken this route before then. These include PLoS Medicine, PLoS One, PLoS Biology and the Journal of Health Psychology.
For those responsible this path means a complete turnaround. In 1996 the journal criticised the American Thoracic Society for its decision not to publish studies funded by the tobacco industry. In a BMJ editorial it was stated: “This decision was another step in this medical society’s honourable battle, but it was also a misguided one”. It threatens medical science, journalism and the freedom of society.

Misled about the risks of smoking

Well a lot has happened in the meantime. In recent years more and more evidence appeared which showed that the tobacco industry wilfully distorted information, withheld study results or interpreted them in a misleading way so as to sow doubt that cigarettes are detrimental to health.

By the late nineties, the five major cigarette manufacturers Philip Morris, RJ Reynolds, Lorillard, Brown & Williamson and the American Tobacco Company due to damage suits in the U.S had to undertake for the next 25 years to pay 200 billion U.S. dollars compensation to the federal states. They were also obliged to publish sensitive corporate documents because they had misled the public about the true risks of smoking.

Academic freedom restricted

In all this there are also documents which gave an insight into practices in Germany. The cigarette industry association (VdC) at the time promoted around 110 research projects between 1977-1991. In the documents there are to be found among others the names of more than 60 scientists involved, including influential doctors, university professors, former presidents of medical societies as well as one former president of the German Federal Health Office.

One of the documents describes in detail how academic freedom was restricted by the sponsors: “The association (VdC) has total control over the design of the experiments, the right of researchers to publish or not to publish, et cetera. Similarly, these projects must be kept internally confidential”. Publication and discussion of this manner of approach, however, have not led to hampering the influence of the industry.

Lobbyists acting on the EU legislation

The British news magazine The Observer reported recently that the tobacco company Philip Morris engaged 161 lobbyists to fight EU legislation – apparently successfully. MEPs are supposed to decide on a new directive which should help in limiting deaths from tobacco use. This included things such as the prohibition of additives, the exclusive sale of e-cigarettes in pharmacies and printing of warning pictures on their packages. In the end the vote in the European Parliament was postponed for months. While it was indeed agreed to, many calls from cigarette opponents in the end were not able to prevail.

“The tobacco industry has not really changed, the cigarette – the most deadly consumer product ever made – is still on the market and is aggressively advertised”, writes the BMJ. Its decision is therefore hailed by many as a necessary blow to the tobacco industry. Critics, however, find fault in the impositions that go along with it.

Money plays a role!

Citations made include: researchers are dependent on money and that this often does come from industry; that the pharmaceutical industry also has interests, and its influence on study results has been demonstrated in abundance; that to renounce all financial contributors is something research-based science would not be able to afford; that in addition, readers would be able to assess the quality of studies themselves, as long as the financial ties are disclosed without exception.

For the editors of the BMJ, this argumentation does not hold, because study results and their interpretation would be verifiably influenced by the interests of donors. They say the differences would hardly be visible to readers. Even peer-review processes cannot discover with certainty all methodological deficiencies and misleading analysis.

Conflicting interests

The task of medical journals is via the publishing of studies to reduce illness and disease in the population. The tobacco industry, however, wants to promote its product. These conflicting interests are held by the editors of the BMJ to be in principle irreconcilable.

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