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A Registry of Journals Free of Drug Ads?

There was intense press interest for a recent policy paper in PLoS Medicine called "Following the Script: How Drug Reps Make Friends and Influence Doctors." Some of the highest profile features on this paper were in USA Today, Wired, and United Press International.

The paper was unusual because it was authored by a former pharmaceutical sales rep collaborating with an academic physician. The authors documented the various techniques that sales reps use to influence physicians' prescribing behavior. "Physicians are susceptible to corporate influence," wrote the authors, "because they are overworked, overwhelmed with information and paperwork, and feel underappreciated. Cheerful and charming, bearing food and gifts, drug reps provide respite and sympathy; they appreciate how hard doctor's lives are, and seem only to want to ease their burdens."

The problem with such close relationships between doctors and drug reps is that there is now a wealth of evidence suggesting that acceptance of gifts and use of promotional information may lead to inappropriate prescribing.

But what can patients do to find out whether their physician is being showered with gifts and wined and dined by drug reps?

Thanks to the campaign group No Free Lunch, whose mission is to "to encourage health care providers to practice medicine on the basis of scientific evidence rather than on the basis of pharmaceutical promotion," patients can now search a No Free Lunch database to find a physician who has pledged to be free of drug industry influence.

The database is a superb idea. At the moment, it only includes US doctors, but there are plans to extend it globally.

The recent launch of the database got me thinking. Why not create a No Free Lunch directory of medical journals that refuse to publish adverts for drugs or devices? I put the idea to Dr Bob Goodman, Director of No Free Lunch, who found the idea intriguing but joked that it would be a very short list! Sadly, he's right. PLoS Medicine and Open Medicine would be on the list, but I can't think of any other general medical journals that ban drug advertising. If you know of any, please do drop me a line.

Discussion
  1. Gavin,

    you will find such journals if you look outside of the US. One example is the German Journal of General Practice/Family Medicine (ZFA – Zeitschrift fuer Allgemeinmedizin – http://www.thieme-connect.com/ejournals/toc/zfa). It is a scientific, strictly peer-reviewed journal edited by the German College of General Practitioners/Family Physicians (DEGAM – http://www.degam.de).

    Unfortunately the Literature Selection Technical Review Committee (LSTRC) of the National Library of Medicine has declined to accept the ZFA for inclusion in Medline at its most recent meeting in February 2007.

    Kind regards

    Michael

  2. Dear Gavin,
    I’m the general manager of an Italian publishing company, established in 1946. We publish two pharma ads free journals, associated to the International Society of Drug Bulletins ISDB: “Ricerca & Pratica”, edited by the Mario Negri Institute http://www.ricercaepratica.it, and the “Giornale italiano di farmacia clinica”, sponsored by the It Soc of Hospital Pharmacy.
    Both are currently payed by their readers (not many, unfortunately) and by their publisher.
    We also produce the “Bollettino di informazione sui farmaci”, sent to 360,000 Italian physicians by the National Agency for Medicines (our … FDA): no ads are included in it.
    Best regards
    Luca De Fiore

  3. Have you ever heard of patients that get better beyond what is clinically plausible?
    Within the structure of what makes a pharmaceutical company a threat to physicians, is the every day patient. The one that out of countless doctors to choose from, can only pick a limited amount.
    If doctors are so easily led then with out a formed direction outside of their limeted financial practice of the job of a doctor, who would keep an eye on you guys?
    If the thought came to your mind, “That heres someone that doesn’t know or understand. …..”
    What your doing or tying to do?
    On the contrarii many understand all to well.
    2008 the year of connecting the Dots.

  4. As the national PharmFree Coordinator for the American Medical Student Association (AMSA), I am excited to report the changes we are seeing in academic medical centers, with the exponential increase in the number of centers/schools with conflicts of interest policies in the last two years.

    AMSA, the first national medical organization to divest completely from pharmaceutical funding (which we did in 2001), is catalyzing the change through its student members at medical schools, who in many of the schools with policies, were the ones to initiate the process. In addition, we are working at a national level with the U.S. Congress (e.g. Physicians Payment Sunshine Act), Institute of Medicine, and groups like the National Physician’s Alliance, Pharmed Out, The Medical Letter, and Consumer’s Reports to reclaim the ethics of medicine by removing the conflicts of interest in medicine, and restoring the sanctity of the patient-physician relationship.

    In health,
    Anthony Fleg, MPH

  5. Advertising campaigns generally begin within a year after the introduction of a pharmaceutical product, which raises questions about the extent to which advertising increases the use of drugs with unknown safety profiles. At least one pharmaceutical manufacturer (Bristol-Myers Squibb) recently announced a voluntary moratorium on direct-to-consumer advertising for drugs in the first year after FDA approval. And PhRMA, the industry trade group, has recommended that manufacturers delay such campaigns for new drugs until after health professionals have been sufficiently educated, although no details have been provided on how long a period was deemed necessary.20 Finally, in a recent study of drug safety, the Institute of Medicine recommended that the FDA restrict advertising for newer prescription drugs.8 Our data show that a mandatory waiting period on advertising for new drugs would represent a dramatic departure from current industry practices.

  6. Within the structure of what makes a pharmaceutical company a threat to physicians, is the every day patient. The one that out of countless doctors to choose from, can only pick a limited amount.
    If doctors are so easily led then with out a formed direction outside of their limeted financial practice of the job of a doctor, who would keep an eye on you guys?

  7. I want to ask Dr. Falotico if there is any reason to believe that Sirolimus or any of the other drugs are cell-specific? I want to know what happens with brachytherapy, for example, if that thrombosis begins later on because they weren’t endothelializing, which Tim just alluded to. Is there any reason to think that Sirolimus, or other drugs, specifically attack these muscle cells, but not endothelial cells, such that you can expect endothelialization without intense proliferation? Also, is that an important mechanism by which we might not expect late subacute thrombosis?

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