With thanks to The One Click Group:
Marcia Angell (the first woman to serve as editor in chief of the New England Journal of Medicine: “it is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of the New England Journal of Medicine.”
Richard Smith (editor of the British Medical Journal and chief executive of the British Medical Journal Publishing Group from 1991 to 2004): ‘We are all more interested in the conflicts of interests of others than we are in our own, and editors are no exception. Having preached to authors and reviewers on conflict of interest, editors have largely neglected their own….’
New England Journal of Medicine 4 Nov 2010 Vol 363
The New England Journal describes itself as the world’s leading medical journal and I wouldn’t argue with that. Every now and again, though, its papers are of such a rarified nature that a mere GP cannot hope to apply their undoubted wisdom and excellence to his personal practice.
You and I shall never use recombinant activated Factor VII in a heavily bleeding patient, which is probably just as well, because it might kill people; we shall never have the satisfaction of seeing the subependymal astrocytomas of tuberous sclerosis shrink under the influence of everolimus; nor indeed are we likely to use brentuximab vedotin in relapsed CD30-positive lymphomas; while advances in haemodialysis we leave in the capable hands of our learned friends, the nephrologists.
I have no objection to such rarefaction on the part of the NEJM editors because these are life-and-death matters for many people around the world. Moreover, I can’t fault the journal’s stance on many of the important debates in medical politics, including criticism of the role of some major pharmaceutical companies, such as GSK in relation to rosiglitazone.
But in one of his latest blogs, Richard Smith reminds us that high-faluting does not come cheap, and 32% of papers published by the NEJM relate to studies paid for by drug companies, who then pay the journal up to $1M for reprints.
It is this sort of thing that led Marcia Angell to her depressing conclusion that “it is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of the New England Journal of Medicine.”
‘Like us, you have probably grown accustomed to the steady stream of revelations about incomplete or suppressed information from clinical trials of drugs and medical devices. If so, this issue of the BMJ features a pair of papers that will dismay but not surprise you‘.