Questions about financial disclosure in New England Journal of Medicine

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Science writer Norman Bauman raises some interesting questions in a note he sent me last night. He agreed to let me post his note on this blog:

I just read an article in the New England Journal of Medicine which recommended a drug. The author was a paid advisor to the manufacturer of the drug. The NEJM didn’t disclose that fact in the paper edition. I could only find that out by going online and doing some searching.

I just finished Nicotine Addiction (Review Article), Neal L. Benowitz, New England Journal of Medicine, 362:2295-2303 (June 17, 2010) Nicotine Addiction, Neal L. Benowitz, M.D.

The “Conclusion” says: “An increased understanding of the mechanisms of nicotine addiction has led to the development of novel medications (e.g., varenicline) that act on specific nicotinic receptor subtypes.”

At the end it says, “Disclosure forms provided by the author are available with the full text of this article at NEJM.org.”

If you follow that link online, and read it carefully, you’ll see that Benowitz is a member of a scientific advisory board for Pfizer. If you look up “varenicline” on the Internet, you’ll see that it’s sold by Pfizer as Chantix.

If you only read the article on paper, and couldn’t easily look it up on line, you’d never know that Benowitz is on the scientific advisory board of the company that makes the drug he recommends.

It seems that all the disclosures in the NEJM are now online.

This raises several questions in my mind.

If I read a review article in the NEJM, and it recommends a particular drug, shouldn’t the article tell me right there that the author is a paid member of the drug manufacturer’s advisory board?

Is it adequate disclosure to require me to go on line and read the disclosure form?

Shouldn’t all the disclosures be in the paper edition?

Should the author of a review article have singled out a particular drug at all in the conclusion, in an article that didn’t otherwise discuss treatment?

Should review articles be written by authors who aren’t taking any drug company money, as former NEJM editors maintained?

And what about the adverse effects of varenicline? When I read a review article in the NEJM, do I have to check Wikipedia to get the rest of the story?

Have others seen, written about, or commented on this practice?

Some journals, like the NEJM, have taken steps to improve their disclosure policies. But might not these practices be improved by helping readers connect the dots a bit – by pointing out clearly relevant and important disclosures in print, while posting others online? So, in the example Bauman raises, couldn’t/shouldn’t the Pfizer scientific advisory board membership have been listed in the print edition?

Please weigh in using the comments section.

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Comments

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Phillipa Rispin (medical writer-editor)

June 18, 2010 at 10:56 am

Unless there is something remarkable that distinguishes a drug from others in the same class or with the same indication, the author of a review article should not single out that drug in an article that didn’t otherwise discuss treatment.
Re disclosures being available only on line: If the printed version of a paper is the version of record, then the disclosures — and everything else relevant — must also be printed.

Peggy Peck

June 18, 2010 at 11:43 am

I raised concerns about NEJM’s new disclosures documents last fall at the AHA meeting when NEJM exec editor Gregory Curfman. My complaint is that the disclosure forms are at best confusing and these forms are used for all articles–original research and review articles. They obscure rather than reveal relevant disclosure.