] Diab Camp 1993; 7.4546

EDITORIAL

Pharmaceutical Industry Sponsored Symposia

I read with interest the Special Article by Bero, Gal- braith, and Rennie that was published in the October 15th, 1992 issue of the Nao England Journal of Medicine. This article entitled ‘The Publication of Sponsored Symposiums in Medical Journals” is quite good and very interesting. They reviewed 58 medical journals of clinical medicine with respect to publication of Sym- posia and surveyed the editors of these journals re- garding their editorial policies with respect to the publication of Symposia. They concluded that “Sym- posiums sponsored by drug companies often have promotional attributes and are not peer reviewed.” They suggest all financial relationships between the sponsors, participants, and Journals be revealed and that the journal retain editorial control.

This report was relevant to me at this particular time, as in this issue of the Journal of Diabetes and Its Complica- tions we are publishing a Symposium entitled “Leader- ship Conference on Diabetes Research and Clinical Practice.“ This Symposium, sponsored by Novo Nor- disk, was held at Boston University Corporate Edu- cation Center, Tyngsboro, Massachusetts, October 9-13, 1991. Because this Symposium is “industry- sponsored,” I thought I should review the article by Bero and her colleagues relative to the editorial policies of the Journal of Diabetes and Its Complications. I do agree with many of the points raised in this article, but I do have a few thoughts that I would like to put forth for our readership’s perusal.

The authors suggest that the primary reason to pub- lish sponsored symposia is ‘financial pressures” on journals. Actually, I am surprised at the naivety of this statement. Of course there are “financial pressures” on medical journals. Why should the medical journal business be different than any other business? All businesses look for new and innovative ways to in- crease their revenue and thus their profitability. There would be no medical journals if there were no financial pressures. According to Bero et al., the financial re- turns for journals vary from selling reprints (an aver-

age of 25,000 reprints at an average cost of $15 per reprint) to page charges that varied from !§400-1500 per page. One Journal charged a flat $lOO,OOO fee to publish a symposium. The Journal of Diabetes and Its Complications charged Novo-Nordisk no page charges. We do hope to sell some reprints, however. The cost of the reprints will depend on the final size of the Symposium publication and the number of copies or- dered. There are also “financial pressures” brought to bear on the contributors to Symposia such as these. The authors of the manuscripts in this and other such symposia are usually paid an honorarium both to par- ticipate in the original symposium and then to provide a manuscript for publication. I do not believe that it is a crime to be paid for your expertise. In fact, some people help to pay for their children’s college educa- tion by this mechanism. (Raskin P: Am J Med 79(suppl 2B):2-5,1985, and Rosenstock J, Meisel A, and Raskin P: Am J Med 83(Suppl3A):lO-15, 1983).

The article by Bero et al. also discussed the fact that many of the Symposium titles were misleading and that the main purpose of the information presented was to promote a drug or drugs. When the symposium had a single pharmaceutical company as a sponsor, the symposium “was associated with single drug topics, misleading titles and the use of brand names.” The Symposium published in this issue is sponsored by a single pharmaceutical company and its title might be classified as “misleading” as it contains the word ‘leadership”. These facts would be considered nega- tive according to Bero et al. On the positive side, this Symposium is clearly “non-drug” and I do not believe that brand names of any kind were used in any of the manuscripts. Finally, Bero et al. discussed the various editorial policies of the journals that published sympo- sia. Editorial policies differed to a large extent. Forty- four percent of the journals surveyed reported the same type of peer review as other articles submitted to those journals. In the case of the Journal of Diabetes and Its Complications, this Symposium was subjected

0 1993 Journd of Diabetes and Ifs Complications 0891-6632/93f$6.00

66 RASKIN J Diab Camp 1993; 7:65-66

to the same peer review process as other articles sub- mitted to this Journal. I served as the primary reviewer for each of the articles. Although the articles submitted to our Journal are also sent to outside reviewers, I review each of the articles myself as well. To be honest, I think the readers of the Iour& of Diabetes and Its Com- plications owe a debt to Novo-Nordisk and to the au- thors of the manuscripts in this Symposium. This is a collection of marvelous reviews. The information provided is the most up-to-date available. The articles are written in a clear and understandable fashion by leaders in each of their respective fields. I am delighted to have the opportunity to promulgate it.

I do agree for the most part with the suggestions of Bero et al., that all the details, financial and otherwise, of pharmaceutical industry-sponsored symposia should be disclosed and that editorial control over contribu- tions be maintained. It is true “that Symposiums spon- sored by drug companies often have promotional attributes” and may not be peer reviewed. In my judg- ment, it is the reader that has the final responsibility to sort through published material. Whether one reads the lead article in the New England Journal of Medicine, a drug company sponsored promotional type Symposia published wherever, the same critical thought process must be brought to bear. Why should anyone believe what they read? I don’t think we should take at face value anything published in a medical journal or the New York Times, for that matter, without thinking about it ourselves, in a sense serving as the “primary reviewer” for that article. I suggest that all readers do this irrespective of who the author(s) of the article

might be. In fact, I suggest careful thought about what you are reading at this minute. There is no more reason to believe what I say than anybody else!

In the end, the final editorial review rests with the reader. We must take the responsibility for the infor- mation we read. Journal editors have a responsibility to be sure the articles they publish in their Journal are factual, that the experimental designs, etc. are reason- able, and that the manuscripts are readable. Of course, we want the most important articles published in our Journal. After all, that will increase our readership, our revenue, and our importance as an Editor.

The pharmaceutical industry has taken a lot of heat of late. Much of it, I must say, has been deserved but clearly not all of it. I was one of the first to bring to public attention what I perceived as an unhealthy rela- tionship between physicians and the pharmaceutical industry (“Goodbye Columbus-Revisited” Clinical Diabetes 3:98,1985). Many of the problems that I sug- gested existed between physicians and the pharma- ceutical industry, have been confirmed by others. As a result, there have been marked changes in these rela- tionships. However, the field of medicine would be nowhere without the “bottom line driven” pharma- ceutical industry. As in other areas of life, the profit motive is excellent fuel to drive the engines of prog- ress. In terms of sponsored Symposia, full financial disclosure is important, but in the end the reader is responsible for believing or disbelieving what they read.

Philip Raskin, MD