Medical Journal Tries to Heal Itself

(AP)--In an extraordinary apology to readers, The New England Journal of Medicine admitted violating its financial conflict-of-interest policy 19 times over the past three years in its selection of doctors to review new drug treatments. The Boston-based weekly journal, considered one of the world's premier medical publications, disclosed in Thursday's issue that it had let doctors with financial ties to drug makers write the reviews. "It was carelessness on our part," Dr. Marcia Angell, the editor in chief since September, said in an interview. The internal review was prompted by a news report about one such violation last fall. It found 18 additional instances since January 1997. The violations involve the journal's "Drug Therapy" feature, a series of reviews of the latest drug treatments for particular illnesses. In each case, the journal failed to disqualify authors even though they had revealed their financial ties up front, Angell said. Angell said the journal solicits authors to write the reviews but is supposed to bar those have directly or indirectly received "major research support" or payment as a consultant from companies that make drugs prominently discussed in those articles. The "Drug Therapy" series is overseen by an outside editor, Dr. Alistair J.J. Wood, a pharmacology professor at Vanderbilt University. Angell said that Wood disqualified authors who personally received significant research funding from the maker of drugs discussed prominently in an article but failed to disqualify authors whose institutions received such grants or authors who served as consultants to the drug companies. She said some in-house editors knew of the practice and overlooked it. She said she suspects that there were violations before 1997, too, but the in-house review went back only three years. Wood has been editing the series for about a decade. In a letter to readers, Angell apologized for the lapse and said steps have been taken to ensure against any recurrence. She said no action was taken against Wood. He and a deputy editor who helps edit the series also signed the letter. The letter listed the 18 newly uncovered articles along with the drug makers, which ranged from little-known biotech companies to pharmaceutical giants like Bristol-Myers Squibb, Merck & Co., Pharmacia & Upjohn, and Wyeth-Ayerst. The journal regularly publishes original, unsolicited articles on clinical trials of particular drugs written by academic scientists who have received major research funding from a drug manufacturer involved. In those cases, the article notes those funding sources at the end. Angell said that the stricter policy for review articles is difficult to maintain because "there's so much connection between academia and the private sector now."