WASHINGTON, D.C. – An article published today in STAT News criticizes the New England Journal of Medicine (NEJM) for publishing a commentary strongly endorsing the pharmaceutical industry’s perspective on drug pricing, authored by economists with drug company ties that were not adequately disclosed within the piece itself.
Last November, the NEJM published the piece, “Drug-Pricing Debate Redux — Should Cost-Effectiveness Analysis Be Used Now to Price Pharmaceuticals?” in which the authors contend that the appropriate price “is a drug’s value-based price, measured appropriately.” The commentary echoes the views of pharmaceutical manufacturers, whose price increases regularly exceed the inflation rate and the actual rise in production and distribution costs. This argument gives pharmaceutical companies license to charge as much as they can extract, rather that something in reasonable relationship to what it costs them to produce the product, write Martin F. Shapiro, a professor of medicine at Weill Cornell Medical College, and Sidney M. Wolfe, an internist and founder and senior advisor to Public Citizen’s Health Research Group.
Shapiro and Wolfe say that the NEJM failed to make clear to readers that the authors had profound conflicts of interest directly relevant to the content of the piece, involving corporations advocating for and benefitting financially from the point of view it expressed.
“There is no justification for failing to provide full transparency regarding the relationships of authors to companies with financial interests related to topics they write about. All journal editors could — and should — do that,” says Wolfe. “Based on the New England Journal of Medicine’s previously stricter financial conflict of interest policy in the 1990s, such an unacceptably conflicted article would clearly have been rejected.”
The Institute of Medicine (now the National Academy of Medicine) has defined conflicts of interest as “circumstances that create a risk that professional judgments or actions regarding a primary interest will be unduly influenced by a secondary interest.” The International Committee of Medical Journal Editors recommend transparency about such conflicts for articles in medical journals. Many journals gather information about such relationships and some publish footnotes specifying the companies involved. NEJM does not alert readers in a footnote about any such relationships but provides an online link to disclosures.
Some editors have noted that there is a special responsibility to avoid having authors with such relationships write editorials and review articles, because readers depend on their objectivity.
“The pharmaceutical industry spends billions of dollars annually to induce demand for their wildly overpriced products,” said Shapiro. “Medical journals should not be providing drug companies with free advertising by publishing opinion pieces that promote the industry’s socially regressive business strategy.”
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