BMJ Editor Acnolwledges Failure to Disclose COI

The editor in chief of the BMJ acknowledges that AHRP was right to criticize the BMJ and its editor for failing to disclose to its readership, the BMJ financial ties to Merck–manufacturer of 13 vaccines. She also acknowledges income from GSK–manufacturer of several vaccines as well.

"Thank you for giving me an opportunity to respond to Vera Hassner Sharav’s comment, [1] which for those of you who haven’t seen it is reproduced below. http://www.ahrp.org/cms/content/view/766/9/

Although Vera’s claims may seem far fetched on this occasion, she is right that we should have declared the BMJ Group’s income from Merck as a competing interest to the editorial (and the two editor’s choice articles) that accompanied Brian Deer’s series on the Secrets of the MMR scare.[2] [3] [4] We should also, as you say, have declared the group’s income from GSK as a competing interest in relation to these articles. We will publish clarifications."

However, her statement, "We didn’t declare these competing interests because it didn’t occur to us to do so " is startling. How seriously are we to take her strongly articulated stance against researchers who fail to disclose their financial conflicts of interest–if she doesn’t recognize her journal’s blatant conflict of interest?

Either she is being disingenuous or downright cynical about the BMJs declared stand against financial conflicts of interest that are undermining the integrity of medical research reports, and its own clandestine partnerships with industry.

How seriously are we to take her stance against researchers who fail to disclose their financial conflicts of interest?

Let’s be clear: financial conflicts of interest ALWAYS influence the position one defends– human nature does not distinguish between politicians whose campaign chests are filled by vested interests, government officials, or academics who have grown dependent on financial support from special interests. Each delivers the service for which he/she is paid.

Vera Hassner Sharav

 

Dear John Stone,

Thank you for giving me an opportunity to respond to Vera Hassner Sharav’s comment, [1] which for those of you who haven’t seen it is reproduced below.

Although Vera’s claims may seem far fetched on this occasion, she is right that we should have declared the BMJ Group’s income from Merck as a competing interest to the editorial (and the two editor’s choice articles) that accompanied Brian Deer’s series on the Secrets of the MMR scare.[2] [3] [4] We should also, as you say, have declared the group’s income from GSK as a competing interest in relation to these articles. We will publish clarifications.

We didn’t declare these competing interests because it didn’t occur to us to do so. We saw this series not as pro-MMR vaccine or pro- vaccination in general, but as against fraud and corruption in medical research. Having said this, the last line in the editorial is indeed explicitly supportive of MMR vaccination. This is in line with the BMJ’s coverage since the MMR scare began and is in line with the evidence.[5] As declared on its website (http://group.bmj.com/group/about /revenue-sources# The%20BMJ%27s%20sources%20of%20revenue) the BMJ Group receives revenues from a range of sources. The contract with Merck’s not-for-profit arm, univadis, is for the distribution of BMJ Learning to doctors outside the UK. GSK is the sponsor for the BMJ Group’s Research of the Year Award. The BMJ’s own direct sources of revenue are also declared in general terms on bmj.com. They consist of a combination of classified, pharmaceutical and non-pharmaceutical advertising, subscriptions to the journal, the sale of reprints, and sponsorship.

The journal’s sources of revenue have remained largely unchanged over the years, but the BMJ Group has grown and diversified, creating a more complex commercial environment for the BMJ. Within this, the editors of the BMJ and our commercial colleagues are acutely aware of the potential for perceived and actual conflicts of interest, and all of us remain fiercely protective of the journal’s independence. Clear rules and structures to prevent commercial influence from affecting editorial decisions are in place and are rigorously upheld by both editorial and commercial staff.

No one who is a regular reader of the BMJ or who has heard me speak, could be left with the impression that we are uncritically supportive of the pharmaceutical industry. Articles directly relevant to the activities of Merck and GSK are referenced below,[6] [7] [8] and a recent lecture I have given on the state of the medical literature is available online: the annual Sense About Science lecture in London in June 2010 (http://www.senseaboutscience.org.uk/ index.php /site/other/297/)

All three articles by Brian Deer were made freely available on line in keeping with our policy of freeing up articles of high global importance.

Fiona Godlee

1. http://www.ahrp.org/cms/content/view/766/9/

2. BMJ 2011; 342:c7452 doi: 10.1136/bmj.c7452 (Published 5 January 2011)

3. BMJ 2011; 342:d22 doi: 10.1136/bmj.d22 (Published 6 January 2011)

4. BMJ 2011; 342:d378 doi: 10.1136/bmj.d378 (Published 19 January 2011)

5. http://onlinelibrary.wiley.com/o/cochrane/ clsysrev/articles/CD004407/frame.html

6. Krumholz H, Ross JS, Presler AH, Egilman DS. What have we learnt from Vioxx? BMJ 2007;334:120-123 doi:10.1136/bmj.39024.487720.68 (Published 18 January 2007)

7. BMJ 2010; 341:c4848 doi: 10.1136/bmj.c4848 (Published 6 September 2010)

8. BMJ 2010; 341:c6985 doi: 10.1136/bmj.c6985 (Published 7 December 2010) From AHRP.org [1]

 

ALLIANCE FOR HUMAN RESEARCH PROTECTION

BMJ & Lancet Wedded to Merck CME Partnership

Monday, 14 February 2011

Why did the BMJ fail to disclose its partnership agreement with Merck, major vaccine manufacturer–13 vaccines, including the controversial MMR vaccine ?

Is it just conceivably possible, that the BMJ’s decision to commission and publish Brian Deer’s series of articles attacking Dr. Andrew Wakefield’s personal and scientific integrity–and lend its unwavering editorial endorsement–without giving him an opportunity to defend himself–might be influenced by a SIGNIFICANT financial conflict of interest?

The discovery that a psychiatry textbook penned by two influential academics who gained notoriety, was actually ghostwritten shocked Dr. Dad Kessler, former commissioner of the FDA, who called it "a new level of chutzpah [that] takes your breath away."

How about the discovery that in 2008, the pharmaceutical giant, Merck –using its tradename, MSD signed a partnership agreement with the BMJ Group that effectively gave the company control of 350 interactive continuing medical education courses in over 20 medical therapy areas?

"This unique partnership will change the face of medical education in Europe and beyond, allowing users access to most of BMJ Learning’s library of ‘Continuing Medical Education’ (CME) and ‘Continuing Professional Development’ (CPD) content. The agreement between MSD and BMJ Group comprises about 350 interactive learning courses in over 20 medical therapy areas."

Why did the BMJ fail to disclose its partnership agreement with Merck?

Why did the BMJ conceal from readers– of the Brian Deer series of articles and the BMJ editorial excoriating Dr. Andrew Wakefield, charging him with deliberate fraud and financial conflict of interest– the fact that the BMJ had a partnership with Merck, a major manufacturer of vaccines–including the MMR vaccine, which is at the center of the Wakefield controversy?

In 2009, Univadis, a Merck trademark, entered into a partnership with The Lancet providing "medical education and an information website."

"Through a unique global medical literature service called Just Published, clinical specialists registered on Univadis ?will receive free access to the full text of recently published articles from The Lancet. This new service will be available on www.univadis.com

I don’t think it a stretch to suggest–as for Martin Walker does (below) that: "Linking Univadis ? /Merck with the BMJ and The Lancet inevitably links them both to Merck’s VIS (Vaccine Information Service) online — ‘a comprehensive source of information, especially designed to provide healthcare professionals with the answers to their questions on vaccines.’"

The fact that BMJ and The Lancet– two of the most prestigious international medical journals would enter into a medical education partnership with the drug manufacturer whose staff drew up a "doctor hit list" to intimidate doctors who dared to discuss the lethal cardiac risks linked to Vioxx–is in itself a betrayal of trust of the worst sort.

The stated purpose of the Merck / BMJ/ Lancet partnerships that remained hidden from readers’ view, is to "change the face of medical education in Europe and beyond."

The BMJ editorial accompanying Deer’s articles, did its best to lend authority to the vaccine industry (Merck’s) perspective. In an introductory sound bite the editors declare:

"Clear evidence of falsification of data should now close the door on this damaging vaccine scare."

Finally, the Statement about Competing Interests at the end of the BMJ Editorial claims compliance with conflict of interest disclosure requirements of the International Committee of Medical Journal Editors. But the BMJ editor in chief and two deputy editors conceal rather than disclose the most relevant financial conflict of interest:

"Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years.

Competing interests: I am the editor of the BMJ and responsible for all it contains."

Submit rapid response

What about BMJ, Merck and GSK (and Andrew Wakefield)?

BMJ is a part free journal. In view of the recent renewed attacks on Andrew Wakefield (which were all free of access) what are we to make of the fact that BMJ Learning is in partnership with Merck under the alias of Univadis [1,2], or that MSD and GSK sponsor BMJ awards [3]? Should not these competing interests be openly declared?

[1] Vera Hassner Sharav ‘BMJ & Lancet Wedded to Merck CME Partnership’ (including Martin J Walker ‘Merck’s Medical Media Empire’), http://www.ahrp.org/cms/content/view/766/9/

[2] Univadis log-in page, http://www.univadis.com/RH/UK_loginpage/

[3] http://groupawards.bmj.com/sponsors

Competing interests: None declared