Accuracy, Transparency, and Conflict of Interest in Medical Journal Drug Advertisements

James R. Scott,1,2,3 Mark Gibson,1 Rebecca S. Benner3

Objective Medical journal editors have been leaders in criticizing financial conflicts of interest and supporting transparency in industry-sponsored research studies. Paradoxically, many medical journals continue to derive substantial income from their own advertisements for prescription medications. The purpose of this study was to evaluate the accuracy and medical value of these advertisements.

Design In this prospective observational study, we assessed all pharmaceutical advertisements for prescription drugs in the New England Journal of Medicine, JAMA, and Annals of Internal Medicine from May 2016 through October 2016. Two investigators independently reviewed the advertisements, and any disagreements were resolved by consensus. Outcomes examined included claims of efficacy; reporting of adverse effects; number, accessibility, and quality of references; and price of the drug.

Results Forty-two unique advertisements for 39 different drugs were identified among 190 total advertisements. Twenty-five of the 39 drugs (64%) were advertised more than once (range, 1-26). The retail price of 22 (56%) of these drugs was more than $1000 for 1 month of treatment, and 7 (18%) cost more than $10,000 per month. Most advertisements featured new drugs promoted through 1 to 3 pages of glossy and colorful attention-getting images followed by black-and-white package insert–like formats that contained detailed information about contraindications and adverse effects. Supporting references from the peer-reviewed medical literature were cited in 22 of the 42 different drug advertisements (52%). Forty-seven of 53 studies referenced (89%) were coauthored by individuals who had financial ties to the drug manufacturer, and they were also usually sponsored by the company. Twenty advertisements listed only prescribing information or data on file. Requests for data on file were successful in only 4 of 13 cases (31%).

Conclusions This study shows that contemporary pharmaceutical advertisements in major American medical journals promote expensive new drugs and do not provide sufficient information for review of claims made. Journal advertising that fails to foster dissemination of evidence-based knowledge and cost-effective patient care warrants reevaluation by publishers and editors.

1Departments of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA, james.scott@hsc.utah.edu; 2University of Iowa Carver College of Medicine, Iowa City, IA, USA; 3Obstetrics & Gynecology, American College of Obstetricians and Gynecologists, Washington, DC, USA

Conflict of Interest Disclosures: None reported.

Funding/Support: None reported.

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