Thursday, February 28, 2013

Paying Thru the Nose for Journal Reprints--For Whose Benefit?

In HOOKED, I noted that one of the biggest income makers for major medical journals, besides ads, is the sale of reprints to drugmakers. Drug reps like to hand out glossy reprints to docs to create the charade that what they say is based on hard science, and to further create the charade that the doc is a careful scientist and so of course will take the reprint back home and study it line by line. It's a much better charade if the reprint carries the byline of a highly respected journal.

A group at Oxford decided to try to get some of the quantitative data that I did not have access to when I wrote HOOKED, as this area had been little studied:

The authors approached the two big British journals and three top US journals (New England Journal, JAMA, and Annals of Internal Medicine) for data on their most widely reeprinted articles. The three US journals refused to play ball. JAMA and NEJM claimed proprietary privilege and Annals said the data would be too hard for them to compile. I'll let you draw your own conclusions as to what we might have learned had these folks provided the data. So the analysis was restricted to the British journals and also included data on some subsidiary journals published by BMJ and Lancet.

The authors compared the most-reprinted articles with a comparison set and decided that the reprinted stuff was about 8 times more likely to have been drug-industry-sponsored, which is hardly a news flash. Of greater interest, I think, is the data on what it can mean to a journal to score big with a sale of reprints to a major drug company.

It turns out that BMJ is small potatoes compared to Lancet, with the biggest sale of reprints for a single article by the former being a bit over $200,000 while the latter hit $2,436,000. Of course you don't do that well every day; the median take for BMJ was a bit less that $20,000 and for Lancet, $451,000. But it does hint at what sorts of sums are at stake.

The authors are careful to note that they cannot prove and won't allege that these sums in any way influence the editorial decisions of journals. They clearly have the worry however that if an editor is faced with accepting or not accepting a questionable paper extolling the efficacy of a new drug, knowing how much reprint sales could amount to might be a factor that could sway the decision.

Here is my perhaps paranoid reasoning in support of the authors' worry. As best as I can figure out from the somewhat opaque tables provided in the article, the Lancet's top sales for a single article was as noted $2.4M. Elsewhere it's reported that the maximum number of reprints sold by that journal was 835,100. Let's assume that the journals charge per copy for reprints and don't have a sliding scale based on factors such as article contents, which drug company is buying, etc. If we assume that the largest selling reprint was the same as sold the most copies, that works out to about $2.92 a copy.

Let's think about this for a while. The average journal article for a major research study is perhaps 8-10 pages max. Even figuring in the glossy paper and good quality printing, what could it cost the journal actually to print that reprint (in these large quantities)? It would seem that the charge of nearly $3 a copy has to be quite excessive. If the drug companies were trying to keep their costs down, you'd think they could have bargained for a much more economical rate--after all, who else buys reprints in that quantity besides them?

Back in the early days of this blog:
--I argued that while most of the literature uses terms like "gifts" to talk about money and things of value that change hands between drug companies and physicians, you might as well call it what it really is, which is a bribe--we pay you these things and expect you in return to prescribe more of our drugs. So what is it when drug firms knowingly overpay for reprints of articles in major medical journals? Doesn't that suggest that at least in the minds of Pharma, they are actually paying a bribe rather than buying goods at the market rate? Maybe they will influence editorial opinion in their favor, maybe they won't, but it seems worth it to them to take a chance and invest a certain sum of money in the possibility of influence. And this is not an industry known for making a lot of stupid investments.

Hat tip to Primary Care Medical Abstracts for pointing out this article.


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