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Let the Buyer (and Reader) Beware
Targeted Advertising in Medical Journals
Arch Fam Med. 2000;9:125.
ON SEPTEMBER 25, 1998, I attended the editorial board meeting for the Archives of Ophthalmology at AMA headquarters in Chicago. Led by the editor-in-chief, Daniel Albert, MD, the annual meeting is an opportunity to review the strengths, weaknesses, and opportunities for improvement of one of our specialty's finest journals. This meeting was also attended by George Lundberg, MD, former editor-in-chief of JAMA, and by the publishing staff.
Like many editorial boards, this one is disproportionately populated by "ivory tower" types from across the United States and around the world. It surprised me, therefore, that these meetings are practical rather than theoretical. The success of the journal, the size of its readership, the impact of its articles on our specialty, the speed and quality of the manuscript review process, and the best way to use new media, such as the Internet, were among the topics discussed. A lot of interesting ideas were brought up during this meeting.
Contrary to popular belief, not all university professors are socialists, and it was clear at these meetings that publishing medical journals, even prominent "scientific" journals such as the ARCHIVES, is a business. A large proportion of the meeting involved looking at advertising revenues, devising strategies to increase readership, and comparing the journal with its competitors. It would be nice to think that our top journals focus exclusively on the pursuit of truth, but financial considerations are important. While I do not have access to detailed financial statements, it seems obvious that journal subscriptions cannot cover the costs of publication. For this reason, advertising revenues are needed.
Never was the relationship between advertising revenues and journal publication as explicit to me as at this meeting. In a booklet prepared for the meeting was a copy of a letter from a small ophthalmic device manufacturer (I will call this company Ophthalmic Widgets Inc) to Dr Albert. The letter presented an offer to Dr Albert that if he would publish certain specified articles or articles on particular topics, Ophthalmic Widgets Inc would place paid advertisements in the same issue of the ARCHIVES. The letter described the articles that should be published to get this advertising revenue, specifying manuscripts that described the use of products sold by Ophthalmic Widgets Inc and also specifying certain authors (Drs X and Y). There was nothing subtle about the letter, which was an explicit offer of money in return for publication of certain articles by certain authors, articles that the manufacturer undoubtedly believed would place its products in a favorable light. Drs Albert and Lundberg had dismissed this offer as unethical.
I was pleased that the pages (at least those dedicated to scientific articles) of the ARCHIVES were not for sale. Whatever the limitations of the peer review process, the journal's readers should take comfort in knowing that the articles are selected based on scientific quality and relevance. Surely, however, this was not a hard call. It was probably the suggestion of a youthful, poorly informed marketing director at Ophthalmic Widgets Inc. Could any journal really seriously consider such a quid pro quo?
By the time I returned home, I was convinced that this sort of thing never happened. Journals certainly would not publish specific articles by specific authors in return for advertising revenue. On my desk, however, I found a non–peer-reviewed journal that covered medical and surgical ophthalmology as well as practice management topics. I was intrigued to find an article by Dr X featuring widgets followed immediately by an advertisement for Ophthalmic Widgets Inc! I usually do not pay much attention to the advertisements in journals in reference to the scientific content of the surrounding pages. The relationship was probably apparent to me only because I had been sensitized during the meeting in Chicago. I concluded that this publication had a different policy than the ARCHIVES; its pages were for sale, and its readers were being exposed to a certain number of articles that were, in fact, little more than "infomercials."
Publishing journals is a business. Manufacturers will place advertisements in journals read by those physicians most likely to purchase and use their products. However, just as some news organizations may cross the line between news and sensationalism in pursuit of ratings and revenues, some journals may publish articles in return for guaranteed advertising. Perhaps there is even a role for non–peer-reviewed journals that publish only favorable articles about products, followed by advertising to guide the purchaser to the manufacturer. In this case, however, the relationship should be explicitly disclosed to the reader, who might otherwise mistake the paid testimonial for a careful scientific study by an unbiased investigator published on its own merits. The reader (who is often a buyer) must beware of the possibility of such an arrangement, unless the journal's editor (as in the case of the ARCHIVES) explicitly rejects such a relationship. It sounds cynical, but unless I know a journal's policy, I will be on the lookout for advertisements selling instruments lauded by the famous physician in the immediately preceding pages.
AUTHOR INFORMATION
Reprinted from Arch Ophthalmol. 1999;117:1077.
Corresponding author: Peter J. McDonnell, MD, Department of Ophthalmology, University of California, 2000 Medical Plaza Dr, No. 2004, Irvine, CA 92697-4375.
Peter J. McDonnell, MD
Irvine, Calif
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Targeted Advertising in Medical Journals
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Arch Fam Med 2000;9:791-791.
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