Professional medical journals are full of advertisements for treatments. A typical issue of a journal- such as the British Medical Journal (BMJ) or the Lancet, two of the world’s most prestigious, based right here in the United Kingdom- consists of news, opinion pieces, peer-reviewed scientific research, and ads for medications and devices. Many may be surprised to learn that these journals often read more like magazines, with full-page and even centrefold adverts for the latest, greatest drugs.
It has long been known that the information in these adverts may be misleading. Drug companies often use various tricks in them, such as reporting ‘relative’ rather than ‘absolute’ effect sizes, which can make treatments seem more effective, often by an order of magnitude. While peer-reviewed research isn’t perfect- one only needs to read recent articles about how pharmaceutical companies continue to be allowed to withhold data, thereby making drugs seem better than they are- it is at least subject to some degree of independent review, usually by two or more scientists. The quality of information available to doctors and policymakers is an important issue in the UK right now, given the scathing conclusions of the recent House of Commons public accounts committee report on access to clinical trial information. For example, it has become increasingly clear that the decision to spend £424 million on Tamiflu, an antiviral medicine used for influenza treatment, was based on misleading and biased information, and that the drug may not be effective.
Despite the increasing popularity of online journal content, print medical journal readership continues to rise, and they remain an important source of information for practitioners. One way of improving the quality of information presented in them might be to eliminate medical journal adverts entirely. But publishers say adverts are a vital source of revenue, and without them, journals would cease to be financially viable.
To investigate whether this claim is true, our international research team from several universities in the UK, Canada, and the United States (University of Oxford, the University of Toronto, York University and other institutions) went through print editions of six of the world’s most prestigious medical journals, going back to the 1970’s. We calculated the volume of each journal taken up by adverts, opinion pieces, job listings, and peer-reviewed research. Using the price guide listed by each journal, we estimated their advertising revenue. We then calculated how much it would cost, per subscriber, to remove adverts entirely. What we found surprised us was and was completely contrary to what journal editors and publishers say in public.
Take the BMJ, for example. This journal has been at the absolute forefront of medical research, publishing groundbreaking articles debunking the connection between the MMR vaccination and autism. It was also one of the first to question the evidence base supporting the use of Tamiflu- that same flawed evidence base used by the government to spend £424 million on a drug that may not work. We determined the cost to eliminate adverts in the BMJ would be £13 per subscriber per year. Considering the salary of an NHS general practitioner is between £54,319 to £81,969 (consultants make a basic salary of between £75,249 and £101,451) this represents a tiny fraction of salary even for the lowest paid doctors in the UK. We found similar figures in other countries: it would cost each subscriber to Canada’s largest journal, the Canadian Medical Association Journal, £20 per year to eliminate adverts entirely. (In case you are wondering, the average Canadian doctor makes £194,000 per year.)
Journal publishers say without this income, they may be forced to shut their doors and stop publishing research on medical breakthroughs and new treatments. It is clear, however, that this is far from the truth. Adverts could be completely removed from print journals for less than the cost of a couple of issues of Hello magazine. I certainly think this is a price worth paying to improve the quality of medical information provided to doctors around the world.