It’s times like these when I’m happy that I haven’t published in too many Elsevier Journals during the course of my career. Actually, I’m not sure if I’ve ever published in an Elsevier journal, although I have reviewed manuscripts for them. In any case, I say that because on Thursday, it was revealed that pharmaceutical company Merck, Sharp & Dohme paid Elsevier to produce a fake medical journal that, to any superficial examination, looked like a real medical journal but was in reality nothing more than advertising for Merck. As reported by The Scientist:

Merck paid an undisclosed sum to Elsevier to produce several volumes of a publication that had the look of a peer-reviewed medical journal, but contained only reprinted or summarized articles–most of which presented data favorable to Merck products–that appeared to act solely as marketing tools with no disclosure of company sponsorship.

“I’ve seen no shortage of creativity emanating from the marketing departments of drug companies,” Peter Lurie, deputy director of the public health research group at the consumer advocacy nonprofit Public Citizen, said, after reviewing two issues of the publication obtained by The Scientist. “But even for someone as jaded as me, this is a new wrinkle.”

The Australasian Journal of Bone and Joint Medicine, which was published by Exerpta Medica, a division of scientific publishing juggernaut Elsevier, is not indexed in the MEDLINE database, and has no website (not even a defunct one). The Scientist obtained two issues of the journal: Volume 2, Issues 1 and 2, both dated 2003. The issues contained little in the way of advertisements apart from ads for Fosamax, a Merck drug for osteoporosis, and Vioxx. (Click here and here to view PDFs of the two issues.)

This is wrong on so many levels that it’s hard to know where to begin.

If there is one thing that science-based medicine requires to function properly, it’s good science and well-designed clinical trials subjected to rigorous peer review. Moreover, that review has to be unbiased, and the journals publishing them cannot be tainted with undue influence of big pharma. A while back, JAMA editor Catherine DeAngelis was criticized for her crusade against undisclosed conflicts of interest by the authors of journal articles, and, most importantly, her hypocrisy and heavy-handed attempt to slap down a researcher and educator who pointed out the failure of a JAMA author to disclose that he had been on the speakers’ bureau for a pharmaceutical company whose drug he had been studying. What made this offense particularly egregious was that the study in question had a rather glaring methodological flaw that, when corrected for, revealed that nonpharmacological therapy was equal to that of the drug company’s medication, which the author admitted when it was pointed out to him.

What does one do when the whole journal–articles and all–is nothing more than a glossy advertisement for a pharmaceutical company’s products?

First off, if there’s one thing most physicians and scientists know, it’s that there are numerous “throwaway” journals out there. “Throwaway” journals tend to be defined as journals that are provided free of charge, have a lot of advertising (a high “advertising-to-text” ratio, as it is often described), and contain no original investigations. Other relevant characteristics include:

  • Supported virtually entirely by advertising revenue.
  • Ads tend to be placed within article pages interrupting the articles, rather than between articles, as is the case with most medical journals that accept ads
  • Virtually the entire content is reviews of existing content of variable (and often dubious) quality.
  • Parasitic. Throwaways often summarize peer-reviewed research from real journals.
  • Questionable (at best) peer review.
  • Throwaways tend to cater to an uninvolved and uncritical readership.
  • No original work.

Throwaway journals are rarely or never cited in the medical literature and virtually never indexed in PubMed. They also tend to have names like, well, Australasian Journal of Bone and Joint Medicine. However, as advertisement-packed as throwaway journals tend to be, they are actually fairly widely read–indeed as much or more so than some peer-reviewed journals. The reason, most likely, is because they tend to publish short, easily digestible review articles, perfect for busy clinicians, particularly in private practice. Moreover, as reported in this JAMA article (ironically enough), despite their lesser scientific rigor, throwaway journals have many aspects that are appealing to clinicians:

The mean (SD) quality scores were highest for peer-reviewed articles (0.94 [0.09] for systematic reviews and 0.30 [0.19] for nonsystematic reviews) compared with throwaway journal articles (0.23 [0.03], F2,391=280.8, P.001). Throwaway journal articles used more tables (P=.02), figures (P=.01), photographs (P.001), color (P.001), and larger font sizes (P.001) compared with peer-reviewed articles. Readability scores were more often in the college or higher range for peer-reviewed journals compared with the throwaway journal articles (104 [77.0%] vs 156 [64.2%]; P=.01). Peer-reviewed article titles were judged less relevant to clinical practice than throwaway journal article titles (P.001).

In other words, throwaway journals tend to be to peer-reviewed journals a lot like USA Today is to The New York Times or The Wall Street Journal. However, in general, they are not blatantly written by pharmaceutical companies, as apparently was the case with the Merck journal. (Yes, I’m going to refer to it as that. After all, that’s accurate.) Moreover, in general doctors are well aware of throwaway journals and that they aren’t meant to be taken as seriously as real journals. (If they were, they wouldn’t be delivered free to their offices, sometimes whether they want them or not, after all.) Rather, doctors tend use them as shortcuts for digesting information quickly or not to rad them at all. (There’s a reason they’re called “throwaway” journals.) They also realize that they are completely advertising-supported. In essence, any conflicts of interest are pretty well right out there in the form of numerous ads.

This effort by Merck took it far, far beyond the throwaway journal:

In response to several questions about the publication posed by The Scientist, an MSDA spokesperson wrote in an email: “MSDA understood that Elsevier envisaged the complimentary publication would draw on the vast resources of Elsevier, publishers of many leading peer-reviewed journals including Lancet, Bone, Joint Bone Spine and others, to deliver novel and timely full text articles and abstracts to physicians.” Many of the articles appearing in the Australasian Journal of Bone and Joint Medicine were in fact reprints or summaries of studies that originally appeared in other Elsevier journals.

As if that excuses the deception. Of course, they must have been reprints of articles that appeared in other Elsevier journals! Otherwise, Elsevier wouldn’t have had the rights to publish them! It’s not necessarily the quality of the reprinted articles that’s an issue. It’s their packaging in a pseudojournal that’s nothing more than an advertising vehicle for Merck without any disclosure that that’s what the purpose of the journal was! Elsevier’s got some ‘splainin’ to do, as they say:

“Elsevier acknowledges the concern that the journals in question didn’t have the appropriate disclosures,” the statement continued. “It is worth noting that project in question was produced 6 years ago and disclosure protocols have evolved since 2003. Elsevier’s current disclosure policies meet the rigor and requirements of the current publishing environment.”

The Elsevier spokesperson said the company wasn’t aware of how many copies of the Australasian Journal of Bone and Joint Medicine were produced or how the publication was distributed in Australia, but noted that “the common practice for sponsored journals is that doctors receive them complimentary.” The spokesperson added that Elsevier had no plans to look further into the matter.

So, in other words, we don’t do it anymore; so it’s not a big deal. Of course, Elsevier also publishes the pseudoscientific journal Homeopathy (after all, homeopathy is quackery, period), a fair number of “integrative medicine” journals, and the highly dubious journal Explore, which regularly publishes Dean Radin’s pseudoscientific articles on “distant healing” and food imbued with “intent.” So you’ll excuse me if I don’t take Elsevier’s hilarious “code of ethics” seriously:

Elsevier takes its duties of guardianship over the scholarly record very seriously. Our journal programs record “the minutes of science” and we recognize our responsibilities as the keeper of those “minutes” in all our policies, including the guidelines we have adopted to support editors, reviewers and authors in performing their ethical duties.

Except, apparently, when it comes to pharma-supported advertising efforts and the publication of quack journals.

Unfortunately, Merck and Elsevier couldn’t do this alone. They needed help. Depressingly, they got it from the very people who should know enough to “just say no” to such blatant marketing ploys:

One of the members of Australasian Journal of Bone and Joint Medicine‘s “Honorary Editorial Board,” Peter Brooks, a rheumatologist in Australia, said he didn’t recall who asked him to serve on the board, but noted that he was on Merck’s Asian Pacific and international advisory boards from the mid 1990s until about 2004, as well as the advisory boards of other pharmaceutical companies, including Pfizer and Amgen. “You get involved in a whole bunch of things at this level,” Brooks said, adding that he had put his name on “a few advertorials” for pharmaceutical companies about 10 years ago.

So Dr. Brooks’ excuse seems to be carelessness. The answer, of course, is for physicians to refuse to “get involved in a whole bunch of things at this level.” He also claims ignorance, namely that he didn’t know that the journal was nothing more than an advertising ploy for big pharma. That, I suppose, is possible, but surely he actually looked at the journal on whose editorial board he had agreed to serve. Surely he must have wondered when, after being on the editorial board, he wasn’t ever actually asked to do anything, such as review a submission–or even solicit a review article. Apparently he did not, even though serving on a real editorial board is generally a large amount of work. Not having any work to do on an editorial board should have been a huge red flag that tipped him that this journal wasn’t a “real” journal. So should the fact that it was listed as an “Honorary Editorial Board.” (I wonder if he put that on his CV.) Moreover, one wonders what he did when he ultimately found out. Apparently nothing, other than to deny that it was a marketing journal. Never mind that there were review articles and even an article labeled as a “meta-analysis” that only listed one or two references. Usually reviews list numerous references that were used as the source material for the review; even more importantly, you can’t do a “meta-analysis” on one or two studies. Such articles should have been even more obvious red flags.

Doctors like Dr. Brooks are every bit as guilty as Merck and Elsevier for deceptive pharma marketing like this. We physicians are supposed to represent the best interests of our patients, and, as far as I’m concerned, to defend science-based medicine. Our credibility depends upon it. Being accomplices to those using deceptive marketing practices such as this not only undermines our credibility and betrays our patients, but it provides an opening for purveyors of unscientific medicine and outright quackery to paint us as hopelessly corrupt. Pharmaceutical companies have ample resources for advertising their wares. We shouldn’t be so willing to give them such cheap access to our credibility and respect as physicians.

ADDENDUM: More commentary at, and by Janet Stemwedel.

Posted by David Gorski

Dr. Gorski's full information can be found here, along with information for patients. David H. Gorski, MD, PhD, FACS is a surgical oncologist at the Barbara Ann Karmanos Cancer Institute specializing in breast cancer surgery, where he also serves as the American College of Surgeons Committee on Cancer Liaison Physician as well as an Associate Professor of Surgery and member of the faculty of the Graduate Program in Cancer Biology at Wayne State University. If you are a potential patient and found this page through a Google search, please check out Dr. Gorski's biographical information, disclaimers regarding his writings, and notice to patients here.