Author: Abd Hamid Mat Sain
Position: Dr./Surgeon
Institution: ColumbiaAsia Medical Centre,292 Jln Haruan 2,Oakland Com Ctr,70300 Seremban,Negeri Sembilan,MALAYSIA
E-mail: abdhamidmatsain@gmail.com
Submitted Date: August 16, 2005
Published Date: August 17, 2005
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

I view the highly controversial but real issue of medical journals' relationships with pharmaceutical companies in the context of the dilemma facing academic medicine as a whole. There are three colluding parties involved: the journals, which are usually published by the professional soceities; the pharmaceutical companies, which are usually multinational industries with enormous funds; and last but not least the academics who form the editorial boards of the journals. They also act as reviewers for the journals and as authors and co-authors of the papers submitted to the them, and they serve as academic promotion reviewers in medical academic institutions the world over. There are seemingly intricate connections between these three parties which mutually sustain one another in that part of modern medicine which we call academic medicine.

The buzzword, mantra or perhaps vogue called evidence-based medicine (EBM) may have also contributed to the issue. The philosophy and scientific basis of EBM is highly commendable and, theoretically, EBM forms the ethical basis of modern clinical practice. However, the comprehensive conceptual understanding of EBM suffers from lack of uniformity among the stakeholders especially clinicians. EBM is quite often erroneously considered to be merely the quantitative evidence, deciphered from statistically relevant and strong clinical studies, without regard to the qualitative components of the subject matter or the clinical settings in which the study results will be applied. The internal, qualitative component of the clinical settings is as important and necessary as the external, quantitative components of the experimental data in forming the total understanding of EBM. This internal, qualitative component is more tacit in nature, less quantifiable and acquired through action and exploration rather through the hypothesis-driven reductionistic research methodology of the quantitative study.

Medical journals in general regard the substantial quantitative studies as real and better scientific works compared to case reports, anecdotes and correspondence, which deserve more space in the journals. Academic institutions in most developed countries take the same view and judge the academic standing of their staff in the same light. This puts pressure on highly ambitious academics to pursue funds from the private sector to conduct such trials. Although there are some companies that are willing to invest in long-term exploratory research that might produce return to the investment, many would prefer to support short-term quantitative trials that might produce immediate results conducive to marketing their products.

The economy in general needs the vibrant private sector for drive and sustainability. Medical practice and academic medicine also need the financial capability of the private sector to sustain standards and support research and development. The intricate relationships between the three parties mentioned above is perhaps inevitable if not mandatory to sustain modern medicine. The parties involved should ensure that the relationship is on ethical ground and based on the broad understanding of science.

The advent of internet and online journals has created unlimited space for continuous dialogue between academics and professionals. Initiatives that seek to achieve freedom in the dissemination of scientific knowledge, such as the open access journals from PLoS, should be supported by all parties. Perhaps medical professionals will get a more balanced perspective to guide their practice, and genuinely talented intellectual clinicians will remain in academic medicine. This would help to moderate the relationship between the parties and avoid medical journals merely marketing the pharmaceutical industry's products.