Thursday, May 11, 2006

Why Are Nearly All the Advertisements in Medical Journals for Drugs or Devices?

PLoS Medicine published an important commentary on advertising in medical journals. (Fugh-Berman A, Alladin K, Chow J. Advertising in medical journals: Should current practices change? PLoS Med 3: e130.)

The main points are summarized below.

Almost all the advertising in multispecialty journals is from pharmaceutical (and sometimes device)companies - Some journals have policies that restrict advertising only to products related to medical practice. A study of one-sixth the issues of a prominent journal for the last 10 years showed that drug advertising made up from 95% to 99% of the advertising content per year.

Advertising rates in medical journals are actually generally lower than rates for relatively upscale consumer magazines with similar circulations - For example, the authors compared cost per thousand readers exposed for one-time full-page four color advertisements, which ranged from US $43 to $88 for four major American journals, but from $86 to $110 for five US consumer magazines. "Some medical journals trumpet their bargain rates." One advertised in Medical Marketing and Media as providing "a priceless audience. At a price you can afford."

Medical journals enable marketers to target specific physician sub-groups, by region, by specialty, or even by prescribing patterns - One prominent journal advertised to marketers, "you can run your Cancer of HIV/AIDS related product to a special list of high-prescribing physicians, including key oncology and infectious disease doctors."

Physician organizations may receive substantial portions of their revenue from the mainly pharmaceutical and device advertising in their medical journals - One large organization gets 15.1% of its total revenue from such advertising.

So, the authors asserted, "by accepting only advertisements for drugs and medical devices, medical journals have accepted an exclusive and dependent relationship with corporations." The authors asserted that this relationship has lead to effects on editorial decisions and content. They quoted the former editors of a prominent journal, "the pharmaceutical industry showed us that the advertising dollar could be a two-edge sword, a carrot or a stick. If you ever wondered whether they play hardball, this was a pretty good demonstration that they do."

The authors' recommendations centered on the curious fact (which we readers of general medical journals have noticed but ignored for a long time) that

Although physicians would be expected to be a desirable audience for purveyors of cars, golf clubs, cruises, and luxury goods, advertisements for consumer goods in medical journals are conspicuous by their absence. Orentlicher and Hehir have argued compellingly that if advertisements for luxury goods were accepted, 'journals would have a larger pool of companies to which they could sell advertising space, and they would reduce the conflict of interest that arises from the practice of only accepting health care advertisements. This suggests that health care companies are not the first place medical journals should look for advertising. Rather, they are the last place medical journals should look .'

Accepting advertising for consumer goods removes the conflict of interest inherent in pharmaceutical advertising, but more importantly may free editors from the threat of lost revenue. It is disturbing that medical journals appear to have exclusive, largely undeclared arrangements with pharmaceutical companies. It could even be argued that it is poor business practice to forego more lucrative advertisements in order to provide cut-rate advertising to manufacturers of drugs and devices. If purveyors of consumer goods are willing to advertise in medical journals, replacing drug advertisements with advertisements for consumer goods could bolster both the bottom line and editorial freedom.
Although, of course,

Another option is to eschew journal advertising altogether.
My college alumni magazine, which presumably goes to a fairly affluent audience, containts tasteful advertisements for cars (from Mercedes-Benz to Bentley), real estate, travel and vacation destinations, financial services, electronics and optics, and books and recordings. The medical journals sitting in a pile in my office contain not a single such advertisement, even though physicians might provide a good market for such products. These patterns have been in place for years. I have seen them for years.

Sometimes the most important facts and ideas are just sitting in front of our faces, waiting for us to see them.

1 comment:

Unknown said...

Very good points here. It makes economic sense that journal ad rates are below market if they are artificially restricting demand by not accepting or seeking ads from non-medical companies.

Journals and the associations that in many cases own them face another problem: to the extent that their credibility is eroded through exposure of certain business and editorial practices (as done on this blog and elsewhere) the value of advertising in them and subscribing to them will drop.

On a related note, one valuable role played by open access journals like PLoS is to discuss these issues.