The Hand that Feeds the Hand that Feeds the Hand that ….

Pharmaceutical development is all about the blockbuster drug. Many of our brightest minds are research scientists and bioinformaticians working at translating in vitro discoveries to improving the lives of human kind.

Many of our brightest minds are also working to ensure, even if their drug candidates are – say – a little flawed, there’s a clinical trial design, trial implementation, and post-approval marketing plan to maximize return to shareholders.

A critical portion of in this chain of survival is publication – the higher the impact a journal, the better. One of the gatekeepers to publication remains peer review, a critical step in ensuring the integrity, transparency, and reproducibility of science. Naturally, this step would be independent and untainted by bias, a vigilant final guardian protecting the public.

It would … wouldn’t it?

This brief report from JAMA finds it would absurd even to imagine such a fanciful state of affairs. Evaluating lists of peer reviewers from The BMJ, JAMA, The Lancet, and The New England Journal of Medicine from 2022, the authors analyzed 1,962 U.S.-based physician reviewers. Of these reviewers, the Open Payments database indicated 58.9% of these reviewers had received payments from industry, totalling USD$1.06 billion between 2020 and 2022. The vast majority – $1.01 billion – were payments supporting research activities, with a mere $60M going towards such things as consulting fees, speaker fees, honoraria, etc. Male reviewers and those in medical and surgical specialties, rather than primary care or hospital-based specialties, were the dominant recipients of said payments.

While these data are not meant to illuminate some sort of dark money ecosystem, it is clear the “peers” doing the reviews are playing at the same game. There is going to be an obvious bias towards allowing publication of content and spin consistent with the output the reviewers themselves would anticipate using in their own work. A receptive audience, if you would.

Just another happy reminder how so much of our medical practice is swept along in a current powered by many moneyed forces at work.

“Payments by Drug and Medical Device Manufacturers to US Peer Reviewers
of Major Medical Journals”
https://jamanetwork.com/journals/jama/article-abstract/2824834