Posts Tagged 'research'

Pharmaceutical flimflam: drug advertising in medical journals is a global issue

Advertising may be described as the science of arresting human intelligence long enough to get money from it.  ~  Stephen Leacock, Garden of Folly (1924) ‘The Perfect Salesman’

A recent systematic review in PLoS One demonstrates quite effectively something that shouldn’t surprise any intelligent high school student: pharmaceutical advertising in medical journals often provides “poor quality information.” This strikes me as the authors’ excessively polite way of saying that drug ads, even those that appear in authoritative periodicals widely read by physicians, are unregulated, manipulative, meretricious and mendacious. Selling the latest SSRI is not really different from shilling shampoo, with the difference, of course, that there is superior evidence of shampoo’s efficacy.

Othman N, Vitry A, Roughead EE. Quality of pharmaceutical advertisements in medical journals: a systematic review. PLoS One. 2009 Jul 22;4(7):e6350. PubMed PMID: 19623259; PubMed Central PMCID: PMC2709919.

The article, buffed to a high scholarly polish with any hint of libellous language or ethical disdain well suppressed, warrants close reading. Here are some highlights:

Advertising in medical journals is one of the techniques used by pharmaceutical companies to promote their products to medical doctors. During the first four years of a new medicine on the market, pharmaceutical companies may gain approximately US $2.43 for each dollar spent on medical journal advertisements for a medicine. The return on investment has been reported to increase to more than US $4 after that period.

We found that pharmaceutical advertisements in medical journals usually provided brand and generic name and indication. Other essential information required for rational prescribing including contraindications, interactions, side effects, warnings and precautions were less commonly provided. The majority of references cited to support pharmaceutical claims were journal articles. However, less than two-third [sic] of the claims were supported [emphasis mine] by a systematic review or a meta-analysis (110/1375, 8%) and randomised control trial (455/1500, 30%).

This review noted that references used to support pharmaceutical claims were often of low quality. The inappropriate use of references in journal advertising suggests that the availability of references does not always guarantee the quality of claims.

Information on medicines is essential to help doctors ensure the optimal use of medicines. However, studies show that doctors who use journal advertisements as a source of information may prescribe less appropriately. In addition, reliance on journal advertising for information is associated with increased costs of prescribing. Even doctors who think that they obtain their knowledge from the scientific literature can be influenced by promotional sources without being aware of it. As information provided in journal advertising has the potential to change doctors’ prescribing behaviour, our review indicates that ongoing efforts including complaints and recommendations by researchers, health professionals and policy makers to improve the quality of advertisements in medical journals are crucial.

Governments may need to take more proactive action such as engaging independent experts to help in designing regulation for journal advertising where self regulatory codes are limited. In addition to that, effective regulatory system may complement pharmaceutical litigation to ensure accuracy and reliability of information in journal advertising.

Our review found that the low quality of journal advertising was a global issue. Poor quality advertising has been observed in developing countries and post-Soviet Russia where controls might be weak and limited as well as in developed countries which have stricter regulations.

Globally, pharmaceutical advertising in medical journals often provides poor quality information. The impact of this problem on doctors’ prescribing behaviour might be even greater in developing countries and post-Soviet Russia where access to industry-free medicine information is limited. The results from our review suggest the need for a global pro-active and effective regulatory system to ensure that information provided in medical journal advertising is supporting the quality use of medicines.

It is the most extraordinary thing, but I never read a patent medicine advertisement without being impelled to the conclusion that I am suffering from the particular disease therein dealt with in its most virulent form.  ~  Jerome K. Jerome, Three Men in a Boat (1889)
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For academic librarians what’s hard to reach is time for research

research-definition
These be the stops that hinder study quite
And train our intellects to vain delight.

Love’s Labour’s Lost, 1.1

Who has the time for research? Very few of us, unless it is somehow part of our work day. Our teaching faculty colleagues do not teach from 9 to 5, Monday to Friday, nor are they always required to be in their offices when not in front of a class, especially between June and August. But academic librarians, it seems, can never have their cake and eat it too. We are expected to be on the job, at the workplace, every day, summer included, unless we are on vacation or on ventilation. And, with some variations, from the midst of this perpetual motion machine we are also expected to produce viable, publishable, imperishable research.

At the University of Manitoba we librarians take our research obligations seriously. We enjoy academic status and are members of the University of Manitoba Faculty Association (UMFA). We have senior management who by and large recognize the value of research and support our pursuit of it. We now also have new language in our Collective Agreement that guarantees us academic freedom and twelve paid days a year to devote entirely to scholarly pursuits. During our last protracted contract negotiations, obtaining recognition from the University that, as part of our academic status, librarians needed time to do the research required of them was a hard-fought battle.

Articles 17 and 20 of the UMFA Collective Agreement, not to mention our own promotion guidelines, more than adequately define both research and the purpose of the working time entitlement for librarians (in particular 17.A.2.5; and see also the Research, Scholarly and Other Creative Works section, 20.B.1.2.2, of the Promotion article). But lately there has been talk amongst my colleagues of establishing “guidelines” to determine the suitability or otherwise of someone’s research and whether a request for time away from other duties to pursue research should be granted.

My generous nature interprets this development as arising from good intentions, but I have to ask: why establish a set of guidelines separate from what has already been well defined in the contract, as well as in a detailed document on guidelines and criteria for the promotion of librarians through the ranks? As I see it, the subject of a librarian’s research is a matter of professional judgement in an atmosphere of academic freedom and collegiality. Our Collective Agreement wisely includes its own warning that librarians’ academic work must be undertaken responsibly: “Academic freedom carries with it the responsibility to use that freedom in a manner consistent with the scholarly obligation to base research, teaching and the collection, dissemination and structure of knowledge in a search for truth.” (17.A.1) Must we form yet another committee to encode and encapsulate what “responsibly” means?

Here is the controversial addition to our contract that seems to stick in some people’s craw. As I mentioned, Article 17 (Academic Librarians) was revised in 2007 to include language on so-called “research days”:

Academic librarians holding probationary and continuing appointments are entitled to twelve (12) working days on full salary in each academic year for research and scholarly activities relating to library science or an academic subject within their expertise, subject to notifying the department head of their proposed work and arranging a mutually agreeable schedule.  (17.A.2.5)

Article 20 on Promotion defines the nature of librarians’ research, scholarly work and other creative activities:

Factors that may be considered include:  the publication of books, monographs, and contributions to edited books; papers in both refereed and nonrefereed journals; papers delivered at professional meetings; participation in panels; both supported and nonsupported unpublished research including current work in progress; editorial and refereeing duties; creative works and performances; and scholarship as evidenced by the candidate’s advanced study and research in library and information science and/or a subject specialization, his/her depth and breadth of knowledge and general contributions to the research of the University. (20.B.1.2.2)

Here, in clear and unequivocal language, the UMFA Collective Agreement spells out what is considered research by librarians and carves out a bit of unencumbered space in which such research can be performed. Some have complained that the twelve days are no more than “automatic days off.” To argue so, I would reply, is misguided in the same way that it would be foolish to maintain that sick days should not be provided because they might, heaven forfend, actually be taken. Should the remote possibility that one of us might abuse a provision of the Collective Agreement be used as a pretext to reshape or subvert what is already appropriately defined in that document? Life is too short for us to start composing intricate commentaries on reasonably comprehensible contractual language. I think what Calvin Trillin once said is appropriate: if law school is so hard to get through, how come there are so many lawyers?

It might be argued that establishing more rigorous guidelines for librarians’ research activities would provide clarity and  improve equity across the library system. My response is that the existing contractual provisions for librarians’ research are entirely sufficient for this purpose. If all librarians read, understand and abide by it, the Collective Agreement itself is the best assurance of equity and should be the primary authority on this issue. It is only when the Collective Agreement specifically calls for the creation of guidelines that we are obligated to go beyond its provisions, as is the case with hiring and promotion at this university.

It is the responsibility of an academic library to foster librarians’ research and to organize the work of the academic staff in such a manner as to accommodate time away from other duties for that purpose. This is in the spirit of the Collective Agreement. If a manager disagrees with a librarian about his or her request for time to pursue research, that is an academic matter which should be resolved between the two of them. If no resolution is possible at that level, there are agreed-upon steps that individual can take. Under the terms of the UMFA Collective Agreement, extended postponement or denial of research time could lead to a grievance. Moreover, any attempt further to enumerate and codify what should or should not be the nature of a librarian’s research – beyond the very detailed provisions already cited above – could be interpreted as an infringement upon his or her academic freedom.

It is unfortunate that we have become accustomed to use the term “research days” – which, by the way, is not to be found in the Collective Agreement – as a convenient but demeaning moniker for what that document calls “twelve working days on full salary in each academic year for research and scholarly activities relating to library science or an academic subject within [a librarian’s] expertise.” (17.A.2.5) The entry of this term into common usage has contributed to a general perception that Article 17’s provision for time given over to research is somehow an add-on, accessory or perquisite, when in fact research is an essential component of our work. This is precisely the attitude that our hard-won provision for research time was meant to dispel.

As I see it – and I speak solely from my Canadian experience – some academic libraries have not yet developed or have not fully developed a culture of research. That goal can only be achieved by creating work environments and job expectations that are not so demanding as to discourage librarians from considering research and creative scholarly contributions, or from thinking that such pursuits could be an integral part of their “regular” working day. A strong faculty association and a Collective Agreement with guts are two other important factors in furthering librarians’ participation in academic research.

I have often heard from librarians at this and other universities that they are too busy just coping with their job even to contemplate doing research. That is why I think it vital to focus on fostering research rather than devising methods to contain or curtail it. It is part of moving away from what I call the “No” school of librarianship, the kind of passive-aggressive impasse where – I speak figuratively – it is illegal to make liquor privately or water publicly. If any more guidelines are to be written for us librarians, let them elaborate on how we can open up the taps of creativity, improve our working conditions, provide better service, and be more rounded scholars and professionals.


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