Journal rejects article after objections from marketing department

[Guest guest]

http://bmj.bmjjournals.com/cgi/content/full/328/7434/244-b?ecoll

 

BMJ 2004;328:244 (31 January), doi:10.1136/bmj.328.7434.244-b

 

Journal rejects article after objections from marketing department Owen Dyer

London

 

A leading nephrology journal has rejected a guest editorial questioning the

efficacy of epoetin in end stage renal disease, despite favourable peer

reviews, apparently because it feared losing advertising. In a letter to the

author of the proposed editorial, the executive editor of the California

based journal Transplantation and Dialysis said he had been " overruled by

our marketing department. "

The editorial was written by Dennis Cotter, president of the non-profit

making Medical Technology and Practice Patterns Institute. In it, he argued

that the US National Kidney Foundation's existing guidelines on end stage

renal disease rely on flawed logic in claiming a survival benefit associated

with higher packed cell volume (haematocrit) achieved through epoetin

treatment.

Joseph Herman, editor of the journal, told Mr Cotter in a letter that: " I

have now heard back from a third reviewer of your EPO editorial, who also

recommended that it be published.... Unfortunately, I have been overruled by

our marketing department with regard to publishing your editorial.

" As you accurately surmised, the publication of your editorial would, in

fact, not be accepted in some quarters... and apparently went beyond what

our marketing department was willing to accommodate. Please know that I gave

it my best shot, as I firmly believe that opposing points of view should be

provided a forum, especially in a medical environment, and especially after

those points of view survive the peer review process. I truly am sorry. "

Mr Cotter's editorial said the evidence cited in support of a survival

benefit " is subject to a fundamental error that confuses the relationship

between treatment response and outcomes with a causal effect of the

treatment. "

His editorial also pointed out that, despite a steady increase in the target

packed cell volumes and epoetin doses over the past decade in the United

States, mortality from end stage renal disease has remained steady. He

wrote: " A 2002 Cochrane Review of randomised trials of epoetin concurred

with the European guidelines concluding that the benefits associated with

higher hematocrit levels are outweighed by the risk of increased

hypertension and mortality. "

The editorial was submitted in response to a call from the Centers for

Medicare and Medicaid Services for public help in review of its policy on

epoetin use among patients with end stage renal disease. It was concerned

that " Medicare spending on EPO may be higher than necessary without

resulting in optimal patient benefit. " Medicare spent over $7.6bn (£4.2bn;

6.1bn) on epoetin between 1991 and 2002.

Arthur Caplan, chair of the Department of Medical Ethics at the University

of Pennsylvania, said: " It is completely unethical for a marketing or

business related part of a journal to have any say over the content of a

journal. "

Mr Hermann said: " I absolutely refuse to comment. This whole issue is being

blown out of proportion. "

 

 

 

Dr Cotter's editorial can be accessed at www.mtppi.org