Should medical journals carry pharmaceutical advertising?

Yes, of course I think that medical journals should be able to carry any advertisements that meet the well established standards for medical advertising.

We’re not talking about advertising fad diets or herbal cures or nonsense like homeopathy to an unsuspecting public. We’re talking about advertising evidence-based, Health Canada–approved, mainstream pharmaceutical products to physicians who are highly skilled in both medicine and the critical appraisal required to make informed decisions.

Yes, but the pharmaceutical companies have influence on the way doctors prescribe! Well, of course they do. That’s like saying Air Canada and WestJet have influence on the way Canadians travel. It’s our pharmaceutical industry that develops, manufactures, and distributes the products that every physician relies on every day. It’s a big part of our health care system.

Advertisements in medical journals give pharmaceutical companies their best chance to announce new products, to raise awareness, to make the case for their particular brands, and to try to persuade physicians to consider them for their patients.

Pharmaceutical advertisements do all this quite effectively. But that doesn’t mean that physicians will be anything less than rigorous in prescribing for their patients. I’m not very worried that advertisements in our journal will cause any physician to start writing prescriptions willy-nilly for ACE inhibitors or SSRIs or antipsoriatic agents if they aren’t indicated for their patients.

I’m also not worried that the fact that we sell advertising will ever have the slightest influence on what is or is not published in our journal—directly, indirectly, consciously, unconsciously or—what’s left?—metaphysically. Our Scientific Editor and our Editorial Advisory Board decide what goes in the journal. Period. Advertising and editorial are kept entirely separate. Period. And I’d like to be there to watch if anyone ever tried to suggest to our editor that he add an article, or drop an article, or change so much as a word in an article for some ad-related reason!

At Canadian Family Physician, we publish research by FPs who rarely have commercial funding. We publish commentaries from anyone who wants to submit a good one. And we publish the clinical reviews and practical content that readers tell us they use the most. What part of that do the opponents of advertising suggest is in our journal as a result of some subtle and improper commercial influence?

I know that a lot of people don’t like advertising in journals. That’s quite understandable. But readers are entitled to turn the page on any ad or even to avoid journals that carry advertising. They’re also entitled to start alternative journals based on other financial models if they think they can do a better job. What they are not entitled to do, though, is to impose their views on other physicians who are quite happy to receive advertising-supported medical journals for free.

Readers of journals can make up their own minds. If they feel that something in an ad is not fair or not true, the answer is not to ban all advertising, but to file a complaint, to go and make their case out in the open for all to see.

I also have to say that I find the more extreme position to be pretty condescending. It seems to me that the people who want an outright ban on advertising can’t be worried that they are themselves being affected, as their minds are clearly made up; they must be worried that other physicians whom they think are not as smart or not as sophisticated are being influenced to prescribe inappropriately!

And yet, in the real world, it’s actually the competition for advertising that guarantees the quality and integrity of a publication—in just the same way that the competition between Air Canada and WestJet gives us more choices, better service, and lower prices when we fly.

When a journal relies on advertising, it’s really up to the readers to decide whether or not they read it and whether or not it stays in business. If the journal drifts out of touch with its audience, if it cuts corners on ethics, or if it just gets boring, people stop reading it. And when the readers fall away, the advertisers do not stick around either.

And, while we’re talking about integrity and quality, I do have to point out that things like conflict of interest or favouritism or just plain old bureaucratic inefficiency are not unheard of in the sort of agencies that some people think would be better than the free marketplace for deciding what Canadian physicians should read.

When a program has to rely on “funding” doled out by a board or a committee, it has to worry about getting the support of committee members who decide who gets funded and who does not. It has to adapt to the bureaucratic realities. Serving the audience becomes an ever more distantly secondary consideration.

Canadian physicians have a terrific range of choices in medical publications: peer-reviewed journals such as Canadian Family Physician and CMAJ; about 2 dozen specialty publications like the Canadian Journal of Cardiology or the Journal of Obstetrics and Gynaecology Canada; French-language publications like Médecin du Québec; and, not least, the privately owned medical magazines such as Parkhurst Exchange and even a biweekly medical newspaper.

Canada’s physicians consistently rate medical journals as by far their number one source of medical information. Most of our considerable journal publishing sector—the hundreds of highly skilled jobs, the broad range of content, the opportunities for physicians to have their work published in Canada, the many choices available to physician readers—is paid for by advertising. And I have to say that I think we’re getting a pretty good deal.

Advertising in journals gives advertisers the chance to reach physicians on the one hand, and helps pay for the production and distribution of medical journals on the other. It’s a straightforward arrangement that works to the mutual benefit of publishers, advertisers, physicians, and, ultimately, the health care system.

Of course medical journals should carry advertisements.

• Copyright© the College of Family Physicians of Canada