Søren Roest Korsgaard.
For a more comprehensive analysis of how the pharmaceutical industry has corrupted biomedical research and healthcare, read my book: The New September 11th: Solving the COVID-19 Pandemic. Download the article as audio here or listen to it in the browser:
A full 16 years before the novel coronavirus became a matter of global concern, The Lancet’s Editor-in-Chief Dr. Richard Horton blew the whistle on the medical profession, warning that it had been colonized by the drug industry [1].
Research questions were now skewed to serve industry interests rather than public health. Government advisory committees had become compromised by members with deep financial ties to the companies they were supposed to regulate. Universities, which he presented as the most conspicuous example, had sacrificed their commitment to objective inquiry for profit and reinvented themselves as corporations.
The colonization, he noted, extended to the very heart of scientific communication: the journals. The process of publication had been reduced to “marketing dressed up as legitimate science,” with paid-for articles bypassing peer review. Consequently, journals had become “information-laundering operations for the pharmaceutical industry” [1].
In a now well-known article, “Offline: What is medicine’s 5 sigma?” published by The Lancet in April 2015, Horton continued his indictment, arguing that science had “taken a turn towards darkness” [2]. He warned of an “endemicity of bad research behaviour,” observing that it had become a frequent practice for scientists to “sculpt data to fit their preferred theory of the world.” Journal editors were complicit by aiding and abetting the “worst behaviours” [2]. Therefore, much of the “scientific literature, perhaps half, may simply be untrue” [2].
A similar gap appeared for other questionable research practices: while 33.7% admitted to engaging in them, up to 72% reported that their colleagues had done so. These practices occupy a gray area between ideal research and outright fraud; yet, they surprisingly cause the “greatest public harm” through wasted resources and dubious healthcare decisions [5]. Scientific misconduct was most prevalent in clinical, pharmacological, and medical research.
Dr. Marcia Angell, the former Editor-in-Chief of the NEJM, is one of several well-placed insiders who have raised similar concerns. In a highly recommended 2009 exposé, she revealed that the drug industry had corrupted the field of medicine. Angell’s conclusion, which she delivered without reservation, was stark:
It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine [3].
Shifting from expert testimony to quantitative data, Dr. Daniele Fanelli indirectly explored the reliability of the scientific literature in a 2009 systematic review and meta-analysis of survey data [4]. He found that 1.97% of scientists admitted to fabricating, falsifying, or modifying data themselves. Revealing the powerful effect of self-reporting bias, the figure jumped to 14.12% when scientists were asked about the conduct of their colleagues.
Dr. Richard Smith, who edited The BMJ for 25 years, is another prominent voice from within the medical establishment who has concluded that “medical journals are an extension of the marketing arm of pharmaceutical companies” [6].
In a 2005 article in PLoS Medicine, he characterized industry-funded clinical trials as completely unreliable [6]. As evidence, he cited a 1994 comparative study by Rochonet al. that reviewed all clinical trials sponsored by manufacturers of non-steroidal anti-inflammatory drugs for arthritis. Not one of them reported results that were unfavorable to the sponsor [7-8].
There are many devious ways, he revealed, by which pharmaceutical companies can strategically design clinical trials in their favor, and they even employ “hired guns” who specialize in this questionable field [6]. A straightforward tactic is to never share unfavorable findings with the public. Alternatively, they can give participants an excessively high dose of a comparator (to make their drug look safer) or provide too low a dose (to appear more effective). It is clear that pharmaceutical companies are “getting the results they want” [6]. In a 2014 “Head to Head” article in The BMJ, Dr. Peter Gøtzsche and Smith summed it up eloquently: “The difference between an honest and a less-than-honest data analysis can be worth billions of euros” [9].
What about solutions? In 2014, Smith and Gøtzsche advocated that medical journals should become independent of drug companies and stop publishing their clinical trials, just as they did with tobacco industry-funded research. The tobacco industry, they wrote, is unmoved by the harm it causes and is solely dedicated to advancing its commercial aims; however, these observations apply “even more strongly” to the drug industry and its research [9].
Under their proposal, journals would become critical watchdogs, analyzing raw trial data, which should be made fully available on a regulated website. It would be a major blow to the industry, they reasoned, because it would no longer be able to leverage exclusive access to raw data and get away with major distortions, omissions, and deceptions. Despite the excellent proposal, the medical community has resisted it, paving the way for the industry to continue introducing flaws in the coding of adverse events “without leaving any trace” of what happened [9].
If conflicts of interest were a major concern when Horton, Angell, Smith, and Gøtzsche first spoke out, the current situation must be described as extreme. Consider an October 2024 research letter that examined the so-called leading medical journals: The BMJ, JAMA, The Lancet, and NEJM. It uncovered that 59% of their US peer reviewers received $1.06 billion in industry payments between 2020 and 2022 [10]. The money was spent on research (94.0%) and general payments (6.0%), such as consulting fees and speaking honoraria. Evidently, the very experts responsible for ensuring scientific integrity are financially entangled with the companies whose work they are meant to be evaluating objectively.
References
[1]. Horton, Richard. “The Dawn of McScience.” The New York Review of Books, 11 March, 2004 https://www.nybooks.com/articles/2004/03/11/the-dawn-of-mcscience/ [accessed May 2025].
[2]. Horton, Richard. “Offline: What Is Medicine’s 5 Sigma?” The Lancet, vol. 385, no. 9976, 11 Apr. 2015, p. 1380, https://doi.org/10.1016/S0140-6736(15)60696-1 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60696-1/fulltext [accessed January 2022].
[3]. Drug Companies & Doctors: A Story of Corruption https://web.archive.org/web/20210109125711/https://www.nybooks.com/articles/2009/01/15/drug-companies-doctorsa-story-of-corruption/ [accessed December 2021].
[4]. Fanelli, Daniele. “How many scientists fabricate and falsify research? A systematic review and meta-analysis of survey data.” PloS one vol. 4,5 e5738. 29 May. 2009, doi:10.1371/journal.pone.0005738 https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0005738 [accessed January 2022].
[5]. Steneck, Nicholas H. “Fostering integrity in research: definitions, current knowledge, and future directions.” Science and engineering ethics vol. 12,1 (2006): 53-74. doi:10.1007/pl00022268 https://pubmed.ncbi.nlm.nih.gov/16501647/ [accessed May 2025].
[6]. Smith R. (2005). Medical journals are an extension of the marketing arm of pharmaceutical companies. PLoS medicine, 2(5), e138. https://doi.org/10.1371/journal.pmed.0020138 [accessed May 2025].
[7]. Rochon, P A et al. “A study of manufacturer-supported trials of nonsteroidal anti-inflammatory drugs in the treatment of arthritis.” Archives of internal medicine vol. 154,2 (1994): 157-63 https://pubmed.ncbi.nlm.nih.gov/8285810/ [accessed May 2025].
[8]. Lexchin, Joel et al. “Pharmaceutical industry sponsorship and research outcome and quality: systematic review.” BMJ (Clinical research ed.) vol. 326,7400 (2003): 1167-70. doi:10.1136/bmj.326.7400.1167 https://pmc.ncbi.nlm.nih.gov/articles/PMC156458/ [accessed May 2025].
[9]. Smith, Richard et al. “Should journals stop publishing research funded by the drug industry?.” BMJ (Clinical research ed.) vol. 348 g171. 14 Jan. 2014, doi:10.1136/bmj.g171 https://www.bmj.com/content/348/bmj.g171.full [accessed August 2021].
[10]. Nguyen, David-Dan et al. “Payments by Drug and Medical Device Manufacturers to US Peer Reviewers of Major Medical Journals.” JAMA, vol. 332,17 1480–1482. 10 Oct. 2024, doi:10.1001/jama.2024.17681 https://pubmed.ncbi.nlm.nih.gov/39388188/ [accessed May 2025].