The .Plan

“I have the most trouble with the eyes.”

“Mr. Thomas, I’m not sure I understand you. What do you mean by ‘the eyes’?”

“The eyes of darkness stand still, beckoning me onward towards an unknown goal, one that will bring the end to me as I am known. I have no way of knowing if the Red Monster is going to take over. He is subdued around others, attacking me when I’m alone. He is a bully. But his power is growing over me.”

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[*] All names, dates, and other HIPAA non-compliant details have been confabulated.

I’m shocked, shocked to learn that pharmaceutical companies engage in ethical tomfoolery when it comes to the publication of biomedical research with commercial implications:

Editors know which sorts of articles are likely to be purchased as reprints by pharmaceutical companies. If they accept such an article then their journal may receive hundreds of thousands of dollars in income—and these reprints are very profitable. If they reject the article then the money is gone. Some editors are directly responsible for the budgets of their journals, and all editors are concerned about their budgets. A healthy budget means job security, praise from the owners, and often the freedom to expand and innovate. A failing budget means the opposite; and for many journals reprint income is an important source of revenue—sometimes the most important. Editors may be faced with a choice as stark as accepting a study that will bring a substantial income or making some editorial colleagues redundant in order to stay within budget. A million dollar order may mean US$600 000 profit, which is the equivalent of several editorial salaries for a year.

Sometimes companies will ring when an article is submitted and make clear that they will purchase reprints if the article is accepted. This is effectively a bribe, and `everybody has their price’. A woman from a public relations company once rang me at the BMJ to say that if we accepted a paper then she would `take me to restaurant of my choice’. She was very effusive and stopped just short of saying she would go to bed with me if we took the paper. This was actually the most brazen bribe I was offered in 25 years as an editor. Readers will be relieved to know that the BMJ did not accept the paper.
–Richard Smith, “Conflicts of interest: how money clouds objectivity”, Journal of the Royal Society of Medicine, June 2006