Intellectual Freedom versus the feudal lords of medicine

According to a paper published in the current issue of the journal Psychotherapy and Psychosomatics by its editor Giovanni A. Fava, the drug industry has full control of many scientific societies, journals and clinical practice guidelines. Members of special interest groups act as editors, reviewers and consultants to medical journals, scientific meetings and non-profit research organizations, with the task of systematically preventing the dissemination of data which may be in conflict with their interest. This censorship may be the result of direct prevention of publication and dissemination of findings by the pharmaceutical company itself, displaying its power as an advertiser in medical journals, a supporter of meetings and the owner of the data.

The paper deals with the issue of intellectual freedom in medical research. This freedom may be endangered by several issues that are critically examined and several examples are quoted to support the statements.

"You will never find a certain type of article in a journal which has drug advertisements" Fava says. Yet, there are more subtle forms of censorship. One has to do with setting a financial threshold for publishing research findings (free access journals). The issue is not open access to self-selected information, but discrimination of independent sources within information overload, Fava says.

Another subtle form of censorship is by counteracting published information with massive doses of propaganda (e.g., manipulated interpretation of clinical trials). Filtering information (selective perception), engineering opinions, using the public relations industry and marginalizing dissident cultures are the well-known modalities of action. Yet, according to Fava, it is deliberate self-censorship which may yield the most dangerous effects. One way to address the problem has to do with the value that is represented by investigators who opted for not having any substantial conflicts of interest (i.e. being an employee of a private firm; being a regular consultant or in the board of directors of a firm; being a stockholder of a firm related to the field of research; owning a patent directly related to the published work).

The paper provides several suggestions for preserving intellectual freedom in medicine, based on research evidence which is available. The paper is available here.