Journal rejects article after objections from marketing department
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《英国医生杂志》
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."(Owen Dyer)
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."(Owen Dyer)