Despite the title, HRC has nothing to do with the subject matter of this post--but she serves as a damn good role model for what is now infecting medical literature. Twin themes here are a) money buys influence and b) there is no end of sell-outs. This article isn't sexy but it is important. New England Journal of Medicine is almost universally recognized as the most authoritative source for medical literature:

The publication Dr. Jeffrey Drazen inherited was initially launched as a quarterly in January 1812 with the less pithy title of the New England Journal of Medicine and Surgery and the Collateral Branches of Medical Science. Today, it is read each week by more than 600,000 people in 177 countries, according to the journal’s website

Those statistics are staggering. No publication in Medicine, even including Nature-Medicine or The Lancet has as much clout at NEJM--and that's been that way for decades. But this is all about to change--or is already changing--in a most disadvantageous fashion:

Like the larger publishing world, their traditionally slow pace and often imperious control have been jolted by the freedom and brashness of the Internet. So-called open-access journals, which publish online and don’t charge for subscriptions, are proliferating, as are websites that allow researchers to post their results before they have been externally vetted. Respected academics, including Harvard’s medical school dean Dr. Jeffrey Flier, are calling for fundamental changes in the way research is reviewed and published, even proposing that peer reviewers give up their historic anonymity.

This push for transparency tracks the rise of research watchdogs who hunt for evidence of fraud and misconduct, then publicize their findings, often blasting out viral bombs via social media. There’s even a popular website called Retraction Watch whose main goal is to flag such lapses, which had largely gone unnoticed even a few years ago.

In response, some top journals, including The BMJ, formerly the British Medical Journal, have already begun moving toward more openness in their operations. The BMJ now requires researchers to share the underlying data that forms the basis of their clinical trials and allows comments on all of its articles, upending the strong hand editors previously had to determine which dissent was worthy of airing. It has even had outsiders examine questions raised about controversial studies.

External vetting is to differentiated from internal vetting. Internal vetting is called peer-review meaning that a proposed article has been reviewed by different experts in the same field before that article is published. External vetting means that once the articles have been published, other experts analyze and comment upon a published article.

The sole intent of peer-review is to insure that information presented is accurate, that the conclusions are supported by the data AND that the article is free from commercial bias. It is this institution, i.e. peer review, which has helped insure the integrity of medical publications. In fact, all medical conferences in addition to medical articles mandate a disclosure of conflicts of interest. Basically this process has, until very recently engendered an expectation of trust in the published results.

But now greed has inserted itself into the NEJM, aided and abetted by the editor-in-chief:

Drazen’s own ties to the pharmaceutical industry presented something of an obstacle when he was named editor in May 2000. A well-known pulmonologist, he had received money for consulting or research into asthma and its treatments from nine drug companies. Because of those ties, he recused himself for two years from editing or personally selecting any papers related to asthma or to those companies.

Two years into his editorship, he loosened the Journal’s conflict policy. Drazen wrote that the policy Relman had put in place — and that his successors had affirmed — had “constrained” editors from publishing the best information for doctors. The new policy said authors of editorials and reviews couldn’t have “significant” ties to a company, which are defined as receiving more than $10,000 annually from a single company....

Although, by definition, a conflict of interest represents a risk that judgment will be compromised — not a determination that such a lapse has actually occurred...

Why is this important?

It should be obvious that money taints so-called objectivity--the more they give you, the more you tilt in their direction. Hillary Clinton again: "I did not take money from the fossil fuel industry". One of the major problems about Big Pharma are the trials required by the FDA prior to a drug being released into the market place. Selective reporting of clinical and even research trials has resulted in omission of negative studies (i.e. no proven efficacy, or worse, actual harm caused by the drug) when that information is presented to the FDA. Big Pharma is as transparent as a concrete wall when it comes to releasing negative studies--usually only doing so after subpoena.

So if a major medical journal engages in deceptive practices, influenced by financial incentives, erroneous inferences about an article are likely to be drawn. Then: everybody suffers except Big Pharma and the unethical physicians entrusted with presenting medical knowledge in a trustworthy fashion.

the pharmascolds’ narrative about conflicts of interest often conflates the two,” author Lisa Rosenbaum wrote, using a pejorative word some have used to describe those who lament the influence of industry on medical decisions.

. Sounds a lot like Hillary Clinton on fossil fuel influence affecting her.

The "establishment" which has been riding roughshod over the 99%, seeing their methods unimpeded are now extending their tentacles even further. Watch out--the Giant Squid is coming for YOU.