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If you think that all doctors have unrestricted access to all medical information and are able to assess it to determine the most appropriate treatments, you are mistaken. In order to develop the ideas and assemble the references in this site required access to dozens of journals in the Electronic Journals of the Health Science Library at McGill. Faculty members of the McGill are fortunate to have this resource that costs McGill hundreds of thousands of dollars in order to make an independent judgment of the merits of trials of drugs and lifestyle change.
The vast majority of doctors do not have access to such a resource. At best they can afford to subscribe to a few journals which can cost thousands of dollars. Everyone can view abstracts to most journals but as we will show abstracts can be very deceptive; the complete paper must be analyzed to assess its value. So, most doctors are dependent upon "free" distribution of literature by drug company representitives who, naturally, will only distribute literature favourable to their product.
The situation is much worse in the developing world where doctors cannot afford any journals because the mailing cost of paper journals is so high. Here is part of an e-mail from a cardiologist in Malaysia: "I am doing less of these [continuing medical education] talks nowadays as the companies are increasingly keen to influence content of talk. I have some friends who work for the pharmaceutical companies, and I have requested their assistance in sending me PDFs of papers I identify as they have access to their companies subscribed journals. Not being able to give a marketing return for this favor, I have become reluctant to do this often. Do you have access to McGill's subscribed journals, or do you know how anyone can help send me PDFs of papers I may need ??? It is expensive trying to buy them all !!! I am concerned about how doctors can get fair information when so much of marketing influence is felt in the dispensing of medical information." In other words, drug companies can bribe doctors with access to information and selectively distribute it.
Even more outrageous is the behaviour of many of those doctors connected to universities with access to all the information who are paid directly or indirectly by drug companies and write "guidelines" for the use of their drugs by non-university doctors without access to all of the information and who think they can avoid analyzing the literature if "experts" explain it to them.
Medical publishing is very profitable. In addition to the astronomical prices for paper and electronic subscriptions, journals also charge very inflated prices to drug companies for reprints for papers favourable to their products. Could this lucrative source of income influence the editorial decisions of journal editors?
See a recent example of how a journal can manipulate information for its benefit.
You decide.
