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Relaxing The Rules

Relaxing The RulesDoes the New England Journal of Medicine's decision to relax its conflict of interest policy strengthen or weaken the prestigious publication?

Boston [06.19.02] For almost 200 years, the New England Journal of Medicine has been widely considered the country's most prestigious medical journal - reporting and reviewing new research and treatments across the medical field. Last week, Journal editor and Tufts graduate Jeffrey Drazen announced that the publication was changing its conflict of interest policy -- blaming it for the small and shrinking pool of authors eligibleto evaluate drugs for the Journal. But some wonder if the change will ultimately hurt the Journal's longstanding credibility.

"We're strengthening the Journal," Drazen said in an interview published in the Boston Herald last week.

According to the Tufts graduate, the old policy made it too difficult for the Journal to find qualified authors to review drugs without any ties to the industry -- which was previously required by the editorial policy.

"We have concluded that our ability to provide comprehensive, up-to-date information, especially on recent advances in therapeutics, has been constrained," Drazen wrote in an editorial on the changes published last week. "Certainly, if we publish nothing on a given subject, we run the risk of promulgating a biased opinion, but our silence does not serve our readers."

In an interview with ABC News, Drazen said the old policy was preventing the Journal from publishing much-needed reviews.

"There are areas where we simply have not published anything because we didn't think we could get a person who was good to write in an area that had absolutely no interaction with a commercial entity," Drazen told ABC World News Tonight.

But Jerome Kassirer -- a professor at Tufts' School of Medicine who served as the Journal's editor in chief between 1991 and 1999 -- told ABC that he is surprised at the lack of available authors.

"There is a lot of depth in academic medicine, sufficient depth so that it's almost always possible to find a first-class person to write an editorial or review article in which they do not have a financial conflict of interest," Kassirer said.

But many authors have been disqualified due to what the Journal's editors deem minor links with the industry. The new policy allows reviewers to receive up to $10,000 from a drug company each year.

"The addition of the word "significant" [to the conflict of interest policy] acknowledges that not all financial associations are the same," Drazen wrote in the Journal's editorial. "Some, such as the receipt of honorariums for occasional educational lectures sponsored by biomedical companies, may be appropriately viewed as minor and unlikely to influence an author's judgement."

Drazen also emphasized that the publication will note any financial ties the author has at the bottom of each review and the Journal's editorial board will continue to review all submission before they are published.

"In the end, we as editors are responsible for weighing the available facts about each prospective author and for making decisions we believe will bring the best scientific and medical information to the Journal," he wrote. "No Journal editor who makes these decisions has any financial relationship with any biomedical company."

But Tufts' Sheldon Krimsky -- a nationally renowned expert who has studied conflicts of interest within scientific journals -- worries about the message the Journal's new policy will send.

"I'm afraid it'll send out a signal [to journals with less-strict policies] that the pendulum is moving in another direction," Krimsky told the Chronicle of Higher Education.

Though he called the changes "disappointing," Kimsky told the Chronicle that he doesn't fault the Journal.

"The sadness of it is that I understand what they're doing," he told the Chronicle. "That they have to pull back tells us just how bad the contamination has been in the scientific community. Alas."

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