Fake journals, the internet, and public health

You've probably already heard that Merck and Elsevier are being called on the carpet for producing a medical "journal" - Australasian Journal of Bone and Joint Medicine - that appeared to be peer-reviewed, but was actually a marketing ploy to encourage doctors to prescribe Merck drugs. Ouch.

Elsevier told The Scientist,

"Elsevier acknowledges the concern that the journals in question didn't have the appropriate disclosures," the statement continued. "It is worth noting that project in question was produced 6 years ago and disclosure protocols have evolved since 2003. Elsevier's current disclosure policies meet the rigor and requirements of the current publishing environment." (source)

Okay, so they're not doing it anymore. But the ethical problems with this are obvious now and should have been obvious six years ago. On this subject, blog.bioethics.net has a comment, and our very own Janet Stemwedel has two excellent posts on the difference between fake journals and biased journals.

What is particularly reprehensible about the Merck/Elsevier story is that we live in a period when individuals are taking on an increasing share of the responsibility for monitoring their own health care. The Pew estimates that between 75% and 80% of internet users have looked online for health information, and that

Internet users living with a disability or chronic disease are more likely than other internet users to be wide-ranging online health researchers and to report significant impacts from those searches. For example, 75% of e-patients with a chronic condition say their last health search affected a decision about how to treat an illness or condition, compared with 55% of other e-patients.

The problem is that most of these engaged patients, no matter how intelligent and motivated, aren't trained to evaluate the health information they find for accuracy or credibility. When they search for information on the internet, they encounter a melange of advertising, advocacy, and science: online health information provided by hospitals, research centers, private medical practices, scientists, pharmaceutical companies, peer-reviewed journals, libraries, and government agencies, not to mention e-patients and motivated citizens (via forums, Wikipedia, blogs, and social networks). It's confusing at best; to individuals of my mom's generation, who aren't generally internet-savvy, it can be both intimidating and overwhelming. (Ditto for many youth, who may feel confident using the internet, but haven't acquired the critical-thinking skills and life experience they need to evaluate evidence for bias).

Among the hallmarks of reliable, accurate health information, I'd generally say publication in a peer-reviewed science journal ranks at the top! That's why it is so offensive that a publisher of legitimate peer-reviewed science journals would deliberately exploit the appearance of peer review to disguise a highly biased advertisement. The publication was clearly intended to fool physicians, so it likely would have fooled most of the general public as well (although active researchers would have noticed suspicious aspects, like "review" articles that cite only two sources).

Every time someone conceals an argument for their personal agenda (whether commercial or political) in the guise of science, it devalues science in the eyes of the public. It makes it that much harder to teach citizens to identify reliable information online. And it makes it that much harder for people like my mom, suffering from chronic health problems and trying to figure out where to go for help, to know what or whom to believe. The responsible parties at Merck and Elsevier really ought to be ashamed.