NEJM tries to steer straight down the middle

The New England Journal of Medicine (NEJM) and other medical journals are sensitive to the charge that they are unduly influenced by the pharmaceutical industry. Today’s issue contains a typical drug company sponsored study: Modafinil for Excessive Sleepiness Associated with Shift-Work Sleep Disorder. Essentially, the study demonstrated that modafinil is marginally efficacious at best for this indication. But the study’s lead author, whose professorship is endowed by modafinil’s maker, Cephalon put a positive spin on the results. From the abstract:

[M]odafinil… resulted in a small but significant improvement in performance… However, the residual sleepiness that was observed in the treated patients underscores the need for the development of interventions that are even more effective.

In an unusual move, NEJM published an editorial in the same issue entitled Shift-Work Sleep Disorder –The Glass is More Than Half Empty by Dr. Robert C. Basner. He argues that,

This drug is little better than nothing in terms of making [people] less sleepy during shift work at night.

NEJM wants to have it both ways –publishing pro-drug articles that sales reps will be happy to cite, while trying to maintain credibility with the dissenting editorial. If NEJM doesn’t agree with the researchers’ conclusions a better idea would have been to reject the article or insist on changes.

August 4, 2005

2 thoughts on “NEJM tries to steer straight down the middle”

  1. “If NEJM doesn’t agree with the researchers’ conclusions a better idea would have been to reject the article or insist on changes.”

    I disagree, David. We don’t expect NEJM to agree with anybody’s conclusions. We expect them to publish papers of important general medical interest that comply with the community standard of scientific research.

    Regarding the article in question. A critical reader doesn’t need an editorial to draw the conclusion that the drug isn’t much good. The editorial is probably for the benefit of the lay press, who is paying attention, but who is not up on the literature enough to represent the result faithfully.

  2. Fair enough, Rob. I’m just worried the article will be one more arrow in Cephalon’s quiver that they don’t deserve. But as you say it’s pretty clear from the study that modafinil doesn’t really work for shift-work sleep disorder so maybe it won’t be prescribed.

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