BMJ Group blogs: BMJ » Blog Archive » Richard Smith: Medical journals: a gaggle of golden geese

“I was reminded of this, a favourite theme of mine, when I read the paper on high reprint orders in medical journals posted on bmj.com last week. The main message of the paper is that high reprint sales are strongly associated with pharmaceutical funding. The authors have laboured long and hard to produce this result, but it won’t surprise anybody who knows the inside of medical publishing. The big sales of reprints are almost always to pharmaceutical companies, and the publishers are very active in selling them. What the authors of the article don’t say (and perhaps don’t know) is that the profit margin on reprints is very high, perhaps 80%. The paper shows that one Lancet reprint was sold for £1.55m, which would mean a profit for Elsevier, the owners of the Lancet, of well over a million pounds. That’s one of the reasons why Elsevier makes a profit margin of over 30% by publishing its 1200 or so journals, a far higher margin than in most industries. The conflict of interest is clearly huge. If Elsevier had to maintain its profit margin by cutting costs rather than publishing that one article then it might mean firing 25 editors. I’ve written about this before in my article arguing rather painfully that ‘Medical journals are an extension of the marketing arm of pharmaceutical articles.’ I applaud the Lancet and BMJ for providing data on reprints, but the publishers of the New England Journal of Medicine (Massachusetts Medical Society), JAMA (American Medical Association), and the Annals of Internal Medicine (American College of Physicians) all declined. They clearly have something to hide... Let me now imagine the financial statements of a very unaverage journal—the New England Journal of Medicine. My guess is that the journal has an income of around $100m a year—and perhaps $20m of that may come from reprint sales. It is generously staffed, the editors are no doubt well paid, they are generous with people from the developing world, and the whole thing is a Rolls Royce operation—so expenses are high. Even so, I bet the journal makes over $20m in profits. That’s why the Massachusetts Medical Society has grown fat and has an expenditure per member way above any other state medical society. But there downsides to all this opulence. The society wants more money and would like, as one editor of the journal put it to me, to start “New England Journal of Medicine Fried Chicken.” There are anxieties that the need to keep up the profits will lead to compromised decisions. But the biggest downside is the journal’s opposition, sometimes vehement, to open access. It’ll be tough, probably impossible, to make the same profits from with open access publishing. This is the age of transparency and accountability. Whatever is not transparent is assumed to be corrupt, biased, or incompetent until proved otherwise—like it or not and fair or not. The time has come for journals to open up their financial statements. I apologise to the New England Journal of Medicine if my guesses on its finances are wildly wrong. If I’m wrong, please show me. This blog overlaps to some degree with a rapid response sent to the BMJ in response to the paper on reprints.”