Editor`s Opinion: The Fine Line between Info-mercial and Information

   It isn't easy, staying in the green. For a journal to meet its publication costs, advertising must be secured and sponsors must be lined up for special projects such as supplements and certain columns (in OWM, those include "Addressing the Pain," "My Scope of Practice," and "The Ostomy Files"). Guidelines are firmly in place to offset the dangers inherent in sponsored research and writing. Things get sticky, however, when the pursuit of the green becomes tinted with a bit too much yellow (journalism) and what could be valuable information takes a decidedly commercial, slightly sensational slant in favor of a particular product. Then articles can start to sound more like ad jingles than genuine research.

   Full disclosure of financial support and assistance with manuscript preparation is standard for most journals, including OWM. But no matter how hard the editors try to be objective and protect the integrity of what is published, disclosures remain an honor system. Furthermore, disclosures cannot possibly cover every conceivable or potential bias. So, every once in a while, across our desks will come a manuscript that clearly favors one product over the other without offering sufficient evidence to substantiate this product's favored status, even when the clinical experience of the authors has shown the product to perform as claimed. Hackles of suspicion automatically raise: Is this a case of company pushing for success stories or simply a matter of an author not doing his/her homework regarding literature reviews to substantiate claims? Should we, in the interest of disseminating information, submit a less-than-stellar paper to peer review with the caveat that it might raise overall awareness of product options, regardless of whether care/product alternatives are acknowledged? Is a detailed "Discussion" section and an honest reckoning of "Limitations" always enough to blunt what can still come across as blatant bias? Is it really possible to compare apples with apples when apples are available in so many different varieties?

   Obviously, companies that provide the products and funds for research should not automatically be held suspect. That would be biased on our part. Assuming their intentions are to sell a product that improves care, these companies provide the wherewithal to allow clinicians to test and try their products - indeed, numerous clinicians heartily sing the praises of knowledgeable sales reps and their miracle potions. Clinicians are often happy with the manufacturer because patients are happy with the results achieved using the product. Company loyalty develops, not because the company is offering "perks" (that would be illegal) but because using the product helps the clinician provide clinical and cost effective care. No wonder happy clinicians want to write about cases that exemplify the outcomes they observe.

   But what happens when a wound, skin, ostomy, or incontinence care clinician is solicited by a company to compose an article that touts a certain product? One would hope that the same guidelines apply - the literature review and data must support the claims made. OWM strives to live by that code... holding fast to this philosophy is likely one of the reasons our publications are referenced in esteemed places, indexed in all major databases, and regarded so highly in respected healthcare circles. Even before the Jayson Blairs of the world gained such notoriety, we insisted that authors substantiate assertions and that all articles appearing in the journal and its supplements are peer-reviewed. Still, even though the reviews are double-blinded (reviewers do not know the names of the authors and the authors do not know who reviewed their manuscripts), the review process is inherently subjective. Yes, reviewers are also asked to disclose potential conflicts of interest, but a reviewer's personal success with a product may color his or her comments, and an article might be published that seems to advertise a bit more than inform.

   We also need to be wary of the use of "celebrity spokespeople." A recent article in The Philadelphia Inquirer¹ addresses the use of celebrity spokespeople who make appeals for drug companies. You've seen the TV ads - Bob Doyle for Pfizer, Noah Wyle for Schering-Plough, Meredith Viera for Merck + Company. They raise awareness about health conditions and the medicines to treat them, enlightening the public (positive for the patients) and increasing sales (positive for the manufacturer).

  Imagine if you will the same strategy involving advanced wound, skin, ostomy, or incontinence technology and one of our many experts in these areas. Wound care clinicians might be more inclined to believe the writings about a particular product from a "famous" expert clinician than from someone with less well-known credentials. Manufacturers know this, of course, and are happy when this clinician writes on their behalf or mentions their products. We just need to tread carefully in this territory, mindful of the implications, positive or otherwise.
As always, we ask readers to consider the source(s). Experienced, reputable clinician contributors are OWM's mainstay. Authors subsidized by companies are no more or no less accountable than authors working independently, but their affiliations need to be considered. When OWM is asked to disseminate information via complimentary or supplemental publications that may be useful to our readers yet might not meet the requirements of the peer review process, we clearly identify that fact on the cover and the publication is not labeled as a supplement (and it is not indexed) so readers can use the information accordingly.

  We encourage you to express your concerns and determine (perhaps even document) whether the product deserves its purported kudos - or not. If something sounds too good to be true, it probably is. Your assignment (and we hope you choose to accept it) is to seek more information and let us know what you discover.

1. McCullough M. An unhealthy dose of Hollywood. The Philadelphia Inquirer. June 16, 2003:E1,E5