The pharmaceutical industry is only a “very small” part of the forces that undermine the values of medicine, believes Richard Horton, editor of The Lancet.

A surprising observation, perhaps, from someone who told the House of Commons Select Committee on Health in 2004 that the “for-profit motive of the pharmaceutical sector clashes with the public health values of NHS clinical care and independent scientific research”. But as he admitted at a recent conference held by the Healthcare Publishing Forum in London, Dr Horton’s relationship with the industry is of the “love-hate” variety.

The many drug company delegates present could be forgiven for wondering when the pendulum was going to swing back to ‘love’. Dr Horton has been vocal in the past about clinical trial manipulation, veiled marketing campaigns and other alleged pharma industry misdemeanours. Nor did he hesitate to air some of these accusations again in an interview at the conference with broadcaster Peter Sissons.

But the criticisms were more a product of disillusion than deep-rooted hostility, Dr Horton suggested. Before joining The Lancet his attitude to the pharmaceutical industry had been “incredibly positive”. As a medical student working in a laboratory for Astra (the precursor of AstraZeneca) in Sweden, he had found the best possible “virtuous alliance” of private and public sector research efforts.

There was little of that sentiment left three years ago when Dr Horton launched a withering attack on AstraZeneca’s GALAXY programme of post-marketing trials for its chosterol management drug Crestor (rosuvastatin). It was this editorial, he told Sissons, that had brought him close to being sacked from The Lancet – something he confidently expected would happen one day.

The editorial’s underlying message, though, was one Dr Horton repeated in London last month: that pharmaceutical marketing departments are leaning too hard on their colleagues in medical divisions.

As evidence he referred to a threat made by one (unnamed) company to withdraw a research paper and deprive The Lancet of lucrative reprint income if the journal’s peer reviewers did not temper their criticism of the research. A matching incident involving a study of one of the COX-2 inhibitors was mentioned by Dr Horton in his evidence to the health select committee two years ago. But he told Sissons this kind of intervention was still happening “all the time”.

Asked why he did not complain to the Association of the British Pharmaceutical Industry (ABPI) about the case cited, Dr Horton said The Lancet should perhaps have done so but was only a week away from publication. And exposing the company involved in the journal would have been self-indulgent, shifting the emphasis of the ‘story’ from what was ultimately a rigorously scientific article, he argued.

Nor did Dr Horton apologise for the GALAXY editorial, which at the time prompted a furious rebuttal from Tom McKillop, chief executive of AstraZeneca. This was “really bad”, biased research that was being used as a marketing tool for Crestor, Dr Horton claimed.

He was more contrite about The Lancet’s role in the measles, mumps and rubella (MMR) vaccine scare. Publishing Andrew Wakefield’s research that suggested a link between the MMR vaccine and autism/bowel disease in 1998 had been an “incredible mistake”, he admitted, and The Lancet took personal responsibility for the consequences.

In his defence, though, Dr Horton pointed out that Dr Wakefield’s paper had been subject to a “very critical” external review and the published article had come with an editorial recommending against any change in immunisation policy. The crucial error had been not realising that Dr Wakefield was working covertly for an organisation preparing a class action over alleged side-effects from the vaccine, he told Sissons.

If Dr Horton saw some common cause with the pharmaceutical industry, it was in supporting the kind of research that underpinned technical advances in medicine and in helping to sustain a beleaguered science base in the UK. He denied The Lancet was contributing to an anti-science culture by advertising its more newsworthy stories through a stream of press releases.

On the contrary, publishing strong research was a way of bolstering the science base, he claimed. “On balance, we do more good than harm,” Dr Holton commented, although he admitted The Lancet did sometimes cause harm. As far as undermining the values of medicine were concerned, divisions within the medical profession itself were at least partly to blame, Dr Holton told Sissons.

Any expectations of a reformed, industry-friendly Lancet would be premature, however. The Lancet was founded in 1823 as an ‘open-access’ journal at a time of “incredible radicalism”, Dr Horton noted. Today the publication saw itself as a campaigning “newspaper of medicine” – and one whose job was still to “cause trouble”.