Joseph A. Lambert 🇨🇦

When the editor of the world’s most prestigious medical journal concluded that much of the clinical research it published could no longer be trusted, the problem was no longer abstract. Marcia Angell, a pathologist who joined the New England Journal of Medicine staff in 1979, rose to executive editor and then served as interim editor-in-chief from 1999 to June 2000. She stepped down after more than two decades at the journal, formally to write a book. The deeper context was her growing conviction, formed from years of editing manuscripts, that pharmaceutical industry influence had compromised the independence of clinical research. She and previous editors had enforced strict conflict-of-interest rules, yet industry-sponsored studies continued to arrive with designs, analyses, and selective reporting that favored the sponsor’s product. Negative results were often suppressed, side effects minimized, and “academic” authors frequently carried undisclosed financial ties. In a widely cited 2009 New York Review of Books essay, Angell wrote the line that crystallized her position: “It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.” She described an industry that had shifted from discovering useful drugs toward marketing, co-opting academic medical centers, researchers, and even the journals that were supposed to serve as independent arbiters. Her 2000 editorial “Is Academic Medicine for Sale?” and later book The Truth About the Drug Companies expanded the critique, arguing that commercial priorities systematically distorted what research was done, how it was conducted, and what reached publication. Angell’s departure marked the end of an era of tighter editorial resistance to industry influence at the NEJM. Her public statements afterward made clear that she viewed the problem as systemic rather than isolated: once the bulk of clinical research depended on commercial funding, journals could no longer function as reliable filters of medical evidence.