The pharmaceutical industry’s corrupting influence on our medical care system usually gets the most attention. Now its corrupting influence on medical journals has come under fire. Yes they’re full of drug ads that prompt the usual suspicions about financial dependency. But that’s the least of it, according to Richard Smith, MD, who resigned last year as editor-in-chief of the BMJ (British Medical Journal).

In a recent commentary for the Public Library of Science, a free online medical journal, Dr. Smith identified the less obvious conflicts of interest that surround the most respected form of research, the randomized clinical trial. Whenever a large trial is published in a high-profile journal, it has that journal’s implicit stamp of approval and may well receive global media coverage thanks to drug company-financed PR. A trial with favorable results will generate far more money for the drug companies than a multi-page advertising campaign, according to Dr. Smith, and that’s why they spend “upwards of a million dollars” on reprints of the trial to send around the world. Doctors won’t necessarily read the reprints, he acknowledges, but the name of a highly respected medical journal will impress them.

Here’s the most disturbing element of this scenario: More and more drug companies are getting the results they want because the trials are often rigged. Most drug trials are now sponsored by the drug companies. They can, and often do, design a trial in such a way as to get results that prove a drug’s benefit. In fact, several reviews have already found that most of the industry-funded trials have findings that favor the drug. Between two-thirds and three-quarters of trials published in the major journals–Annals of Internal Medicine, JAMA, Lancet, New England Journal of Medicine–are funded by drug companies.