Conflicts of Interest in Science

What's a conflict of interest? (COI)

According to the International Committee of Medical Journal Editors, a COI involves the following:

A conflict of interest exists when professional judgment concerning a primary interest (such as patients' welfare or the validity of research) may be influenced by a secondary interest (such as financial gain). Perceptions of conflict of interest are as important as actual conflicts of interest.

Financial relationships (such as employment, consultancies, stock ownership or options, honoraria, patents, and paid expert testimony) are the most easily identifiable conflicts of interest and the most likely to undermine the credibility of the journal, the authors, and of science itself. However, conflicts can occur for other reasons, such as personal relationships or rivalries, academic competition, and intellectual beliefs. Authors should avoid entering in to agreements with study sponsors, both for-profit and non-profit, that interfere with authors’ access to all of the study’s data or that interfere with their ability to analyze and interpret the data and to prepare and publish manuscripts independently when and where they choose.

Yes, industry research can be fruitful, but one should be weary of what the aims are of those funding research. I shouldn't have to go into private industry’s motives in depth to explain why the incentives should look a bit suspect if, say, a coffee company is the one backing a study on coffee, or a wine company backs a study on wine, or an energy company backs a study on fracking, or a beef company backs a study on grass fed beef, and so forth and so on.

People should, for example, question the intentions of someone trying to disprove causal links between second-hand smoking and disease if they have this to say

They reject our results because they disagree with our interpretation of data from other studies and because our analysis was funded by the tobacco industry.

Passive smoking and heart disease

Personally I believe that we would all be better off with more public research dollars to back scientific research, so that researchers wouldn’t have to feel so much pressure to appeal to private industry as a source of funding. I don't enjoy harping on about science in general in a negative light because on the whole it does so much good for humanity, especially considering some of the more baseless anti-science rhetoric being bandied about in places like the US.

Industry ties seem to be increasing over time in some cases

I think psychology and psychiatry are important fields that contribute positively to the mental wellness of many but can anyone please explain how this happened?

However, it is clear that transparency alone is not enough of a safeguard: approximately 68% of the members of the DSM-V task force reported having industry ties, which represents a relative increase of 20% over the proportion of DSM-IV task-force members with such ties. Also, of the 137 DSM-V panel members who have posted disclosure statements, 77 (56%) have reported having industry ties, such as holding stock in pharmaceutical companies, serving as consultants to industry, or serving on company boards — no improvement over the 56% of DSM-IV members who were found to have such industry relationships.

A closer inspection of the origins of the DSM-V reveal that every passing iteration of the DSM involves more people with financial ties working on it. There are many debates on whether or not industry involvement in such projects are beneficial, and while I know that pharmacological assistance is often needed in treating patients I cannot help but wonder how much that influences the process of adding wider and wider diagnostic criteria for a longer list of illnesses that sometimes weren't illnesses at all in the past. I'm of the opinion that it's not quite healthy to over-medicate what are sometimes overly vilified behaviors especially among the youth, when those behavior patterns are of the sort that people tend to grow out naturally as they age.

And this sentence gives me confidence...

Moreover, both disclosure requirements and specific policies about the management of existing conflicts of interest are missing in the APA's clinical practice guidelines.

As it stands I don't think too many people are up in arms over the potential conflicts of interest there, which is somewhat strange given the huge public health implications of having the DSM-V as the de facto reference point for so many mental health practitioners. I guess the APA doesn't feel the need to cut down on the entanglement there because there's a lack of negative PR surrounding the issue for now. Don't get me wrong, there is certainly a place for pharmaceutical assistance in helping to treat some individuals, I just wish they were more transparent about the whole process of writing it.

Having industry ties doesn't suddenly make you evil, but it'd be nice to know if the material you're writing is coming from an unbiased source. And based on the current trajectory, with a little extrapolation it seems that the DSM-VII might have 100% of its members reporting industry ties, hehe.

Does money change the way people talk?

Does having industry ties matter? I guess it would depend on the individual, their circumstances, and the expectations of their benefactors.

Just look at these figures from a study on the correlation between receiving industry money and scientific authors' attitudes towards the safety of calcium-channel agonists for some papers published between March 10, 1995, and September 30, 1996.

Conflict of Interest in the Debate over Calcium-Channel Antagonists is a study of the financial ties of authors of published papers that weighed in on the calcium-channel agonist safety debate. Basically they sent out surveys that asked the authors of the papers to report their financial ties to industry, and they supposed that because the people filling out the surveys didn't know they were specifically being asked in relation to these papers they might have been more open about which companies they've been supported by. It's interesting to think that they may have thought differently about this survey because they were just given a list of companies to check off if they had received various forms of funding from them, as opposed to feeling accused of any sort of improprieties nearer the time of publishing when confronted with a more direct COI form.

Two of the people on the support team, who didn't know the authors' survey results, went through the articles and labeled them as supportive, neutral, or critical towards the calcium-channel agonists, with a third member weighing in if the two didn't agree. Because many authors wrote more than one paper authors who were neutral on one and supportive or critical on others were labeled supportive or critical.

Sixty-seven percent of the supportive authors reported three or more of the five types of interactions, as compared with 40 percent of the neutral authors and 13 percent of the critical authors (P<0.001).

The researchers for the study found some surprising (or not) results. It's almost as if those taking money from industry had a slightly different view on the safety of the products sold by companies that may have supported them financially.

Of interest is the fact that scientists might be more open to disclosing their ties if they aren't aware that they're disclosing their ties to any singular study, and they may be more prone to withholding information if they think it paints themselves or their research in a negative light. So maybe self-reported disclosures at the time of publication aren't really as effective as we'd like them to be, but that's not to say that the effort shouldn't be made, because short of a different system involving fines, different cultural mindsets towards disclosures or invasive audits of researchers I don't see how we would get completely transparent reporting anytime soon.

Do guinea pigs have the right to know?

When COI are disclosed, who deserves to know?

Now this may be a bit outdated because it's from November 2000 and many of the schools they contacted said they were revising and updating their policies on disclosures, but this is the list of the ten schools discussed in this study:

Conflict-of-Interest Policies for Investigators in Clinical Trials

Baylor College of Medicine, Columbia University College of Physicians and Surgeons, Harvard Medical School, Johns Hopkins University School of Medicine, the University of Pennsylvania School of Medicine, the University of California at Los Angeles School of Medicine, the University of California at San Francisco School of Medicine, the University of Washington School of Medicine, Washington University School of Medicine at St. Louis, and Yale University School of Medicine.

It's likely that you're familiar with most if not all of these, and they're generally well-regarded schools in the field of medicine. So you'd trust they have your best interests at heart if you were about to sign up for a clinical study there, right?

All 10 universities required that faculty members disclose financial interests to university officials. Only four required disclosure by all members of the research staff.

Only two required any disclosures be made to the research subjects themselves! It's clearly important enough that all ten universities want to be informed of them, and you'd think people might want to be aware of what financial ties the people experimenting on them have. I know I would, although I wouldn't want to be in a situation where I'd have to get experimented on by someone who doesn't have to tell me who they're really working for in the first place.

It seems odd to me that these institutions wouldn't have stricter COI policies, even circa 2000. How come four of these schools don't require disclosures be made to institutional review boards, and a whopping six don't require them be made to the professional community in publications or presentations? You're telling me that the universities themselves, at least at the time of this study, didn't require their own researchers make these sorts of disclosures transparent unless journal they're publishing in forced them to?

There are also other strange omissions, especially with the research staff and who among them has to report COI. The researchers of this paper state

We disagree with recent suggestions that prohibitions on stock, stock options, or decision-making positions be imposed only on investigators who are responsible for the selection of subjects, informed consent, or clinical management. Bias may also occur in the design of the study, the ascertainment of outcomes, or the interpretation of results.

and I'd have to agree with that. Universities should be at the forefront of fostering a culture of openness and transparency with regards to research, as the dominant cultures there will surely influence the ways in which their researchers think and act in the future when it comes time to leave the universities.

If you don't have anything nice to say

Should they suppress negative results? Or maybe they just accidentally forgot to publish the studies that the FDA thought weren't positive. Paperwork gets lost all the time!

Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy is a study that reveals what happens when they took a look at reviews for 12 antidepressant agents.

Among 74 FDA-registered studies, 31%, accounting for 3449 study participants, were not published. Whether and how the studies were published were associated with the study outcome. A total of 37 studies viewed by the FDA as having positive results were published; 1 study viewed as positive was not published. Studies viewed by the FDA as having negative or questionable results were, with 3 exceptions, either not published (22 studies) or published in a way that, in our opinion, conveyed a positive outcome (11 studies). According to the published literature, it appeared that 94% of the trials conducted were positive. By contrast, the FDA analysis showed that 51% were positive.

To be fair, this study itself does state that it's unclear where along the line the failure to publish came from so we can't automatically blame just the authors of the studies as individuals. It's certainly reasonable to think that journals and their editors play a part in this, given their hunger for publishing positive results and bias towards them. They all work as part of a large machine that tends to praise the new and the positive, part of the same machine that doesn't celebrate solid replication and reproduction as loudly as it does novelty.

Negative results strengthen science by increasing the body of evidence in all directions, not just the ones that lead to profit. It allows other researchers to not waste time following false leads and helps prevent the building out of more bridges over tenuous science that's already been quietly disproved.

What's the point of doing research if you're just going to bury it? I find it rather unacceptable that one can load up a shotgun of studies, blast out data and cherry-pick the ones that suit their financial interests. It would certainly help us make more informed choices on the medications we take if we knew more of the potential risks and consequences of taking them. And like the paper says, doctors make choices based on published papers, so if they don't have a clearer view of the downsides then how can they really make informed choices on the behalf of their patients?

My totally unscientific thought is that researchers should be mindful of the ways in which influxes of money can change the way one thinks about the companies giving them said money or other perks, report those contributions accurately and up-front, especially to those who may be immediately impacted. And they should attempt to be scrupulous when choosing what to publish and weigh the benefits for society, not just a subsection of it, when doing so.

Sources

http://icmje.org/recommendations/browse/roles-and-responsibilities/author-responsibilities--conflicts-of-interest.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1113639/

https://www.nejm.org/doi/full/10.1056/NEJMc0810237

https://www.nejm.org/doi/full/10.1056/NEJM200011303432206

https://www.nejm.org/doi/full/10.1056/NEJMsa065779

#steemSTEM has cool people who like, create, and support nerd stuff like Science, Technology, Engineering, and Mathematics related content and activities on the STEEM blockchain. If you want to be a part of it you can contribute relevant STEM content with the #steemstem tag, support and vote on steemSTEM authors, join the curation trail, hop in the Awesome Discord Channel, and delegate SP to steemSTEM.

50 SP| 100 SP| 500 SP| 1000 SP| 5000 SP| 10000 SP| 50000 SP