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Don’t Show Me The Money*Non-Financial Conflicts of Interest
Ivan Oransky, MDExecutive Editor, Reuters Health
Clinical Assistant Professor of Medicine, New York UniversityCo-Founder, Retraction Watch
CHEST 2012Atlanta, Georgia
*With apologies to Jerry Maguire and TheConversation.edu.au
The Hidden Problem
theconversation.edu.au
The Hidden Problem
“The discussion has focused almost exclusively on pecuniary, or financial, interests. But these may play a relatively minor role in medicine. Most doctors or researchers
don’t do what they do primarily to increase their material wealth. If making money was their primary goal, they could choose more effective ways of doing so.”
The Hidden Problem
“The motivations that underlie most decisions in medicine are not financial.
Rather they range from an interest in patient care or research or public welfare, to a commitment to certain ideas, principles or values and the desire for personal advancement in career, reputation or status.”
PLoS Editors’ Take
Published: September 30, 2008
PLoS Editors’ Take
“Non-financial competing interests (sometimes called ‘private interests’) can be personal, political, academic, ideological, or religious.
Like financial interests, they can influence professional judgment. Much as we'd like to believe that the reporting and evaluation of research are always objective, there is substantial evidence to the contrary .”
PLoS Editors’ Take
“Like all human activity … research and scientific publishing are inherently subjective, imperfect, and prone to bias, corruption, and self-interest.
Indeed, because professional affinities and rivalries, nepotism, scientific or technological competition, religious beliefs, and political or ideological views are often the fuels for [passions and careers], private competing interests are perhaps even more potent than financial ones.”
Non-Financial COIs in Grant Review
Published: April 9, 2012
Non-Financial COIs in Grant Review
“Most participants (73/98) spontaneously reported that non-financial COIs predominated over financial COIs.
Non-financial COIs mainly involved rivalry among disciplines, cronyism, and geographic and academic biases.”
Non-Financial COIs in Grant Review
“However, none of the participants challenged the validity of peer review.
Reviewers who felt they might be affected by CoIs said they reacted in a variety of ways: routine refusal to review, routine attempt to conduct an impartial review, or decision on a case-by-case basis.”
Competition vs. Cronyism
• Turf battles between disciplines/specialties• Geographic biases• Anticipating peer review
• How to manage: Would open peer review help?
Protectionism
Protectionism
“Policies regarding retraction announcements vary widely among journals, and some, such as the Journal of Biological
Chemistry, routinely decline to provide any explanation for retraction. These factors have contributed to the systematic underestimation of the role of misconduct and the overestimation of the role of error in retractions (3, 4), and speak to the need for uniform standards regarding retraction notices (5).”
-- Fang F et al. PNAS 2012.
Protectionism
How to manage:
Embrace transparency (e.g., detailed retraction notices)
Conflicts between Roles
Patient Care vs. Clinical Research
How to manage:
Separation of staff
Religious and Political Beliefs
AbortionStem cellsEnd-of-life care
How to manage:
Tricky!
Positive Publication Bias
• Inherent human optimism• Need to publish quantity for tenure, grants
How to manage:
Journals could publish percentage of studies showing positive results
Messy and Imprecise – But Worth It
Published: September 30, 2008
Messy and Imprecise – But Worth It
“Despite the messy and imprecise nature of private interests, researchers and editors must persist in establishing a better
understanding of their extent and impact. Any assumption that non-financial competing interests are less common or influential than financial incentives is probably misguided.”
Messy and Imprecise – But Worth It
“It's accepted that political interference in science is dangerous, that governments and funders do not make decisions on the basis of science alone,
and that intellectual and professional commitments often lead to strong personal views. When it comes to making sense of non-financial competing interests, why shouldn't we be interested?”
Contact Info/Acknowledgements
Twitter: @ivanoransky
Thanks to Nancy Lapid
