Conflict-of-Interest.net

Here’s a story that caught my attention in the last few days, because its not about one of the “usual suspects” of drug companies, the need for policy in med schools or journals, etc. While financial interests are at the heart of the case, the mechanisms and harms are somewhat different and so worth thinking about…

Conflict of Interest and Textbooks

The issue here is about profs using their own textbooks in classes they teach. The COI is a financial one, because in choosing one’s own textbook, the prof receives royalties on the sale of the book. In the context of large Intro classes with hundreds of students, the royalties (e.g., 3-5% per text, on a $100 book, for a few hundred students) could be in the order of thousands of dollars. The concern then is that this not insubstantial interest could bias the judgment and choice of text for the class. There’s also the indirect interest of having students read the prof’s own textbook (good for the ego!), and the fact that this may stymie freedom on the part of students to critique or critically engage with the text, undermining another important element of the university learning environment. So the challenge, like with many COI, is twofold. 1) Determine the extent and magnitude of harm, and 2) Decide what to do about the situation.

1. Potential Harm: bias in choice of text (maybe not the best), loss of critical judgment on the part of the class. Clearly this will vary based on factors such as the size of class (a large Intro class vs a small advanced undergrad or grad class), and also maybe the subject – we can imagine that in some areas there simply aren’t many texts to choose from, or the contrary, that there’s so much choice that one text is as good as another. In both cases, this factors may reduce our perception that there’s a real bias at play.
2. What to do? Eliminating such COI by banning a prof’s right to choose their own teaching material seems like an extreme measure, and also an undue restriction on academic freedom. After all, if I’m hired to teach a course, surely there should at least be the presumption of confidence in my ability to choose appropriate material. And an extreme measure such as prohibition also undermines the possible positive impact of disclosure of the COI to the class, debate about the issue (a great learning opportunity!), and the development of innovative solutions to separate the interest such as deciding (together with the class) that royalties from sales of the text will go to fund research, for extra resources or opportunities for the class (a trip, a party, etc.), or to a charity.

This story brings to our attention the fact that COI can occur outside the bioscience lab, in the classroom, and thus should also be a concern for scholars in the humanities and social sciences. It also leads us to think about appropriate responses to COI, and in particular, question the scope and magnitude of harms and possible appropriate (and innovative) mechanisms to deal with the conflict.

Thanks to Chris MacDonald of the BusinessEthicsBlog for discussions on this subject and thinking through possible responses…

Bryn Williams-Jones

I’ve decided to open the blog for comments to see if this stimulates discussion (and ideas for me to blog about!). I’ll see how this works for a few weeks, and whether the comments are inundated by Spam…

Bryn

Bryn Williams-Jones

After a well needed two week break for the Xmas holidays (the Fall academic semester is always a killer!), I’m back into teaching prep (running 2 grad courses this term) and so am just now catching up on COI news. Here’re a few stories that caught my interest:

1) Journal editor gets royalties as articles favor devices (Dec. 24)

• This story continues with the ongoing debate about publishing and COI, but sheds light on a little examined area – that is COI encountered by journal editors. The gist of the issue that lots of focus has gone into building disclosure mechanisms for authors and reviewers, but very little to address issues associated with the editors, the ultimate arbiter of journal content and quality.
• See also this analysis by Nancy Walton at the Research Ethics Blog

2) Harvard Teaching Hospitals Cap Outside Pay (Jan 2)

• Two Harvard affiliated hospitals have implemented policies to limit the amount of pay for outside consulting on the part of senior administrators. “Senior officials…must limit their pay for serving as outside directors to what the policy calls “a level befitting an academic role” — no more than $5,000 a day for actual work for the board. Some had been receiving more than $200,000 a year. Also, they may no longer accept stock.”
• The issue here is ensuring that senior managers are 1) not being influenced by outside consulting (e.g., from pharma, medical device manufacturers) in their strategic planning, purchasing choices, etc., and 2) actually spending sufficient time in their primary job as administrators (which are already well paid): also called “conflict of commitment”. But one has to wonder if hospital officials should “ever” be on corporate boards? Even if they’re not doing much work or are only being moderately recompensed, isn’t the apparent COI sufficiently worrisome as to threaten the trust on the part of hospital staff and patients? (P.S. Feb 20: Partners’ Conflict of Interest Policy’s Reach Concerns Docs)

3) University of Michigan Medical School’s conflict of interest policies will likely improve in 2010 (Jan 4)

• There’s been a lot of coverage of Michigan’s COI policy development over the last year. Its good to see here that they’re moving the discussion outside the policy making environment of senior administrators, into the hallways and getting faculty, staff and students involved. Also good to note that, from the associate-dean, “I think most places have policies in place to deal with research and that’s in part driven by the fact that (National Institutes of Health) and others expect that,” Hutchinson said. “I think the conflict of interest piece with respect to clinical care and educational activities (in the health care realm) is less well developed, but places are rolling out policies like Stanford and (Washington University) and St. Louis, and we’re coming up with ours.” [Its worth reading the whole interview]

4) Faculty group urges UW provost to quit Nike board (Jan 5)

• Continuing with the thread of academic administrators and corporate involvement (see also my Dec blog post about Canadian funding agencies), this story about the Provost of the University of Washington joining the Nike corporate board raises issues about the responsibility and reputation of senior administrators.
• Beyond the issue of financial COI linked to personal remuneration (the Provost stands to add another $100-200K to her $500K university salary), the situation is further muddied by the fact that the “UW athletic department in 2008 signed an exclusive 10-year contract with Nike, worth at least $35 million to the university” and that Nike’s been the subject of a number of very public allegations about systemic poor labour standards (sweat-shops and such in early 2000; although maybe this situation has turned around). So there is a real concern on the part of faculty that the Provost’s appoint to the Nike corporate board could have “a “chilling effect” on future research about labor violations that implicates Nike, and that it isn’t in the best interests of the UW for top administrators to “offer up knowledge about the institution” to corporations — especially when the administrator stands to personally benefit.” — a serious institutional COI.

Bryn Williams-Jones