The issue about COI and policy recommendations in favour of stockpiling Tamiflu to protect against a potential flu pandemic has been in the news in Canada recently, following an investigative report by the CBC (CBC Tamiflu probe sparks drug policy review) and French language RDI (Le Tamiflu au coeur d’une polémique). In April I did a presentation on this case (online video) at the Institut de recherche en santé publique de l’Université de Montréal; the following write-up (Les conflits d’intérêts exigent la transparence, in French) summarises the key points of my presentation. My main message was that in a situation where public health agencies are making policy decisions that impact the general public, they need to work towards the highest levels of transparency and accountability, and should avoid even the perception of COI. This is a situation that, like the judiciary, cannot permit even a hint of COI, because the risk for undermining public trust and confidence (and the serious negative consequences of this, i.e., refusal to participate in public health prevention campaigns) is simply too great.
Nancy Walton at the Research Ethics Blog has a nice analysis of the issues of COI in research and the implications for public health policy making (Disclosing Conflicts of Interest: The Case of Tamifl).
It looks like the WHO is again (after the H1N1 situation) facing COI allegations with regards to industry involvement in its expert advisory panels. This time, there is Concern as Novartis exec approved to WHO group. Paul Herrling, the Swiss head of corporate research at Novartis, has been named to a WHO expert group that will evaluate funding applications for projects into neglected tropical diseases. Not only is “the only expert in the group who is also an executive in the drugs industry“, but he is also “the author of a proposal to the same working group for a new funding model that would allocate $10 billion (SFr9.42 billion) in grants to fund research by pharmaceutical firms as well as public research institutes and public private partnerships”. Even if the WHO can put in place effective mechanisms to manage these COI, the optics are still terrible!
With disclosure becoming the key mechanism promoted to manage COI in academic — and especially biomedical — conferences and other educational events, its interesting to see that there is still enormous work to do so that academics and clinicians even understand what and when to disclose. As the following story reports “Conflict of Interest Reporting Varies Among Spine Meetings”
There is a lack of uniformity among disclosure policies of various medical associations, and confusion regarding what relationships need acknowledgement results in variability in the reporting of financial conflicts of interest in clinical research, according to research published in the January issue of The Spine Journal [full text of the study]
In a very interesting development, the Office of the Inspector General of the US Department of Health and Human Services recently released a report (summary and complete report) that found that while there have been important improvements in the development of policies to manage individual researcher COI, there are real problems with the management of institutional COI. [See also Report prods NIH to address institutional conflicts of interest]
The OIG argues that the
NIH should require grantee institutions to identify, report, and address institutional conflicts in a consistent and uniform manner. It is important that NIH know of the existence of such conflicts so it can ensure that the related research is free from any intended or unintended bias. Therefore, we recommend that NIH promulgate regulations that address institutional financial conflicts of interest.
The January edition (11/1) of the American Journal of Bioethics (AJOB) has an excellent article by Howard Brody – Clarifying Conflict of Interest – which stimulated a flurry of interesting peer commentaries. My editorial/commentary in this issue, entitled Beyond a Pejorative Understanding of Conflict of Interest, makes the argument (to which readers of this blog will be familiar), that one of the major problems with COI is that there is still a widely held view that COI = financial fraud. A result of this pejorative or negative connotation is that the term loses much of its utility, in practice. So in line with Howard Brody, I argue that we in the academic community need to do a much better job of clarifying the concept, and in particular, that we move beyond a focus on financial COI to deal with the range of other personal interests at stake, in order to better manage COI when they cannot be avoided.
[Unfortunately these articles aren't open access].