This morning’s post is a bit of a jumble of ideas, coming from reflections on a range of stories that I’ve been reading over the last few weeks, but which I haven’t yet had time to write about in more detail.
Payment for service
Health reform in the US has been the source of a lot of popular press about COI in recent weeks, in part turning on the story of the AARP lobby group (Conflict Of Interest For AARP In Health Bill Debate?). But see also this article in the NY Times (Maybe a New Day for Doctors’ Pay) about a more fundamental issue, and one that’s also common in countries — such as Canada — that have universal health insurance, but where MDs are paid on a fee-for-services basis.
Disclosure as remedy
Disclosure of COI to scientific journals, a voluntary act, is maybe too permissive (Physicians’ disclosures to UW, journals inconsistent). Journals do not have in hand any mechanisms to actually verify that contributing authors are being truthful in their declarations. But what are the alternatives, to not trust academics at all? See also: Medical Journal Conflict of Interest Disclosure and Other Issues
The use of disclosure requirements in institutional policies (e.g., at Universities, medical schools) is a common mechanism for preventing or managing COI (U panel proposes conflict-of-interest policy). The problem is that, like with scientific journals, these are voluntary disclosures and thus subject to manipulation, being ignored, etc. More problematic, in my mind though, is the fact that most academics probably have little idea of what actually constitutes a COI, and many disclosure forms do not help matters, being vague, punctual (once a year?), and with little in the way of education or other resources to encourage ethical behaviour.
Drug development
With the global press coverage of the H1N1 “pandemic” and concerns about sufficient access to vaccines, there’s also been a fair amount of conspiracy theory-type critiques of Big Pharma for creating a market for its products. Now, while I think most conspiracy theories are based on misplaced fears (and an unrealistic belief in the power of large bureaucracies to actually keep secrets!), stories like the following should make us pause a moment: Conflicts of interest? Dr. Mehmet Oz owns 150,000 option shares in vaccine technology company.
Bryn Williams-Jones
Its the Thanksgiving long weekend in Canada, and I really should also be doing other work alongside getting out to enjoy some of the gorgeous Fall colours with my family. So here’s a quick list of interesting COI stories:
Bryn Williams-Jones
Here’s an interesting story that is particularly appropriate for this blog – FTC to bloggers: Fess up or pay up. The US Federal Trade Commission is requiring that independent bloggers disclose any interests (especially financial) that they might have in the stories they produce, particularly if this involves reviews or evaluations of products. As the story notes, the FTC is trying to deal with an issue that has long been a challenge in the media and public press. (See also: FTC Drops the Banhammer on Undisclosed Reviews | Infusionsoft Blog)
As a Canadian blogging about academic COI, this move by the FTC has no impact on my behaviour. But it does raise an interesting issue that is more generally of concern to academic presentations and publications, including the growing number of science blogs.
- Blogs are often completely independent from academic or other professional entities and so are essentially free from oversight like peer review.
- Its not clear whether academic blogs should be thought of as “merely” individual opinion, academic self-promotion, or more formal publication (e.g., like at a conference presentation).
- Nor is it very clear that there are (or even could be) widely shared norms about the ethics of blogging given the diversity of people that blog and the types of blogs that exist.
- Yet that doesn’t mean that certain blogging communities, such as academic bloggers, couldn’t try to create locally relevant and accepted norms – its what we academics have done with peer review, debates about declaring COI in publications, grant reviews, etc.
So in the name of transparency:
- this blog is hosted on a private web server, paid for out of my pocket, and my solely responsibility;
- I receive no income from this blog, and if I do I review a product (e.g., a book), I’ll be transparent about whether I received a free copy of the book;
- the blog is a front page (and thus publicity) for my ongoing research programme on COI that recently received grant funding from the Quebec (FQRSC) and Canadian (CIHR) funding councils.
Bryn Williams-Jones
The University of Wisconsin appears to have made a rather bizarre distinction in their new COI rules. As the following story notes (Speaking fee ban riles UW doctors), the COI rules allow
orthopedic surgeons and other doctors who implant devices to earn large sums of money making presentations for medical device companies. The new policy would keep in place a ban on UW doctors giving talks about medications for drug companies.
And,
If implemented, the policy essentially would create two classes of doctors, those who can’t supplement their income speaking for drug companies and those who can, making presentations for device companies.
But why favour medical devices (and by extension their manufacturers) over drugs (and drug companies)? You would think that the issue of COI relating to physicians working as promotional speakers (and opinion leaders) for medical technologies would be a serious concern, regardless of what type of company or technology was involved. MDs consulting with the Drug Industry has received much attention in recent years (see the AMSA PharmaFree ranking that I blogged on in July); my concern, though, is that too much attention in COI policies on Big Pharma as the Bad Guys marginalises other type of industrial sectors, and non-financial COIs more generally.
Bryn Williams-Jones
In early August – while I was on vacation, thus my slow return to blog posting – my friend Chris MacDonald at the BusinessEthicsBlog posted the following blog entry about Wyeth, ‘Ghost-Writing’ and Conflict of Interest.
Briefly, ghost-writing is when scientific articles (usually about the results of clinical trials) are written by technical writers (often working for the pharmaceutical industry) and then “authored” by an academic scientist who is paid to have their name put on a paper they didn’t write. This type of misleading authorship raises huge concerns about the validity of scientific studies being reported in the academic press, and has been subject to much critique in the scientific community. Not only does it undermine the credibility of the scientists involved when such false authorship is discovered (careers can be destroyed), it raises questions about the confidence that other scientists, and the general public, should have in the academic publication process.
There’s a Canadian (and Montreal) angle to the story about the pharmaceutical company Wyeth using ghost-writers and paying scientists for publications, specifically regarding a researcher at McGill University who admitted to being paid to put her name to an article she did not write:
Bryn Williams-Jones