Conflict-of-Interest.net

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.

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.

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:

• Closer ties emerge in HRT scandal – Toronto Star
• Recherche médicale: la belle affaire! – Le Devoir
• Taking their medicine – Montreal Gazette
• Prevalence of ghostwriting spurs calls for transparency – Canadian Medical Association Journal

Here’s a great overview (by Vivian Cheng at Science Progress) of the problems posed by, and challenges in resolving, financial COIs in biomedical research: Financial Conflicts of Interest 101.

The American Medical Student Association has a Scorecard ranking of American Medical School COI policies (AMSA PharmaFree), with an explicit focus on the involvement of the pharmaceutical sector. See the following story for a detailed discussion of this ranking: Medical Students, Pew Find Improvement in Medical School Pharmaceutical Conflict-of-Interest Policies, But Many Lag

Over one-fifth of U.S. medical schools improved their conflict-of-interest rules in the past year, yet dozens of others lag behind according to the 2009 American Medical Student Association (AMSA) PharmFree Scorecard, released today. The Scorecard, developed by AMSA and the Pew Prescription Project, finds that 45 of 149 medical schools now receive a grade of A or B for their policies governing pharmaceutical industry interaction with medical school faculty and students, compared with only 29 last year. However, for the second year, dozens of schools received grades of D or F and remain far behind the national leaders…

This type of detailed analysis and ranking goes a long way to helping map out the terrain of COI policies in institutions. It also provides the data necessary for researchers and policy makers to think about how to develop better governance mechanism. My one critique would be that in focusing almost exclusively on “Big Pharma” and financial relations with medical schools, critics and policy makers may ignore or downplay other non-financial interests, or relations with other actors that can still contribute to important COI.