Don’t Show Me The Money" Non-Financial Conflicts of Interest
Don’t Show Me The Money* Non-Financial Conflicts of Interest CHEST 2012 Atlanta, Georgia Ivan Oransky, MD Executive Editor, Reuters Health Clinical Assistant Professor of Medicine, New York University Co-Founder, Retraction Watch*With apologies to Jerry Maguire and 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 researchersdon’t do what they do primarily to increase theirmaterial wealth. If making money was their primarygoal, they could choose more effective ways of doingso.”
The Hidden Problem “The motivations that underlie most decisions in medicine are not financial.Rather they range from an interest in patient care orresearch or public welfare, to a commitment to certainideas, principles or values and the desire for personaladvancement 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 professionaljudgment. Much as wed like to believe that the reportingand evaluation of research are always objective, there issubstantial 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, religiousbeliefs, and political or ideological views are often the fuelsfor [passions and careers], private competing interests areperhaps 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 “Policies regarding retraction announcements vary widely among journals, and some, such as the Journal of Biological Chemistry, routinely decline to provide any explanationfor retraction. These factors have contributed to thesystematic underestimation of the role of misconductand the overestimation of the role of error in retractions(3, 4), and speak to the need for uniform standardsregarding retraction notices (5).” -- Fang F et al. PNAS 2012.
ProtectionismHow to manage:Embrace transparency (e.g., detailed retraction notices)
Conflicts between Roles Patient Care vs. Clinical ResearchHow to manage:Separation of staff
Religious and Political BeliefsAbortionStem cellsEnd-of-life careHow to manage:Tricky!
Positive Publication Bias• Inherent human optimism• Need to publish quantity for tenure, grantsHow 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 betterunderstanding of their extent and impact. Anyassumption that non-financial competing interests areless common or influential than financial incentives isprobably misguided.”
Messy and Imprecise – But Worth It “Its 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 commitmentsoften lead to strong personal views. When it comes tomaking sense of non-financial competing interests, whyshouldnt we be interested?”
Contact Info/Acknowledgements firstname.lastname@example.org Twitter: @ivanoransky Thanks to Nancy Lapid