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Tips for covering conflicts of interest


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My presentation at the SWINY-Hastings-CUNY Bioethics Bootcamp, 3/30/12

Published in: Health & Medicine, Business
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Tips for covering conflicts of interest

  1. 1. Conflicts of Interest: Research and Clinical EthicsSWINY-CUNY-Hastings Center Bioethics Bootcamp March 30, 2012 Ivan Oransky, MD Executive Editor, Reuters Health Co-Founder, Retraction Watch
  2. 2. Does Funding Influence Results?
  3. 3. Does Funding Influence Results?
  4. 4. Do Journals Have COIs?
  5. 5. Do Journals Have COIs?Publishers know that pharmaceutical companies willoften purchase thousands of dollars worth of reprints,and the profit margin on reprints is likely to be 70%An editor may thus face a frighteningly stark conflict ofinterest: publish a trial that will bring US$100 000 ofprofit or meet the end-of-year budget by firing an editor. -- former BMJ editor Richard Smith
  6. 6. Are Journal Policies Consistent?
  7. 7. COI Reporting Tips
  8. 8. COI Reporting Tips
  9. 9. COI Reporting Tips
  10. 10. COI Reporting Tips1. Find out just what “no conflicts” means. I have definitely been guilty oftaking at face value statements by authors that they “have no conflicts ofinterest,” especially when other authors on the same paper disclosevoluminous conflicts. Joelving actually followed up to see what was hidingbehind that phrase:…of the 50 most recent BJD reports from scientists at LOreal, Shiseido, Novartisand similar companies, 13 declared no conflict of interest. And thats notcounting one study that promoted a LOreal-Nestle product on shaky groundswithout disclosing that most of the authors were employed by the manufactureror had been paid by it. The BJD only corrected the problem ( a Reuters Health story ( pointed it out in July.
  11. 11. COI Reporting Tips2. Ask the author. Too few health writers do this. Joelving showed that it’ssimple and that it works. He wrote about an author, Dr. Fernand Labrie, whoholds patents for a hormone called DHEA and “owns companies dedicated tomarketing it for certain medical problems.” Has Labrie disclosed this? No.But when Reuters Health contacted him, he acknowledged that he owns thecompany that funded the research, EndoRecherche, and holds patents forDHEA, including one for anti-aging skin treatment. EndoCeutics, a daughtercompany of EndoRecherche, is currently involved in late-stage development andmarketing of DHEA for female sexual problems. According to a 2010 pressrelease, the company has signed a contract with pharmaceutical giant Bayer,which may net EndoCeutics up to $330 million (CAD) in addition to royaltiesfrom sales. Of three recent DHEA skin studies published by Labrie and hiscolleagues, none mentions this relationship.
  12. 12. COI Reporting Tips3. Give the science a stress test. Don’t just take a study’s word for it. Show thestudy to other experts and see what they think. Probe the study’s limitationsand weaknesses, especially when scientists with conflicts are involved.But the findings only looked at skin changes at a microscopic level, andwhatever visible effects the hormone might have -- and potential side effectswith long-term use -- are uncertain. In fact, one dermatologist who reviewed thestudy for Reuters Health said it shows DHEA also boosts skin molecules that mayslow wound healing. "I would ask if giving DHEA actually has a pro-aging effectand not an anti-aging effect," said Dr. Christos C. Zouboulis of Dessau MedicalCenter in Germany.
  13. 13. COI Reporting Tips4. Find the rebels. It’s easy to see the widespread funding of medical journalsof drug makers and device makers as a fact of life, but there are journals thatrefuse industry funding. Joelving provided examples throughout.Earlier this year, an Australian medical journal decided to pull the plug on drugads. "Essentially, our subscribers had to pay more for the journal," Dr. GeorgeJelinek, past editor of Emergency Medicine Australasia, told Reuters Health inan e-mail. "We believe that is perfectly reasonable," he added, "and farpreferable to having a dependence on drug company revenue, a dependencewhich ultimately requires some repayment."
  14. 14. COI Reporting Tips5. Cite when it’s right. Reporters are often discouraged by editors from citingother people’s work. We particularly liked the way the story gave due credit tothe Milwaukee Journal-Sentinel.One of the most egregious examples of financial double-dipping in the journalcommunity is Dr. Thomas Zdeblick, editor-in-chief of the Journal of SpinalDisorders & Techniques. Since taking the helm at the journal in 2002, Zdeblickhas made more than $20 million in patent royalties for spinal implants sold byMedtronic, according to a 2009 report in the Milwaukee Journal Sentinel. At thesame time, Zdeblicks journal published dozens of studies on Medtronicproducts, and they often were positive, the Journal Sentinel found.
  15. 15. It’s Not All About Money
  16. 16. Acknowledgements/Contact InfoThanks to Nancy Lapid, Reuters Health @ivanoransky (better)