Are conflicts of interest a big deal?
Although many of us, definitely including myself, think that conflicts of interest are a serious issue in medical and academic medical practice, a recent series of
puff-pieces editorials in the previously prestigious New England Journal of Medicine (from now on it will be the PPNEJM) proposed that physicians earning huge income from pharmaceutical companies was really not such a big deal after all.
pathetic, clearly conflicted, nonsensical editorials in the PPNEJM invented new terms to denigrate those of us who want clarity, transparency and accountability (“pharma-scolds” was one). However, I guess, as someone who wants medical practice to be evidence-based, I should also want CoI responses to be evidence-based. Fortunately that is possible, as a new post in the BMJ blogs , by a lawyer and bioethicist points out
So what is surprising to me in my experience teaching ethics & COIs is how frequently people who (correctly) insist on the significance of following rigorous evidence in terms of clinical practice seem to offer opinions on the effects of COIs that IMO do not sufficiently reflect what the best evidence on motivated bias actually shows.
…the literature shows that relationships between commercial industry and physicians or scientists are extremely likely to influence physician/scientist behavior in a variety of ways. The claim that various barriers to such influence—i.e. individual virtue, institutional management, disclosure—are sufficient to prevent such influence is simply not an evidence based view.
Daniel Goldberg, the blogger concerned, presents a CoI Bingo card, which includes most of the excuses and responses to questions about CoI that are commonly heard.
He also has a blog, which is worth visiting, he has a lot of insights into the evidence regarding cognitive bias, and in particular on “motivated bias”. Evidence that was completely ignored in the PPNEJM editorials that I referred to earlier.
One quote from Professor Goldberg
It is not evidence-based to claim that these kinds of entanglements do not have an influence on our behavior. They do. We know that they do. Across a population of actors subjected to these entanglements, a significant percentage of them will modify their behavior in ways favorable to the commercial entity.
His post on the influence of Coca-Cola on professional recommendations and position statements about sugary drinks is a classic.
Indeed he has a whole series on the issue. One point that he makes repeatedly, and which I wholeheartedly endorse, is that simply revealing conflicts of interest is not enough. Transparency about connections with industry, or other financial conflicts is the absolute minimum that we should expect. Reducing conflicts and their undeniable influence on decision-making and policy also needs to be a priority.