A recent editorial in the Journal of Psychiatry and Neuroscience examined Conflicts of interest (COIs). The article titled, “Bias in the research literature and conflict of interest: an issue for publishers, editors, reviewers and authors, and it is not just about the money,” mentions how some of the recent investigations of congress and psychiatric researchers have been investigated for the amounts of money they received from drug companies and the amounts they mention in COI disclosures.
The editorial however, feels that congress is forgetting about non-monetary conflicts that are just as influential.
Instead of spending most of their criticizing such monetary payments, Simon N. Young, PhD, frames his editorial by noting that although most “COI concerns drug company payments to researchers,” there are non-monetary conflicts that can play just as critical of a role. Dr. Young explains that “conflicts of interest exist in every aspect of the production of research journals, and the conflicts derive from more than just money paid to researchers by drug companies.” As a result, his editorial attempts to use human behavior research to explain COIs as they relate to non-monetary issues.
COI: Where’s the Money?
Dr. Young claims that “a COI occurs when individuals’ personal interests are in conflict with their professional obligations,” such as when someone will profit personally from decisions made in his or her professional role.” He makes the distinction however, that the gain or profit does not necessarily have to be monetary; “it could be progress toward the personal goals of the individual or organization.” Dr. Young thinks that while money can pose as a conflict for researchers, “the success of a journal for a publisher or editor or the acceptance of ideas for a researcher” is just as influencing.
This skepticism leads him to believe that “the idea that scientists are objective seekers of truth is a pleasing fiction.” If this were true, why would doctors be providing work across borders or providing their time for free at health clinics? Why would physicians invest their own money in research and development of new treatments or hospitals, when the risks are so high? Simple: because there is no need to be objective when the majority of scientists only want to help people and advance science.
Still, Dr. Young uses behavioral research to assert that “the automatic nature of self-interest influences judgment and makes it difficult for people to understand its influence on their judgment.” While it may be difficult for people to understand what influences their judgments, a physician or scientist who replaces a heart valve or implants a pace maker is not deciding to operate for the profits, rather, they are doing it to save a life.
Dr. Young also believes that researchers’ biases can be caused by “preference for their own ideas when they present their own work and when they are involved in any aspect of peer review.” How else can we get people with experience in practice area? He associates this idea with the notion that opinions can be “biased by the first information encountered on a topic.” Such a generalization is problematic because scientists and researchers are trained to question everything until the truth is proven. So regardless of “if the first information a physician or researcher learns about is from a drug or pharmaceutical company developing that drug,” scientists are going to use their training, intelligence and experience to weigh all information neutrally.
Disclosure
One of the strategies he discusses to combat potential COIs is disclosure. In agreement with Dr. Young, and as we have discussed many times, “most peer-reviewed journals require authors to make a COI statement that is often published with the article,” and “many journals adhere to the statement of the International Committee of Medical Journal Editors.” Dr. Young feels that readers who see disclosure statements will “be more skeptical about any claims made in the article.” Although he cited a study, which found that articles that mentioned COI to be “less interesting and important … the results had limitations.”
For example, “in some circumstances disclosure may result in the recipient of the biased information placing greater weight on the biased information.” In other words, when a COI is disclosed, readers will put more emphasis on determining the neutrality of statements made regarding the nature of that COI. Dr. Young discusses the roles of journal editors and managing COIs—both monetary and non-monetary—in more depth throughout the editorial. He even dedicates a section regarding the costs of publishing journals and the use of drug advertising.
Dr. Young attempted to discredit such business practices by citing a study, which found that “some advertisements made claims that were not well supported by evidence.” Doctors who read these journals can make such determinations based on their own training and experience. He also thinks advertising can be an issue of conflict because the ads “sometimes focus on the newest, most expensive drugs that may not be superior to cheaper alternatives.” Besides forgetting freedom of speech and the press, who a medical journal accepts funding from for advertising should play no role in conflicts for the articles that appear, as long as all other rules are followed.
Dr. Young also discussed studies, which found that “financial ties between industry and academia influence biomedical research in important ways.” Although he may have been referring to the potential for bias, we know that such ties create better treatments and medicine for patients that reach physicians sooner, and are safer. Dr. Young believes these payments are a problem because its “unrealistic to think that researchers might mention the exact amount of payments when declaring COIs.” As recently as this week, numerous drug companies are reporting such payment amounts in order to avoid such gaps in disclosure.
Conclusion
Since Dr. Young asserts that “there is no entirely satisfactory way of dealing with COIs,” it is evident that “better training and mentoring of scientists concerning COIs and bias” is needed before more extreme regulations or policies are enacted that could stigmatize industry-academic collaboration. Especially considering the fact that “exactly what constitutes a financial COI can be complex.”
While the investigations of Congress may have brought to light a few mistakes, despite these incidents “research continues to advance.” In order to keep advancing such breakthroughs, scientists should not be discouraged from working with industry, but they should be reminded about the careful balance they need to maintain.