Intended for healthcare professionals

Rapid response to:

Editor's Choice

Turning the tide on conflicts of interest

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d5147 (Published 10 August 2011) Cite this as: BMJ 2011;343:d5147

Rapid Response:

Subjective editorials and clinical reviews require proof of objectivity

I would suggest first that the term "industry ties" needs to be
clarified. I, for example, am getting consulting income from a small
pharmaceutical firm that is trying to market an imaging device. That is
not a competing interest or an industry tie if I am writing about statins.
The relevant questions should be:

1. Does this editorial or clinical review advocate or discourage the
use of a commercial product?

2. If so, does the author have a financial tie to a company that
sells this commercial product or sells a competing commercial product.

If the answer to both questions is yes, then the tie needs to be
disclosed. If the research is mostly objective, such as a randomized
clinical trial or a systematic review, and if the process is documented in
enough detail to allow independent replication, then declaration of the
conflict of interest is all that is needed.

If, however, the work is largely subjective in nature, as an
editorial or clinical review must be, then a financial tie to the
commercial product or a competing product should be an automatic
disqualification. There is no way that an outside party could replicate
the thought processes that goes into writing an editorial or clinical
review. That process is not transparent and individual steps in that
process are not open to critical commentary or suggestions for alternative
approaches. Therefore, editorials and clinical reviews must be held to a
higher standard.

Financial ties may be defined as holding patent rights or receiving
royalties, owning stock in the company (other than through a mutual fund
where investment decisions are not made by the author), or receiving
consulting income or speaker fees in the past five years. There may be
other examples, but the key thing is that the tie must involve the
exchange of money.

Note that others have raised the prospect of non-financial conflicts
of interest. This is a dangerous extension of this concept. There is the
unproven assertion, for example, that recipients of research grants have a
bias towards exaggerating the extent of the problem that they study in
order to increase their chances of getting further funding. This is
dangerous because it subtly implies that a plausible but unproven source
of bias is equivalent to a proven and widely documented source of bias.

I suspect that some people who have commercial ties are encouraging
the extension to non-financial conflicts so as to make it appear that
everyone is biased, therefore no one should be banned from writing
editorials and clinical reviews.

Note for example, Marlies van Lent's comment that an expert's "chosen
independence may also be based on preconceived negative feelings on the
industry, leading to an overall pessimistic appraisal of their products."
As a statistical consultant, I am greatly disappointed that Merck has not
had the wisdom to hire me for statistical advice. Therefore, the logic
goes, I am predisposed to criticize any Merck product.

What rubbish! If those of us with financial ties to a company are
able to convince BMJ that it is the people WITHOUT such ties who have a
biased perspective, then the whole process of identifying conflicts of
interest becomes worthless.

If you define industry ties carefully, then I would say that yes,
let's ban editorials and clinical reviews written by those with industry
ties.

Steve Simon, www.pmean.com

Competing interests: Dr. Simon has received consulting income from several pharmaceutical firms.

14 August 2011
Stephen D. Simon
Independent Statistical Consultant
P.Mean Consulting