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Editor's Choice

Let’s talk about sex, and relations with industry

BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l2093 (Published 09 May 2019) Cite this as: BMJ 2019;365:l2093

Re: Let’s talk about sex, and relations with industry

The vast majority of life-changing medical advances are the product of highly effective collaborations between researchers, clinicians and industry. It is therefore important that issues of conflict of interest, relations with industry and financial competing interests are resolved in a way that researchers and clinicians can continue to apply their skills in research and innovation in both academic and industry environments. Moreover, it is critically important that stakeholders are not drawn into a dispute that repeats the mistakes of the 40 year old conflict involving the World Health Organisation (WHO), breastfeeding activist groups and the infant food industry (1), where the key stakeholders are now so entrenched that that they will not even meet in the same room (2), and this behaviour continues despite WHO data reporting that globally 45% of child deaths under the age of 5 years are nutrition-related (3), and there are 150 million children damaged by stunting (4).

Unfortunately it appears that the BMJ is already digging a trench with their decision not to accept clinical editorials and education articles from authors that have relevant financial ties with industry (5), and for, example this presumably would exclude a scientist who was involved in the development of a vaccine against Ebola virus and during this critically important development held a contract with a pharmaceutical company. There are already many steps that authors must take to achieve an acceptance of their submitted manuscript, and if these are all met, and the BMJ then rejects the paper solely on the grounds that an author has / had links with industry, this should be considered as professional discrimination. It is not surprising that the BMJ is the only major journal so far to adopt this policy.

Moreover, it is concerning that the BMJ is now commissioning articles from authors who are known to favour the BMJ position on the issue of relations with industry, and these articles are journalistic, not peer reviewed, the authors do not declare a conflict of interest and the articles are specifically promoted by the Editor (6,7). This undoubtedly creates an element of bias, and the approach is clearly a departure from the standards required for scientific and educational submissions.

Before this dispute becomes self-destructive, lessons need to be learned from the ongoing infant feeding conflict and these include the importance of encouraging collective dialogue, discouraging unilateral action, managing self-interest, balancing idealism with realism, recognising the wisdom of compromise, and preventing collateral damage on other stakeholders, including patients (1,8). Most importantly there needs to be effective leadership that enables partnership working to be conducted in a climate of trust and respect, allows transparent and rational analysis of the evidence, and achieves a resolution that includes appropriate regulations and safeguards for researchers and clinicians in order that they can safely apply their professional skills and knowledge in different environments without reputational or personal damage.

References
1. Forsyth JS: International code of marketing of breast-milk substitutes -- three decades later time for hostilities to be replaced by effective national and international governance. Arch Dis Child 2010;95:769-70.
2. Evans A: Food for Thought. An independent assessment of the International Code of Marketing of Breast-milk Substitutes. Breastfeeding Innovation Team. 2018
3. World Health Organisation. Children: Reducing mortality. https://www.who.int/news-room/fact-sheets/detail/children-reducing-morta...
4. World Health Assembly. Global Nutrition Targets 2025: Stunting Policy Brief. https://www.who.int/nutrition/topics/globaltargets_stunting_policybrief.pdf
5. Godlee F. Medical journals and industry ties. BMJ 2014;349:g7197.
6. van Tulleken C. Overdiagnosis and industry influence: how cow’s milk protein allergy is extending the reach of infant formula manufacturers. BMJ 2018;363:k5056
7. Detsky A, Booth CM. From the $80 hamburger to managing conflicts of interest with the pharmaceutical industry. BMJ 2019;365:l1939.
8. Forsyth S. Should the World Health Organization relax Its policy of non-cooperation with the infant food industry? Ann Nutr Metab. 2018;73:160-162.

Competing interests: I have received research grants from government, charitable organisations, and industry; and consultancy fees and honoraria from government and industry, including companies that produce infant formula. I currently receive consultancy fees from DSM Nutritional Products, an international ingredient supplier.

21 May 2019
Stewart Forsyth
Retired Medical Director and Consultant Paediatrician
Honorary Professor, University of Dundee
West Ferry, Dundee