Conflicts of interest and drug information
Conflicts of interest in healthcare are nowhere more relevant than in
the drug information available to regulators, prescribers, and consumers.
Because of the financial implications of licensing and prescribing, such
information is often contested, as are government policies regarding
direct to consumer advertising (1). In this light, it is easy to see why
commercial pressures driving publication will tend to bias available
information, thereby threatening evidence-based practice, prescribing
quality and cost-effectiveness. Ghost-written industry sponsored trials
may thus conclude that treatments are "safe and effective" when the data
indicate otherwise (2).
Promoting access to unbiased, expert drug information has been the
mission of the International Society of Drug Bulletins (ISDB,
www.isdbweb.org) since its inception in 1986. Because they refuse
pharmaceutical industry money, member bulletins typically run on tight
budgets. Like the FDA and BMJ, ISDB bulletins also must reckon and manage
authors' and reviewers' potential conflicts of interest. In a current
survey, 28 responding bulletins endorse the importance of disclosure, but
vary in how conflicts, once declared or detected, are dealt with. The most
stringent policy, endorsed by 4 bulletins, is to consider work only from
authors known to lack conflicts.
The debate about whether journals should avoid versus manage
conflicts of interest (3) has been advanced by evidence that disclosure
alone fails to reduce bias reliably and, in some situations, may aggravate
it (4). Disclosure, though imperfect, is still essential, as is peer
review to gauge the relevance of conflicts in particular cases. It is
clear from the debate that we are better at judging the impact of others'
conflicts than our own.
1. Mintzes B. Is patient information on prescribed drugs just another
form of advertising? BMJ 2011;343:d4899.
2. Lacasse JR, Leo J. Ghostwriting at elite academic medical centers in
the United States. PLoS Med 2010;7:e1000230.
3. Lexchin J, O'Donovan O. Prohibiting or 'managing' conflict of interest?
A review of policies and procedures in three European drug regulation
agencies. Soc Sci Med 2010;70:643-7.
4. Cain DM, Detsky AS. Everyone's a little bit biased (even physicians).
Competing interests: Member of Healthy Skepticism; convenor of ISDB working party on conflicts of interest