(Being updated)

Steve Simon

1999-01-01

This page is being updated from a version on the original website.

BMJ published a commentary on conflict of interest policies that ended with the question “should the BMJ … ban editorials and clinical reviews from authors with ties to industry?” Here’s my response to that question, which you can also find on this site, with a bit of digging.

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 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 Pfizer has not had the wisdom to hire me for statistical advice. Therefore, the logic goes, I am predisposed to criticize any Pfizer 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.

I mentioned the following in the section on competing interests: Dr. Simon has received consulting income from several pharmaceutical firms.

You can find an earlier version of this page on my original website.