Conflicts of interest

In the 21st century the majority of medical/scientific journals require their authors to provide conflict of interest statements with their manuscripts. The reasons for this are obvious, particularly for outcome studies where new pharmaceuticals, procedures, or medical devices are the focus of the investigators’ scientific interest.

I think we would all have some reliability-of-data misgivings if it became known post-publication that the principal investigator and author of an extremely positive paper was the majority stockholder of the company producing the product under investigation. We certainly see this with some of the new non-mainstream medical treatments, particularly those that use medical devices originating from non-North American sources and where all the published studies (generally, poorly designed studies, using post-treatment questionnaires) have been authored by the owner of the device or by the individuals who own the distribution rights to the device in North America. Personally, I have no faith in the reported results of these treatments/devices, and will continue to disregard them until properly designed studies are conducted and reported in mainstream journals by non-conflicted investigators. I suspect that I will be waiting a long time.

A recent article in the CMAJ recommended that editors and members of editorial boards also provide conflict of interest statements, and I suppose they are suggesting this should be provided with every article reviewed and by every reviewer. I am having some difficulty coming to terms with the reasoning behind this recommendation. Other than reassuring authors that their reviewers are not being paid huge retainers by a competing pharmaceutical conglomerate I continue to struggle with the need to appear to be free from any possible encumbrances to a proper peer review. After doing this kind of work for more than 20 years I can think of no instance where there was a suggestion that a reviewer would provide anything but a proper, critical review of a manuscript irrespective of some connection to the individual or corporation who owned or who was studying the object, substance, or device being reported.

However, as being visually politically correct is de rigueur in medical/scientific circles these days, the BCMJ is in the process of developing commonsense editorial board conflict of interest processes.

Every one of us is in conflict of interest virtually every day of our professional lives. For instance, every time surgeons recommend a surgical intervention to a patient they should refer the patient to another surgeon in order for the recommendation to be free of conflict of interest. Every time I refer a patient for a medical or surgical opinion I do so based on a decision equation with a large bias component. As a result, the recommendation, more often than not, is based on personal preferences and may or may not be in that particular patient’s best interest. In order to be free of a conflict of interest I should provide the patient with a list of the professionals providing that particular service complete with their record of clinical successes and failures, College censures (if any), and years of experience. The same applies in many instances to my choice of quinolones, ACE inhibitors, calcium channel blockers, non-steroidal anti-inflammatories, and so on.

Obviously, all of this is nonsensical in the extreme and in the overwhelming majority of instances our patients are well served by our professional decisions. In the same breath, in my opinion the whole conflict of interest statement for most authors and for most editorial board members is unnecessary, lacks common sense, and in the end is not terribly collegial.

There, I feel so much better now that I’ve had a good rant.

—JAW