Dianthus Medical Blog Archive

Conflicts of interest

We are no strangers to conflicts of interest in the world of medical writing. The best known case of this is when a pharmaceutical company has paid someone to write an article about one of their own drugs. The conflict of interest here is obvious. Because it is so obvious, however, journal editors are very well aware of the potential for bias in this situation, so such conflicts of interests are, in the main, transparent and well managed. That doesn't mean that some egregiously biased articles don't sometimes slip through the net, of course, but in my experience that doesn't happen often.

But direct financial interests are not the only conflicts of interest. Other things can cause a conflict of interest, and in my opinion, that is a more serious problem, because the more subtle nature of the conflicts may allow them to act unchecked.

I was thinking about this last night after my research ethics committee meeting. As I've stated previously, the quality of applications for this meeting was pretty atrocious. I frequently found myself disagreeing with most of the rest of the committee about what we should do about this. My reaction, when faced with a poorly designed and scientifically worthless piece of research, is not to approve it. Even if the physical risks to participants are negligible, I still think it is dishonest, and therefore unethical, to ask patients to take part in a research study and give the impression that the research might benefit future patients when in fact the research is so flawed it will never benefit anyone. That pretty much put me in a minority of one on my committee.

So this got me thinking: why do I so frequently disagree with the rest of the committee? My conclusion was that it was probably something to do with the different environments in which we work and some rather subtle conflicts of interest.

Let me give a specific example. One of the studies we reviewed (one of the few that actually had some scientific merit, as it happens) planned to study children aged 6-16 years. The researchers had an information sheet for 6-10 year old participants. It was written in quite unnecessarily technical language, and I doubt that many 10 year olds would have understood it. A 6 year old wouldn't have stood a chance. I argued that this was unethical and that the researchers needed to go away and write a proper age-appropriate information sheet. The rest of the committee argued that it was difficult to write for 6 year olds and that this would pose an unreasonable burden on the researchers.

A similar situation arises with alarming regularity, namely researchers who have not sought statistical advice. This frequently leads to poorly designed studies and analysis methods that are doomed to failure. If I had my way, such researchers would be required to consult a statistician before we would approve their applications. The rest of the committee tend to take a much more relaxed attitude.

What does this have to do with conflicts of interest? Well, most of the rest of the committee are medics. They sympathise with the medics who want to run the study, because they all come from the same world. Doubtless some of the members of the committee consider some of the applicants their friends. That is a subtle conflict of interest. Similarly, I come from the world of professional clinical researchers. I would not gain personally if the researchers on my committee were to seek professional help with their applications (given that it would be completely inappropriate to offer the services of Dianthus Medical to the applicants to my committee), but there are people out there who provide the sort of services that many of the researchers clearly need, such as writing information sheets for 6 year olds and of course providing statistical advice, and there are many such people whom I would consider my friends. By suggesting that more effort be put into such things, I believe that I'm only asking that research be done to appropriate professional standards, but it's also true that I would be putting valuable business in the direction of my friends. That's a conflict of interest. Similarly, no doubt the other members of the committee genuinely believe that they are helping research to take place without putting unnecessary burdens in the way of researchers, but of course they are also helping out their friends.

Who is right? I'd love to know what you think via the comments form below.

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