I clicked on the highlighted text "with an open mind" and got this:Conflicts of interest don’t always involve money
ANDREAS LAUPACIS, MD AND KAREN BORN, MSC | EDUCATION | FEBRUARY 10, 2012
Conflicts of interest in medical research are extremely common – one recent study found that 52% of the experts involved in developing clinical practice guidelines for the management of diabetes in the United States and Canada had a financial conflict of interest. Although doctors and researchers often declare financial conflicts of interests when they make presentations and publish papers, there are many who argue that declaring financial conflicts is no longer enough, and that other conflicts, such an intellectual conflicts, may be more important to manage.
Typically, attention has been focused on easily identifiable financial conflicts of interest – most commonly when researchers receive funds from industry. But conflicts of interest are not just about money. According to Gordon Guyatt, a Professor in the Faculty of Medicine at McMaster University, “intellectual conflicts of interest are completely ubiquitous” and have generally been ignored.
Intellectual conflicts occur when clinicians or researchers may be too deeply embedded in their own area of expertise to objectively look at a research question “with an open mind”. Guyatt argues that “even when money is not involved … we [scientists] get very attached to our ideas.” This is compounded by university culture, which rewards researchers if their work is highly referenced by others and is perceived to be influential. This environment creates an incentive for those participating in guideline development to highlight their own research in clinical practice guidelines.
Arthur Slutsky, Vice President of Research at St. Michael’s Hospital in Toronto, believes fintellectual conflicts can be even stronger than financial ones. He argues “researchers are motivated by the opportunity to profile their work” and that the opportunity to “publish in a prestigious journal can influence decision making more than a payment from industry, unless the payments are substantial.”
The trouble is that while disclosure of financial conflicts of interest has become standard practice, few disclose their intellectual conflicts. This, however, may be about to change. The American College of Chest Physicians recently adopted a new method of guideline development in an attempt to better mitigate financial and intellectual conflicts in developing their guidelines about the management of clotting disorders. Experts will have input into the development of the guidelines, but will not have a final say. In addition, the editors for each chapter will be physicians who are experts in clinical epidemiology and research methods, with no financial or content-specific intellectual conflicts. The researchers who led this process were motivated by the argument that “clinical experts who write guidelines are influenced by (usually) declared financial conflicts and by equally important undeclared intellectual conflicts of interest”.
The American College of Chest Physicians is the first group to attempt this approach, and it is not without its critics. Some argue there needs to be greater involvement of experts even if they have conflicts, because only they can understand the nuances of the research findings and the diseases being treated.
Time will tell if the ACCP approach is adopted on a wider scale, and whether the guidelines developed by this group are perceived as both free of conflicts and clinically credible. fIf nothing else, the ACCP has helped draw attention to the largely unrecognized danger posed by ignoring conflicts that don’t have to do with money.
Andreas Laupacis is an internal medicine physician. Both he and Karen Born write at Healthy Debate.
American Thoracic Society Documents
An Official American Thoracic Society Policy Statement: Managing Conflict of Interest in Professional Societies
Holger J. Schu ̈nemann1,2,3, Molly Osborne4, Joel Moss5, Constantine Manthous6, Gregory Wagner7,
Leonard Sicilian8, Jill Ohar9, Shane McDermott10, Lance Lucas11, and Roman Jaeschke3, on behalf of the
ATS Ethics and Conflict of Interest Committee and the Documents Development and Implementation Committee
1Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; 2Department of Medicine, University at Buffalo, State University of New York, Buffalo, New York; 3Department of Medicine, McMaster University, Hamilton, Ontario, Canada; 4Department of Medicine, Oregon Health and Science University, and Portland VA Medical Center, Portland, Oregon; 5Translational Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; 6Medical Intensive Care, Bridgeport Hospital, Yale University School of Medicine, New Haven, Connecticut; 7Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts; 8Department of Medicine, Adult Cystic Fibrosis Program, Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston, Massachusetts; 9Section on Pulmonary, Critical Care, Allergy and Immunologic Disease, Wake Forest University School of Medicine, Winston-Salem, North Carolina; 10Office of Ethics and Conflict of Interest Policies, and 11Office of Documents and Ad Hoc Projects, American Thoracic Society, New York, New York
THIS OFFICIAL POLICY STATEMENT OF THE AMERICAN THORACIC SOCIETY WAS APPROVED BY THE ATS BOARD OF DIRECTORS ON MAY 20, 2009.
Principles: The policy is based on eight principles that are summarized in Table 1. These principles encompass (1) the recognition that the ATS membership is diverse with work affiliations ranging from academic institutions, industry, patient care, government, research, to administration; (2) individuals employed or directly affiliated with the pharmaceutical and/or medical device industry make important and often unique contributions to official ATS activities; (3) conscious or subconscious influence as a result of COI, or the perception by others that such influence exists, may impact the balance of considerations within institutions and organizations in favor of a particular management option. Since the ATS is likely to affect health care, public health, and health policy proportional to its credibility, the ATS must preserve its organizational integrity and rigorously safeguard its processes to disclose and resolve COI; (4) many individuals have ‘‘competing interests’’ that may cause conflicts of interest. A conflict of interest depends on the situation, and not on the character or actions of the individual; (5) simple a priori declaration of COI is insufficient; (6) chairs and organizers of official ATS activities should evaluate the COI disclosures of potential participants and take steps as recommended by the ATS to resolve relevant COI; (7) project committee members and/or conference or workshop participants should be apprised of the declared COI of all other participants before deliberations begin; (8) COI should be acknowledged in final published documents or other products of the project or confer- ence, with footnotes that allow users of the document or other products to access and assess the policies that safeguarded COI during the project or conference’s development.
Definitions: COI is defined as (1) a divergence between an individual’s private interests and his or her professional obligations such that an independent observer might reasonably question whether the individual’s professional actions or decisions are motivated by personal gain, such as financial, academic advancement, clinical revenue streams or community standing; or (2) a financial or intellectual relationship that may impact an individual’s ability to approach a scientific question with an open mind.