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Re: The movement to reform medicine from within

Posted: Sat 2 Feb 2013 0:01
by Lorima ... money.html 
Conflicts of interest don’t always involve money


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.
I clicked on the highlighted text "with an open mind" and got this: 
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

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.

Re: The movement to reform medicine from within

Posted: Thu 21 Mar 2013 23:14
by panda
EvidenceLive for everyone with an interest in evidence-based healthcare:

Example of the blog (without belonging links):

Forcing the spring towards a new era in evidence-based medicine

“But, by the words we speak and the faces we show the world, we force the spring.”

The beginning of Bill Clinton’s first inaugural address seems an odd place to start a discussion about epidemiology, I admit. For us, though, it reflects the developments over the past few months that have changed how evidence-based medicine is practiced, and how it’s going to look in the near future. And we’re excited about all of it.

It’s no secret that there is massive pressure on drug companies to fundamentally change how they operate. This push for a new era of accountability is due to the efforts of many people, including Ben Goldacre, whose Bad Pharma has become an international phenomenon, and Tom Jefferson and Peter Doshi, whose campaign to obtain all the data on Tamiflu has been a major driver towards exposing withheld data. The current state of pharmaceutical research is a little like when you were in school doing an experiment, and something didn’t quite turn out right, and you ‘forgot’ to write down the results for that one part of the experiment. It may have worked in high school, when the worst that could happen is that you would have to stay after class. But when billions of pounds and thousands of lives are at stake, the stakes are quite different.

The All Trials campaign- an online petition that’s rapidly gaining publicity and support- now has over 25000 signatures, including major medical journals (our EvidenceLive partner, the BMJ, is one of the instigators of the campaign). Last week, pharmaceutical giant GSK signed on - an incredible step in the right direction for an industry that continues to be, in large, stuck in the dark ages when it comes to transparency.

This week, another campaign has started to heat up, this time questioning how guidelines are developed and where the incentives lie in their creation. Bad Guidelines has initially targeted the “Guidance on collaboration between healthcare professionals and the pharmaceutical industry” as a particularly egregious example of a document that august institutions, such as the UK Department of Health, have signed on to and probably shouldn’t have. At the very least, one wonders if they read it through before signing up.

The philosopher Thomas Kuhn suggested that the history of scientific progress has been one of paradigm shifts, in which research continues along in a certain paradigm until someone comes along to break out and move on to another radically different way of looking at phenomena. We can’t help but wonder if we are in the midst of a paradigm shift in healthcare- one that values transparency, scientific progress, and responsibility to patients above all else. If you haven’t already signed up, come to EvidenceLive, and help “force the spring” towards a new era in evidence-based medicine.

Re: The movement to reform medicine from within

Posted: Fri 22 Mar 2013 13:39
by Lorima
Thanks, Panda.
I am just starting to review the site; it looks very interesting.

Re: The movement to reform medicine from within

Posted: Sun 26 May 2013 16:45
by panda
New website PubPeer: is a new website that allows scientists to journal club any published paper with anyone else on the planet. Open/Free/Anonymous
PubPeer seeks to create an online community that uses the publication of scientific results as an opening for fruitful discussion.

- All comments are consolidated into a centralized and searchable online database.

- Authors, as well as a small group of peers working on similar topics, are automatically notified when their article is commented on.

- Pubpeer strives to maintain a high standard of commentary by inviting first and last authors of published articles to post comments.

- The chief goal of this project is to provide the means for scientists to work together to improve research quality, as well as to create improved transparency that will enable the community to identify and bring attention to important scientific advancements.

PubPeer started from the lack of post-publication peer discussion on journal websites. Thus was born an idea for a website where open peer review was not intimidating to users, while maintaining the rigor and anonymity of the closed review process currently used by the major journals. The site has been put together by a diverse team of early-stage scientists in collaboration with programmers who have collectively decided to remain anonymous in order to avoid personalizing the website, and to avoid circumstances in which involvement with the site might produce negative effects on their scientific careers.

Snippets of an interview with a German newspaper ( ... -plattform ):
1) Who are you?
PubPeer was set up by researchers early in their careers who were frustrated by the difficulty and danger, from the point of view of our own careers, of discussing and commenting on published research. Because questioning the work of other researchers can have negative consequences for a young scientist's career, we prefer to remain anonymous for now.

3) How does PubPeer exactly work?
Anybody wishing to ask a question about a paper or to make a comment can do so. Comments are anonymous by default and usually made from an account. Opening an account requires a previous publication and an email address at an academic or research institution. However, for those desiring stronger anonymity or without an academic account, comments can be submitted via a moderator.

4) The reviewers who post their comments on recently published papers are anonymous on PubPeer. Why?
Many scientists are fearful of appearing to criticise colleagues who will review their grants, their papers and generally decide their future careers. That is the reason that peer review is always anonymous. The only difference here is that the "review" takes place after publication and anybody in the world can offer their expertise after calm reflection.

11) Why does science need platforms like yours or Retraction Watch to review papers after they have been published?
Most researchers will agree that few papers are perfect, with problems ranging from simple misunderstandings (by the reader) through statistical errors or logical problems to outright fraud. But dissemination of knowledge about these problems is extremely inefficient. There might be informal discussions at conferences or local journal clubs, but the wider community or people external to the field (teachers learning about a new subject, for instance) do not have access to this information. There are also many barriers to commenting on papers, especially negatively. We have already mentioned that most researchers are very unwilling to risk antagonising colleagues. There are also few channels for actually making such comments. Most researchers definitely cannot afford the time, expense and conflict involved in publishing a paper directly contradicting published results. Only a few journals have a "correspondence section" and those that exist are often hidden behind a paywall, extremely low volume, very formal, non-anonymous and under editorial control. Which brings us to the point that it is not in the interest of a journal to see its publications (and implicitly its editorial policy) criticised, so commenting procedures often suffer from a lot of friction. Some journals allow comments, but these are controlled in a manner similar to other correspondance. They have rarely proved successful. Finally, there is a community of bloggers commenting sporadically on publications, but the information is not at all structured or easily discoverable.