BMJ: Are commercial conflict of interests justifiable in medical
journals?
Experts criticise a leading journal’s backtrack regarding policies
on conflict of interest
A group of former senior editors, writing in The BMJ today,
criticise a “seriously flawed and inflammatory attack” by The
New England Journal of Medicine (NEJM) on what that journal
believes have become overly stringent policies on conflicts of
interest.
The NEJM was the first major medical journal to introduce
conflict of interest policies in 1984. It required all authors to
disclose any financial ties to health industries and made conflict
of interests more transparent.
But recently the NEJM published a series of commentaries and
an editorial that attempt to justify and rationalise financial
conflicts of interests in medicine, and assert that there are
negative consequences of such policies.
The articles by national correspondent, Lisa Rosenbaum, and
supported by editor in chief, Jeffrey Drazen, “reinterpret and
downplay the importance of conflicts of interest in medicine”
and do not provide evidence to back claims, argue former
senior editors from the NEJM.
They explain that the key concerns for medical journals are not
about doctors and researchers bei
ng bought by drug
companies, or being motivated by a desire for financial gain.
Rather the essential issue is that the objectivity of authors with
financial conflicts of interest “might be compromised, either
consciously or unconsciously and there would
be no easy way
to know whether it had been.”
They explain that judges and journalists, for example, are
expected to stay away from cases or stories in which they have
a financial conflict of interest.
“Yet Rosenbaum and Drazen seem to think it is insulti
ng to
physicians and medical researchers to suggest that their
judgment can be affected in the same way,” they add.
The authors acknowledge that doctors and researchers
sometimes have financial ties with industry for research and
consulting specifically
related to research, but argue that
physicians who develop products and hold patents or receive
royalties should not evaluate the products they develop.
Financial conflicts of interest have eroded the credibility of the
medical profession, and doctors an
d the public expect journals
to be trustworthy, they explain.
In addition, they commend The BMJ’s introduction of a “zero
tolerance” policy on educational articles by authors with any
industry ties.
In an accompanying editorial, a group of senior editors
at The
BMJ also respond to NEJM’s articles, saying
that they are
“deeply troubled by a possible retreat from policies that prevent
experts with relevant commercial ties from authoring
commentary or review articles.”
Such policies were not motivated by a
few events, as Drazen suggests, but by recognition of extensive, systemic problems,
they add, and argue for a separation between doctors working
with industry to develop treatments and those who can assess
medical evidence without any conflict of interest
.
While they agree that experts with industry funding may be able
to express independent views, journal readers and editors do
not have a reliable way to see which thoughts might be
influenced. “Bias is not always overt or easily detected,” they
explain.
They conclude: “It is a mistake by NEJM to suggest that
rigorous standards should be revisited. To do so would
undermine the trustworthiness of medical journals and be a
disservice to clinical practice and patient safety.