A Cure for Public Distrust: Journals Must Exercise Their Authority as Gatekeeper

An article in Science section of The New York Times is an exmple of its efforts to deflect public criticism of the Journal of the American Medical Association—after The Wall Street Journal and The Associated Press exposed two recent biased reports whose authors failed to disclose financial conflicts of interest.

The reporter asks nothing about JAMA’s financial conflicts of interest that likely play a major role in its "tough-talk" but no action.  http://www.nytimes.com/2006/08/01/science/01prof.html?

Unlike the Times, Dr. Jerome Kassirer, former editor of The New England Journal of Medicine, puts the issue in proper perspective :  “The public trust is at stake, and despite the widespread publicity, journal editors fail to weed out writers with conflicts.”

In an Op Ed in the Boston Globe (below), he recognizes that mere disclosure of financial conflicts of physicians is not enough to offset their bias.
“Discerning the validity of oral or written material from a financially conflicted physician is more akin to reading Tarot cards than a scientific or intellectual endeavor.” “The cure for public distrust,” Dr. Kassirer, says, “is to employ people who have opted not to be compromised by money.  He debunks the specious argument offered by medical journal editors and FDA officials for continuing to rely on “financially conflicted physicians”  because “those with financial company ties are the real experts.”  His response is a resounding challenge: prove it, “nobody has ever shown that conflicted physicians are better in evaluating data than nonconflicted physicians.”

See also: our letter to the BMJ (British Medical Journal), written at the request of BMJ editor, Dr. Fiona Godlee but not posted. Our letter takes journal editors to task for failing to exercise their authority, and offers six recommendations to stem the tide of polluted science. 

Contact: Vera Hassner Sharav
veracare@ahrp.org

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http://www.boston.com/news/globe/editorial_opinion/oped/articles/2006/07/27/a_cure_for_public_distrust/
BOSTON GLOBE
A Cure for Public Distrust
By Jerome P. Kassirer — July 27, 2006

RECENT NEWS STORIES have focused on physicians who failed to disclose financial ties to a company whose products they have touted. Journals that failed to warn readers about such arrangements have been disparaged; and so has the Food and Drug Administration, for the same reason. In fact, there is plenty of blame to go around: Companies would prefer such ties to be hidden, doctors don’t believe that their financial connections to industry can affect their judgment, and journal editors fail to ask the questions necessary to identify the conflicts. Behind the public outcry for disclosure is a serious misconception, namely that disclosing financial connections solves the problem of conflict of interest and bias. Unfortunately, it does not.

Discerning the validity of oral or written material from a financially conflicted physician is more akin to reading Tarot cards than a scientific or intellectual endeavor. Why? Because trying to determine whether information from a conflicted physician is biased requires assessing a person’s motivation. Did the conflicted speaker bend over backwards to minimize bias and thus has he been completely objective about the subject? Did the speaker think that he was being rigorously impartial, but was subconsciously skewing the information in favor of the company that helps to pay his son’s college tuition? Did the speaker know exactly what he was doing, and that in biasing his talk, he knew he would incur more favors from the company? The uncertainty regarding the speaker’s motives underlines the problem of interpreting disclosures of conflict of interest: It leaves us guessing about what to believe.

Despite this flaw, journal editors still recruit financially conflicted physicians to write articles and editorials that involve selective interpretation of data. The FDA does the same for its committees that monitor the safety of drugs and recommend approval of drugs, and Congress has threatened to pass legislation to force the FDA to stop this practice. The editors and FDA officials claim that they need to use such people because those with financial company ties are the real experts.

I dubbed this concept the “fallacy of unique expertise," and have argued that nobody has ever shown that conflicted physicians are better in evaluating data than nonconflicted physicians. Are the individuals who recruit authors and FDA panel members simply not trying hard enough to find physicians who have eschewed taking money from industry? And if it is true that editors and the FDA cannot find sufficient experts who are not conflicted to write articles or serve on committees, what does it say about the extent to which the medical profession has been co-opted by the pharmaceutical, biotechnology, and device industries? Has the profession been compromised?

The public trust is at stake, and despite the widespread publicity, journal editors fail to weed out writers with conflicts. The FDA and professional medical organizations also continue to populate committees that make clinical recommendations that can affect millions of people with physicians who are being paid as speakers and consultants to industry. Even a smattering of conflicted physicians can bias such recommendations, and the practice of openly disclosing company conflicts only sanitizes the proceedings. It takes a strong-willed person to buck a trend in these meetings, and some who have tried it have been ostracized from the group.

Disclosure is nothing more than an excuse to continue business as usual. The cure for public distrust is to employ people who have opted not to be compromised by money. We must find ways of rewarding academic physicians who decide that patient care and personal integrity is more important than a $10,000 infusion into their bank accounts. One cure is to reward physicians by recruiting those without financial ties to write the review articles and to serve on panels that recommend what devices we use and what drugs we take. Maybe then many will opt not to be bought.

Dr. Jerome P. Kassirer, a professor at Tufts University School of Medicine, is author of “On the Take: How Medicine’s Complicity With Big Business Can Endanger Your Health."     © Copyright 2006 The New York Times Company

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