Conflicts of interest 


Outrageous fortune
May 17th 2001
From The Economist print edition (May 19th 2001) 

Some people feel that corporate sponsorship of scientific research
amounts to the purchase of it. Editors of scientific journals reckon
that vigilance is the answer

NEVER look a gift horse in the mouth, goes the adage, and the
University of Nottingham, in England, certainly did not. Last winter,
when British American Tobacco (BAT) offered the university 3.8m
($5.4m) to finance a centre for research on business ethics, with no
strings attached, the university gratefully accepted. One of its
academics, however, did not acquiesce so readily. 

Because Richard Smith, a professor of medical journalism at
Nottingham, also happens to be editor-in-chief of the British Medical
Journal (BMJ), he was able to air his protests before a large and
concerned audience of biomedical researchers. Two weeks ago, the BMJ
polled its readers on the matter. It asked whether Nottingham ought
to return the money to BAT. And it asked whether Dr Smith should
resign his chair if the university kept the cash. When the Internet
poll ended on May 10th, having garnered just over 1,000 responses,
the voters had decreed by a small margin—55% to 45%—that Dr Smith
should resign. And resign he will. By a far larger margin,
however—84% to 16%—the voters opined that Nottingham ought to give
the money back. The university, though, had not promised to make its
policy by plebiscite, and so it will not oblige. 

Should it? To Nottingham’s critics, allowing a firm from one of the
world’s least socially responsible industries to sponsor a centre for
the study of corporate responsibility smacks of the ludicrous. But
such curiosities are not new. Alfred Nobel made his fortune from
dynamite, yet the Nobel Peace prize is a coveted tribute. The
Wellcome Trust, Britain’s largest medical charity, received its
original endowment from a drug firm. Rupert Murdoch, a press and
broadcasting baron, recently endowed a chair in media studies at
Oxford University. And Harvard has just appointed the first incumbent
of a chair modestly entitled the “Quincy Jones Professorship of
African-American Music, Supported by the Time Warner Endowment”. 

Dr Smith fears that BAT’s donation amounts to the purchase of
respectability by the tobacco firm at the expense of Nottingham’s
reputation. A more worrying threat would be if the donation amounted
to the purchase by an interested company of scientific research at
the expense of the integrity of the researchers and their findings.
There is evidence that this has occurred in the past, sometimes in
subtle and uncontrollable ways. 

And now, a word from our sponsors
If hiring and firing decisions appear to turn on the interests of
sponsors, for example, the independence of research may suffer. Such
an incident occurred in April at the University of Toronto, which
rescinded its offer of a job to David Healy. Dr Healy is well known
for arguing that Prozac, an anti-depressant drug, raises the risk of
suicide among depressives. The university’s Centre for Addiction and
Mental Health, where Dr Healy would have worked, receives funds from
Eli Lilly, the makers of Prozac. The incident has caused much
hand-wringing among Canadian academics, although the university and
Eli Lilly both deny that the company’s money influenced the centre’s
decision to withdraw its offer.

Financial interests can also exert an insidious bias on the results
of research. In 1998, a review of literature published in the New
England Journal of Medicine showed that authors who supported the use
of a certain kind of drug for treating heart ailments were
significantly more likely to have a financial relationship with the
drug’s makers than those who did not.

In the same year, a review published in the Journal of the American
Medical Association (JAMA) examined articles about the health risks
posed by passive smoking. The review’s authors found that they could
reliably predict what an article would conclude about the effects of
passive smoking by looking at one simple factor: whether the
article’s authors had any financial affiliations with the tobacco
industry. (No prizes for guessing which way results veered when they

On the face of it, these discoveries look damning, both of science
and of scientists. But Dr Smith thinks that mendacity is not always
the explanation. Unintentional—even unconscious—bias can have
powerful effects. Researchers do try to eliminate this. The standard
experimental procedure for a test of a drug’s effects, for example,
demands a “double-blind” trial; that is, one where neither the
researcher nor the subject knows whether a given pill contains a
placebo or a drug. Double-blind design is not meant to imply
mendacious intent on the part of researchers or of subjects; it
merely takes into consideration the subconscious human bias that
subtly creeps into scientific observation.

Nevertheless, “To try to abolish bias is impossible”, according to Dr
Smith. Since he is the editor of one of medicine’s chief journals,
and because such journals are the gatekeepers of the scientific
community, this attitude may depress those committed to maintaining
the purity of scientific research. But Dr Smith, as well as the
editors of many other journals, believes that making the links
between researchers and their sponsors plain will do the trick as
well as it can be done.

To this end, the editorial boards of many journals are instituting
more stringent and wide-reaching policies designed to get researchers
to disclose their financial interests. The move has most relevance to
medical journals that report drug trials. The BMJ already asks
authors to declare “competing interests” and may soon shift to asking
for “relevant interests”, because its editors have found that such
changes in terminology affect the proportion of people who own up
quite significantly. The Lancet requires that a declaration of all
conflicts of interest, past and present, must accompany each article
submitted. JAMA insists that, if there is commercial sponsorship of a
study, the authors must sign a form guaranteeing that they, rather
than the sponsors, controlled the design, analysis and presentation
of data. 

Other scientific journals, such as Nature and Science, have less
cause for concern, since the research they report tends to be basic,
rather than commercial. Nevertheless, Phil Campbell, the editor of
Nature, says that within a few months the journal will create a
policy on the disclosure of financial interests. Donald Kennedy, who
edits Science, says that the journal’s editorial board is thinking
about creating such a policy, too. 

These editors are quick to point out that such requests, and the
disclosures they elicit, are not a watertight way of ensuring the
integrity of science. A scientist who is determined to conceal a
conflict of interest will have little trouble doing so. But there is
a natural check on such trickery—if an observant reader points out
the ruse, the journal will publish a correction. Drummond Rennie, the
deputy editor of JAMA, says, “We are JAMA, not the FBI or the IRS.
Authors have lied to us, signing forms they knew to be wrong. That
makes us look like naive idiots. Then we publish the facts and they
look like corrupt idiots.”