June 9th, 2011

Financial transparency skin-deep at medical journals

Reuters

When scientists concluded in a report from November that they found a potential anti-aging skin treatment, readers had good reason to think they could trust the claim.

After all, the findings appeared in the prestigious British Journal of Dermatology (bit.ly/j8M8Ng), and the authors said they had no financial interests in the product, a hormone called DHEA.

Yet Reuters Health has learned that the senior researcher, Dr. Fernand Labrie, holds patents for DHEA and owns companies dedicated to marketing it for certain medical problems.

His lack of disclosure, a routine requirement at medical journals, points to a bigger problem in the field: nobody is making sure that authors declare their conflicts of interest.

That has very real potential to influence public health and corporate bottom lines, experts say, because researchers with industry ties are more likely to promote drugs and downplay side effects.

When scientists from the tobacco industry reviewed the effects of secondhand smoking, for instance, more than 90 percent of them found no evidence of harm. Yet only 13 percent of the reviewers without industry ties came to that conclusion, according to a 1998 report in the Journal of the American Medical Association (bit.ly/mKIyrc).

“At its worst, it can allow patients to have unrealistic hopes about a treatment for their conditions,” Dr. Virginia Barbour, chief editor of the journal PLoS Medicine, told Reuters Health. “And it can distort the prescribing practice of physicians.”

In a review of 50 reports from the British Journal of Dermatology, a top-tier skin research journal, Reuters Health found that authors often don’t disclose even the most glaring conflicts of interest. And editors are reluctant to do anything about it—in fact, they don’t even agree on when a conflict of interest exists.

What’s more, many journal publishers derive a substantial part of their revenue from drug ads and reprint requests from pharmaceutical companies, and there are examples of editors who moonlight as paid consultants for the industry.

“Editors probably need to be more vigilant than they are at the moment,” said Barbour, whose journal doesn’t run drug ads. “And I think that editors also need to be very aware that they themselves can be part of the competing interests.”

TRANSPARENCY CLOAKS CONFUSION

The disclosure policy of the British Journal of Dermatology (BJD) is deceptively simple.

According to an e-mail from its editor Dr. Tanya Bleiker, “Authors are responsible for disclosing all financial and personal relationships between themselves and others that might be perceived by others as biasing their work.”

That includes signing a statement that relevant patent rights, stock ownership, consultancy fees and employers have all been declared—even if the employer was also listed at the beginning of the manuscript. That statement will show up in the report.

Yet of the 50 most recent BJD reports from scientists at L’Oreal, Shiseido, Novartis and similar companies, 13 declared no conflict of interest.

And that’s not counting one study that promoted a L’Oreal-Nestle product on shaky grounds without disclosing that most of the authors were employed by the manufacturer or had been paid by it. The BJD only corrected the problem (reut.rs/eTnMOq) after a Reuters Health story (reut.rs/jujOYb) pointed it out in July.

Asked how more than a fourth of the 50 studies could end up in print without financial disclosure, BJD spokeswoman Nina Goad said, “We have looked at all the papers listed and can see no significant conflicts of interest.”

But experts who spoke with Reuters Health—including other journal editors, ethicists and doctors—said there is little doubt that industry scientists have a financial stake in their publications.

“If it’s an article written by people who work for the company, the company has almost certainly invested money in that research,” said Josephine Johnston, a bioethicist at the Hastings Center in Garrison, New York. “That’s a massive conflict of interest.”

Internal sales documents made available by Pfizer during a lawsuit over its antidepressant Zoloft, and later quoted in an article by University of Minnesota bioethicists, speak to her point.

According to those documents, the “purpose of data is to support, directly or indirectly, the marketing of our products.”

Given that backdrop, many experts say a conflict of interest exists whenever readers might reasonably wonder if a scientist’s judgment is biased.

Goad, the spokeswoman for the British Association of Dermatologists, which publishes BJD, declined to spell out how it determines when there is a conflict of interest.

Instead, she referred Reuters Health to the Committee on Publication Ethics, which advises the association on ethical matters. But Elizabeth Wager, who chairs the committee, told Reuters Health that industry scientists clearly have financial interests in their findings.

Read more: http://www.reuters.com/article/2011/06/08/us-medicaljournals-conflicts-idUSTRE75761520110608?feedType=RSS&feedName=healthNews&WT.tsrc=Social+Media&WT.z_smid=twtr-reuters_health&WT.z_smid_dest=Twitter

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