On 8/15/2011 6:17 AM, Djulbegovic, Benjamin wrote:
> That's why reading the article about a drug X for disease Y will not
> be perceived as credible unless they are written by the folks in the
> field...who, alas, by and large, and almost by definition must have
> intellectual or financial conflict of interests...
As much as I hate to quibble with Dr. Djulbegovic, I have to raise a
question about "intellectual conflicts of interest." I have a lengthy
discussion of this and other non-commercial conflicts of interest at
--> http://www.pmean.com/08/PrivateConflicts.html
and my general conclusion is that allegations of non-commercial
conflicts of interests are largely a smokescreen raised by people who
have financial conflicts of interest. They want to establish that
everyone has a conflict or bias of one type or another, and therefore,
no one should be barred from writing an editorial or other subjective
review.
Saying that everyone has a bias is certainly true, but some biases are
more serious than others. A surgeon, for example, may be predisposed to
recommend surgical approaches over non-surgical interventions. But how
strong is this predisposition anyway? Every surgeon I know has pretty
strong opinions about when surgery is NOT needed, and thus can't be too
terribly biased. Financial conflicts, however, lead to some fairly large
and consistent biases that have been empirically verified.
So I have no problem with saying that someone with a financial tie to a
drug eluting stent should be barred from writing an editorial about the
advantages of drug eluting stents. But a surgeon who routinely uses drug
eluting stents should not be barred from writing that editorial.
Steve Simon, [log in to unmask], Standard Disclaimer.
Sign up for the Monthly Mean, the newsletter that
dares to call itself average at www.pmean.com/news
P.S. I did get a rapid response published to the original BMJ article:
--> http://www.bmj.com/content/343/bmj.d5147.extract/reply#bmj_el_268581
and I tackle the comment of another writer that researchers who don't
get any financial support from industry must be biased against industry.
It's an example of how silly the argument has become that NOT getting
money is perceived as being a comparable source of bias to getting
money. My goodness, if we adopt that belief, then we might as well let
the CEO of Pfizer write editorials in BMJ about the advantages of
Lipitor. After all, no one understands the advantages of Lipitor better
than the person who actually manufactures that drug, and the CEO of
Pfizer is no more biased than anyone else.
Those of you who still believe that intellectual conflicts of interest
need to be considered alongside financial conflicts of interest should
note the following anecdote in the book, Denialism. How Irrational
Thinking Harms hte Planet and Threatens Our Lives, by Michael Specter.
He starts off Chapter 2 with the story of Marie McCormick, a
pediatrician with a research interest in "high-risk newborns and infant
mortality." She was asked to serve on a National Academy of Science
panel on vaccine safety.
"McCormick took on the assignment readily, although she was surprised at
having been selected. It was not as if she considered vaccine safety
unimportant--the issue had preoccupied her for decades. Nevertheless,
vaccines were not McCormick's area of expertise and she couldn't help
thinking that there must be someone better suited for the job. 'My
research has always been on the very premature,' she explained. 'So I
was a bit naive about why they wanted me to run that committee.' She
soon made a discovery that surprised her: 'I realized that all of us on
the committee were selected because we had no prior contact with
vaccines, vaccine research, or vaccine policy.'"
To believe that someone who does research on vaccines has a comparable
conflict as someone who owns a patent on vaccines leads to absurdities
like this.
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