The Voice of Epidemiology

    
    


    Web EpiMonitor

► Home ► About ► News ► Job Bank Events ► Resources ► Contact
Articles Briefs People Blog Books Forum Quote of the Week Reprint of the Month
   

Ethics in Turmoil

Neil Pearce Shares His Views On Conflicts Of Interest in Epidemiology

Concern about conflicts of interest in epidemiology has been heightened in the last year after the revelations last year that well-known epidemiologists in the field had failed to disclose some of their links to industry. Compounding the concerns, criticisms of epidemiology by scientists with industry ties appear to have increased over the last 5-10 years, according to Neil Pearce of the London School of Hygiene and Tropical Medicine who has tracked these criticisms.

Alaska Symposium

Pearce was a featured speaker about ethics in epidemiology at the special symposium held last August in Alaska at the meeting of the International Epidemiological Association. It was triggered by the revelations earlier in the year.

Interviewed for another article about criticisms of IARC monographs in this issue, Pearce was asked how the attacks on IARC might be related to conflicts of interest in epidemiology.

Financial Conflicts of Interest

According to Pearce, everyone has a conflict of interest. Researchers want to be successful and this can lead them to make less than fully objective conclusions. However, he called conflicts of financial interest something different by an order of magnitude. He bemoaned the conflation of other types of conflicts with financial conflicts of interest. “Follow the money if you really want to find the major conflicts of interest”, he said.

‘What has been striking about some of the recent ethical controversies in epidemiology (see the recent Epidemiology Monitor issue) is that when I have been contacted by journalists, they have said to me that “your colleagues are concerned about this and want to comment, but no-one wants to be named”’, he said. ‘There is a natural reluctance to be seen to be criticizing your colleagues, but this means that some fairly debatable practices are not being discussed’. In the recent Le Monde article (see Epidemiology Monitor…) only Neil Pearce and Paolo Vineis were prepared to be named, although others also expressed anonymous concerns.

Two Lessons

Pearce told the Monitor he learned two things from the workshop in Alaska. First, there is a whole range of views about this topic. Second, there is agreement that transparency and disclosure are fundamental, if not sufficient, to addressing the problem.

Open Payments System

The importance of disclosure was reinforced recently with the implementation of some of the sunshine provisions in the Affordable Care Act. This Act requires pharmaceutical, biological, and medical device manufacturers to publicly report payments and other transfers of value made to physicians, dentists, and teaching hospitals each year. The provisions are being implemented by the Center for Medicare and Medicaid Services (CMS) and the system created to receive and publish these disclosure reports is called the Open Payments system.

According to CMS, Open Payments 1) encourages transparency about these financial ties, 2) provides information on the nature and extent of the relationships, 3) helps to identify relationships that can both lead to the development of beneficial new technologies and wasteful health care spending, and 4) helps prevent inappropriate influence on research, education, and clinical decision making. It is possible that eventually this new program will also have a positive impact in addressing conflicts of interest in epidemiologic research.

Rewards For Ethics

For the present time, Pearce noted that the rules we have for addressing conflicts of interest are not working very well. He proposes that a better approach would be not only to demand full disclosure, but to go further than that and to reward scientists and/or institutions for ethical behavior. He called for a “Best ethical practice” award. “In the United Kingdom, institutions are ranked (bronze, silver, gold) according to their demonstrated ‘commitment to advancing women’s careers… in higher education and research" (http://tinyurl.com/lubaxoa) and this will ultimately be linked to funding’ he said. "Why can’t we do the same for ethics, and reward good behavior rather than just having a list of things that we are not allowed to do?" He believes ranking institutions for acting ethically would bring about reform. ‘Linking this to funding would certainly get their attention" he said.

ISEE Research Integrity

The International Society for Environmental Epidemiology already gives out a Research Integrity Award honoring those in environmental epidemiology who have demonstrated exceptional integrity in the face of pressure from special interests. This award is made periodically at the discretion of the ISEE Council and with the acceptance of the awardee.  Steve Couglin was the winner of the award in 2014 for his courage in revealing deficiencies in research at the Veterans Administration.  While not quite the same as an award for ethical behavior, the award does reflect some of the same thinking as the Pearce suggestion.  ■


Reader Comments:
Have a thought or comment on this story ?  Fill out the information below and we'll post it on this page once it's been reviewed by our editors.
 

       
  Name:        Phone:   
  Email:         
  Comment: 
                 
 
       

           


 

 
 
 
      ©  2011 The Epidemiology Monitor

Privacy  Terms of Use  Sitemap

Digital Smart Tools, LLC