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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. ■
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