Blog Commentary
The conflict of interest issue is now a crisis of credibility for the medical profession, despite early warnings; it requires a comprehensive framework.(1) Therefore, I am seriously puzzled by some editors’ naïve pledge for reporting “potential” conflict of interest.(2)
The International Committee of Medical Journal Editors never investigated the reasons why it failed for so long to implement an efficient policy. Chimonas et al confirmed that current journal disclosure practices do not yield consistent information regarding authors’ industry ties.(3) Their proposal to use company data to move to a system of full, verifiable transparency is in fact irrelevant. Secrecy “needs” some transparency to give public trust and to maintain preferred hierarchies of power.
Will editors and reviewers succeed if someone wants to mask a conflict? Companies repeatedly cope with regulations which ought to grant for transparency. In 2004, the Sarbanes–Oxley Act (2002) failed to prevent many major affairs (eg. Enron, Vivendi-Universal). In 2008, the new regulation did not prevent even more serious affairs (eg. Lehman Brothers Holdings was certified by the US Securities and Exchange Commission). Moreover, for a long time, consultancy fees have been just the tip of the conflict of interest iceberg. As early as mild 90’s, I observed some doctors engaged in insider trading schemes. Only those who are too voracious are caught.(4)
The bottom line for an article is simple: Is there scientific evidence — regardless of any conflict– or not? This means that scientific controversies must be possible. The editor must accept for publication responses to promote controversies and not hide himself behind the excuse of “the lack of space”. Among the editors, I must cite Joseph S. Alpert, MD, from the Green Journal, who dared to disclose serious breaches in scientific ethics and in evidence that many hid.(5,6)
Lastly, I propose to add at the end of each conflict of interest statement “Neither the editor and the reviewers, nor the institution where the work was performed seriously investigated the authors’ conflict of interest.”
Interest for conflict: Alain Braillon was recently sacked for whistleblowing.(HealthWatch, october 2010, issue 79, p3-7 available at http://href.fr/healthwatch_oct10.pdf)
— Alain Braillon MD, PhD
1 Fava GA. Unmasking special interest groups: the key to addressing conflicts of interest in medicine. Psychother Psychosom. 2010;79:203-7.
2 Fontanarosa PB, Flanagin A, DeAngelis CD. Implementation of the ICMJE form for reporting potential conflicts of interest. JAMA. 2010 6;304:1496.
3 Chimonas S, Frosch Z, Rothman DJ. From Disclosure to transparency: The use of Company payment data. Arch Intern Med. 2010 Sep 13 . [Epub ahead of print] PMID: 20837820
4 United States Attorney’s Office. Manhattan U.S. Attorney charges French doctor for insider trading securities fraud allegedly illegal inside tips at time of fatality and other problems in clinical drug trial allow hedge fund to avoid $30 Million in trading lLosses. November 2, 2010. available at http://newyork.fbi.gov/dojpressrel/pressrel10/nyfo110210a.htm
5 Braillon A, Nguyen-Khac E. Hepatocellular carcinoma: a pledge for evidence-based medicine. Am J Med. 2008;121:e7.
6 Braillon A. Sciensationalism. Am J Med. 2010 ; 124 :e13
