Map of life expectancy at birth from Global Education Project.

Monday, April 16, 2018

Conflict of Interest

There's a big debate in BMJ this week about non-financial conflicts of interest in research. As readers know, medical journals generally require that authors disclose whether they have any financial interests that might be affected by the outcome of their study. Disclosing the funding source for studies is standard practice in every journal, and most reputable journals require a declaration that funders did not have a role in determining the findings or reporting the results. This is actually true in the case of most government funders -- or at least has been until the current administration -- although it is the case that if they want to get the next grant, investigators should be reluctant to undermine the conventional wisdom or the entrenched positions of reviewers. In the case of industry funding, if you want to get another grant, you would be well advised to find what they want you to find. In the typology listed by Marc Rodwin on page 17, this would be "interest in maintaining good relations with future research funders," and this is not considered a legal conflict of interest. [Disclosure: I was a TA for Marc when I was in grad school.]

However, just receiving funding for your research is not considered a conflict of interest. A conflict of interest arises if a researcher, for example, owns stock in a company that could be affected by the research, or receives substantial consulting fees. The debate is about other kinds of conflicts, such as professional reputation, career advancement, or your own prior intellectual commitments.

I would say that these are actually part of the very fabric of science. I struggled with these problems recently when I was asked to review a paper that concerned a problem that I have studied in some depth, and published on extensively. In the first submission, the authors did not cite my work, which was inconsistent with my own findings. I believed they were wrong, and that if they had read my work they would have taken a different approach, but I had to ask myself if I was likely to be the fairest judge. In my review, I refrained from specifically pointing them to my publications but did say there was literature they had not consulted that would inform their analysis. In a confidential note to the editor, I listed my relevant publications and expressed my concern about my impartiality. The editor did not respond and sent my review to the authors along with a request for major revision. This journal has an open review policy so I chose to disclose my identity.

In the resubmission, they did cite one of my papers but they did not describe it accurately. They made some changes that reduced the misalignment between their conclusions and mine, but still left me unconvinced. In my second review, I specifically discussed my own research and the ways in which it undermined their analysis. So now we are having an open scientific debate, which is ordinarily all to the good, but of course there is a power imbalance here. They want to get their article published and I'm standing in the way. If they change their conclusions, is that because I have convinced them using the power of my deeper wisdom about this issue, or is it because I have bullied them into submission?

The editor is the ultimate referee in this situation but may not have the expertise to choose wisely, and may not have the time or energy either. Editors pretty much lean on reviewers and seldom override them. I believe that my review was fair and correct, but so does everyone whose review is unfair and incorrect. Science is about discovery, but it has some built-in conservatism. I wouldn't label that as a "conflict of interest," if that means it's going to be conflated with a financial stake. But it's a complicated question whether anything can or should be done about it.

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