182. The Reality of Science: Conflicts of Interest Must Be Addressed

There is an impression that science and scientists are dedicated to conducting independent studies which will provide objective results that can be regarded as definitive. Unfortunately the reality is anything but. Individuals who happen to be working as scientists are subject to all the pressures and prejudices which are common to everyone. Invariably people have preconceived ideas about what to expect from any investigation, which can influence the way in which the results are presented and interpreted. Hence the quality of any study is determined not only by the competence of the individuals involved but also their intellectually honesty and integrity.

Within the area of medicine, health and nutrition there are fundamental characteristics which mean that many of the issues to be addressed are difficult and complex. For a start, there are the variations between people because of genetics, gender and age. Secondly, there can be a long time span between cause and effect. Chronic diseases such as Type 2 Diabetes (T2D) and cancers can take years to develop. Thirdly, unlike infectious diseases where there is just a single cause, chronic diseases are usually the culmination of several different factors. All of this means that designing studies that will provide results which are genuinely sound is not easy. Inevitably finance is usually a key issue. Ideally the more participants the better because this is one way of overcoming the variation between individuals but this pushes up the expense. At the present time, much of the money for research is provided by companies. This then raises the possibility that the source of funding may have an influence on the results which are produced.

A study on research in the biomedical field Identified 37 eligible studies conducted between 1980 and 2002 which provided adequate information on the financial relationships between the industry, scientific investigators and the academic institutions involved (1). The relationship between industry sponsorship and outcome in original research was examined. It was found that there was a statistically significant association between industry sponsorship and pro-industry conclusions which favoured the industry by a factor of 3.6. Industry sponsorship was also associated with restrictions on publication and data sharing.

It was concluded that financial relationships among industry, scientific investigators, and academic institutions are widespread. Conflicts of interest arising from these ties can influence biomedical research in important ways.

In the field of food and nutrition, a recent investigation has examined reviews on the relationship between Sugar-Sweetened Beverages (SSBs) and weight gain to compare those financed by industry with those financed by independent sources (2).

In all 17 suitable reviews were found that were analysed in the study which reached 18 conclusions. Six of these declared potential conflicts of interest with industry, and 11 declared having no potential conflicts of interest with industry or did not report on potential conflicts of interest. The results showed that 61% of the conclusions from the 17 reviews (11/18 conclusions) supported an adverse association between SSB consumption and weight gain or obesity; none reported any significant benefit.

Among the reviews that reported having no conflict of interest (11 with 12 conclusions), 83.3% conclusions (10/12) were that SSBs were directly associated with increased weight gain or obesity. In contrast, 83.3% (5/6) of the conclusions from reviews that reported having some conflict of interest with the food industry were that there was insufficient scientific evidence to support a positive association. This means that those which had industry support were five times more likely to present a conclusion of no positive association than those without them.

Commenting on the results, the authors contend that the fundamental objective of scientific endeavour should be seek the truth irrespective of financial or other interests. They conclude that:

“If other concerns influence the results of research, nutrition science as a whole is likely to suffer, partly because of incorrect information and partly through a loss of confidence in the discipline from the general public. Eventually, nutrition research itself might be at risk because perceived biases would threaten to make it irrelevant. The influence of biased reviews on policy makers and medical practitioners might also be another potential threat for public health.”

The report on “Carbohydrates and Health” (3) which has just been published was prepared by a panel chaired by Professor Ian Macdonald of the University of Nottingham. A Channel 4 Despatches programme revealed that he was in receipt of money from Unilever, Coca Cola and Mars (4). This information was not shown on his university website although he had informed the government of his financial links with these companies. However the eminent pharmacologist David Colquhoun says that the Macdonald case is a “shocking conflict of interest”. He advocates that all these interests should be declared in every research paper and presentation.

However even this may not be sufficient as Mark Wilson, a researcher in Canada has pointed out (5). Within the field of medicine and the relevant science, specialised knowledge, training and practice is needed if the implication of bias are to be assessed properly. It is all very well having these financial links on the record but this information simply draws attention to a potential conflict. It flags up the possibility of bias. As Wilson notes:

“But it does nothing more. It does not inform the public whether the person with a commercial COI is the grip of bias or not. Nor does it provide the means to assess the implications of a bias. And to suggest that these tasks can be accomplished simply through disclosure is to endow this accountability tool with extra ordinary super governance powers. It is not surprising then that disclosure has had a poor record on combating bias on Wall Street and in psychiatric medicine. It has been mythologised as a cure-all”.

The BMJ has made a determined effort to get to grips with these financial conflicts of interest. It has now concluded that declaration of these interests does not go far enough. Although it accepts that transparency is essential, it is not sufficient to eliminate bias or the perception of bias. As a consequence much more stringent conditions will be introduced in an effort to get to grips with this issue. Hence it has decided that:

“From next year our clinical education articles will be authored by experts without financial ties to industry … By industry we mean companies producing drugs, devices, or tests; medical education companies; or other companies with an interest in the topic of the article. We are phasing in this policy to start with editorials, clinical reviews, and most practice series. We hope that by the end of 2016, this will have extended to the rest of our education section: our specialist state of the art reviews and diagnostics and therapeutics series. “(6)

The journals concern was triggered by specific examples where clinical decisions based on information biased by commercial interests had resulted in harm to patients. It is attempting to achieve a shift in culture by promoting authors without financial ties to industry and offering them appropriate prominence and visibility. In this way it is hoped that readers will be able to trust the information.

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