Crackdown on Conflict of Interest
December 27th, 2008Posted by: admin
An Emory University Researcher has been sanctioned by the school for, among other things, failing to report about $800,000 in speaking fees from GlaxoSmithKline. As Science Magazine’s science policy blog reports, psychiatrist Charles Nemeroff has been banned from accepting industry money at certain speaking engagements, and not to seek any National Insitutes of Health funding for 2 years. You can get the complete details from the university’s report.
I don’t have much patience for research misconduct, and only a little bit more for the appearance of conflicts of interest. If Nemeroff served jail time I’d think it well deserved. Scientific communities could do a lot better to make things more transparent and to diminish the appearance of conflicts of interest. Most of the reported cases come from biomedicine, but I think that’s more likely a result of how easy it is to find the conflicts (apparent or not), than any particular quality of the discipline. I am not calling for an end to industry sponsored research – in part because they aren’t the only sources of conflicts. I do think research support needs to be more explicity accounted for. Simple acknowledgements of support in the back of research articles seem inadequate in expressing the relationships in play.
I do not want to immediately distrust a researcher because of the area of study they are in, but it’s getting harder and harder not to. If Emory saw fit to impose the sanctions they did while also claiming that Nemeroff didn’t taint his research or patient care, I suspect the university sees where I’m coming from.
December 27th, 2008 at 6:10 pm
[...] Vote Crackdown on Conflict of Interest [...]
December 29th, 2008 at 7:11 am
I am not sure why Nemeroff became the ethics scapegoat of the day.
Although Emory says Nemeroff’s failure to disclose the amounts he received didn’t taint his research or patient care, the university imposes these limitations on his activities: Nemeroff will need to “seek review and approval by the dean’s office of any and all outside compensated engagements before he accepts them,” and he can’t seek National Institutes of Health grants for 2 years. When it comes to speaking at continuing medical education events, Nemeroff will be permitted to talk only at those “sponsored by academic institutions or professional societies.”
1. The article says he accepted speaking fees, not research funding.
2. The article says that his behavior did not taint his research or patient care.
3. The report says that he did violate COI reporting requirements imposed by Emory and NIH.
4. Nemeroff’s excuse is that he did not know he was violating the COI reporting requirements.
How exactly do those facts add up to an ethics violation? I suppose if you take the view that anyone who violates COI reporting requirements in any way is unethical, then Nemeroff deserves his castigation. But I suppose I take the view that “ethical” in these discussions is best used in a philosophical sense, in which case I’m not sure Nemeroff is as unethical as this article makes it seem.
I am certainly not advocating the violation of COI reporting requirements. I think COI reporting requirements are important and can help keep researchers ethical. But when the IRS audits someone it doesn’t necessarily make them an depraved and immoral criminal, and in the same vein, I don’t see how a finding of a COI violation is grounds for us to impugn this guy’s ethics.
December 29th, 2008 at 7:51 am
[...] David Bruggeman at Prometheus has what I think can only be described as an extreme view of conflict of interest: An Emory University Researcher has been sanctioned by the school for, among other things, failing to report about $800,000 in speaking fees from GlaxoSmithKline. As Science Magazine’s science policy blog reports, psychiatrist Charles Nemeroff has been banned from accepting industry money at certain speaking engagements, and not to seek any National Insitutes of Health funding for 2 years. You can get the complete details from the university’s report. [...]
December 29th, 2008 at 8:52 am
The appearance of conflict of interest is enough of a problem that Nemeroff’s actions are actionable. The amount of money at issue is significant, and it wouldn’t be unreasonable for an average patient to think that Nemeroff was influenced to prescribe GSK treatments, either over treatments from other companies, or possibly to prescribe something when it wasn’t needed.
Attracting the attention of Congressional oversight is no small feat, especially in the most recent era of limited oversight. I think the New England Journal of Medicine’s point of view is the right one with respect to conflicts of interest, and it needs to spread.
http://content.nejm.org/cgi/content/full/329/8/570
And yes, I probably favor more punishment than less in these cases on a more…visceral level than anything else.
December 29th, 2008 at 9:22 am
I guess I don’t understand why anyone should kowtow to other people’s opinion of what “appears” to be a conflict of interest. It probably makes sense given our current system to have the reporting requirement for speaking fees, so that patients could make a decision about whether Nederoff had a conflict of interest. So I don’t have a big problem with the finding against him, but like the openmarket.org commenter says, it seems like more of an accounting mistake.
But suppose he had reported the speaking fees. If it appeared to patients that he had a genuine COI, they could have gone elsewhere. But if the “conflict” meant being slightly more prone to use GSK products, so what? The FDA is supposed to ensure that GSK products are safe and medically effective. So to mel, if predisposition to dispense GSK products endangers anyone’s health, its only the doctor’s fault if the products are grossly misapplied.
Say I hire Tiger Woods as a golf instructor, and he says I might want to check out Nike’s line of golf clubs. Could there be a COI? Sure, I guess. Nike clubs might be a little too heavy for me or unoptimally sized. But I would have a hard time saying that Tiger should go to jail for recommending Nike clubs to me, or even that he did anything wrong. I think this is true even if his Nike sponsorship contracts were a big secret. You might say that medicine and science are “more important” than golf, and I agree, but my point is that as long as Tiger is recommending golf clubs to me to use when I play golf, I don’t see a COI which is detrimental to the patient/golf student.
December 29th, 2008 at 9:49 am
An $800,000 accounting mistake? I don’t know about you, but that’s real money to me. And given that many universities have disclosure policies, Nemeroff’s excuse translates to him being stupid.
With health and welfare at stake, I have no problem with higher penalties. The issue with conflict of interest is that they can be abused to a point similar to where the tobacco companies chartered a research institute to develop peer-reviewed science to support their fallacious claims.
http://jhppl.dukejournals.org/cgi/content/abstract/21/3/515
When a doctor receives money from specific companies, and then prescribes their products, how do I know that there isn’t a better treatment out there, or that a generic drug is available that would do as effective a job as the prescribed treatment? I can’t take the doctor’s word on it, and that’s a problem. It’s not just an issue of preventing harm (which the FDA should be able to do through it’s regulation), but of providing the best treatment.
When a researcher is receiving money and doing research on that company’s products, they are much more likely to report positive findings.
http://www3.interscience.wiley.com/journal/118783719/abstract?CRETRY=1&SRETRY=0
So an appearance of a conflict would give the appearance of bias toward a particular outcome. That is a problem because it reduces the possibility that the best outcome for the patient, or the public, will be found. Depending on circumstances, this could meet the standards of willful negligence.
July 2nd, 2009 at 11:32 am
[...] Scientist has a collection of articles related to scientific misconduct in its July issue. I have little patience for scientific misconduct, and some of the articles in the magazine help explain why (at least one requires registration). As [...]