Conflict of Interest Yesterday, Associate Editor Kathlyn Stone summarized ongoing reaction to the New England Journal of Medicine’s long-winded series justifying closer ties between physicians and the pharmaceutical industry. She noted that the NEJM itself had pioneered today’s conflict of interest disclosure policies, and that throughout the 1990s, its editors would not publish editorials or review articles by authors with any financial interests related to the content of the article.

Today, three former NEJM editors who upheld those policies are wading into the debate with a very pointed commentary, “Justifying conflicts of interest in medical journals: a very bad idea.”

Writing in The BMJ, Robert Steinbrook, Jerome Kassirer, and Marcia Angell said it was “sad that the medical journal that first called attention to the problem of financial conflicts of interest among physicians would now backtrack so dramatically and indulge in personal attacks on those who disagree.”

They note that there is an extensive body of literature — largely overlooked by NEJM correspondent Lisa Rosenbaum and editor Jeffrey Drazen — attesting to the negative impact of physician conflicts of interest on medicine and medical journals. And they are concerned that Rosenbaum and Drazen seem to willfully ignore such compelling evidence.

“Judges are expected to recuse themselves from hearing a case in which there are concerns that they could benefit financially from the outcome. Journalists are expected not to write stories on topics in which they have a financial conflict of interest. The problem, obviously, is that their objectivity might be compromised, either consciously or unconsciously, and there would be no easy way to know whether it had been. Yet Rosenbaum and Drazen seem to think it is insulting to physicians and medical researchers to suggest that their judgment can be affected in the same way. Doctors might wish it were otherwise, but none of us is immune to human nature.”

They add that Rosenbaum uses shoddy logic and invents non-existent reasons to justify her opposition to conflict of interest policies and regulations.

“No one is proposing that ‘we prevent the dissemination of expertise, thwart productive collaborations, or dissuade patients from taking effective drugs,’ or allow ‘true experts to be replaced on advisory panels, as authors of reviews and commentaries, in other capacities of authority by people whose key asset is being conflict-free.’ Where is the evidence of ‘a loud chorus of shaming,’ or ‘a stifling of honest discourse,’ or that ‘the license to trample the credibility of physicians with industry ties has silenced debate?’ Silliness and fear mongering about straw men are masquerading as scholarly analysis.”

As editors, they say it was “sometimes difficult, but nearly always possible, to find outstanding authors with the needed expertise and without a conflict of interest to write editorials and review articles.” And they laud The BMJ for implementing a “zero tolerance policy” on educational articles by authors with industry ties. They predict that the NEJM’s new approach could herald a decline in journal quality or, perhaps, help galvanize strong opposition.

“In 1990, it was a bad idea for authors of editorials, review articles, and other opinion articles in medical journals to have financial conflicts of interest. A quarter of a century later, it is a very bad idea. The articles by Rosenbaum and the supportive editorial by Drazen could presage a further weakening of the conflict of interest policy at the NEJM, or they could serve as a wake-up call for all medical journals and the profession. It is time to move forward, not backward.”

The piece is worth reading in its entirety, as is a related editorial by current BMJ editors Elizabeth Loder, Catherine Brizzell, and Fiona Godlee, who say they are “deeply troubled by a possible retreat from policies that prevent experts with relevant commercial ties from authoring commentary or review articles.”

While Dr. Susan Molchan – one of our editorial contributors – was one of the first to register opposition to the NEJM’s soft-pedaling on conflict of interest, it is important for leaders like these editors to weigh in forcefully as they did with their conclusion: “It is a mistake by NEJM to suggest that rigorous standards should be revisited. To do so would undermine the trustworthiness of medical journals and be a disservice to clinical practice and patient safety.”

(Publisher’s note for journalists:  We offer a list of industry-independent experts to help you do your work. But we wonder why we’ve seen almost no mainstream news media coverage of this continuing NEJM controversy.)

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