A Viewpoint article in the Journal of the American Medical Association (JAMA), “Confluence, Not Conflict of Interest: Name Change Necessary,” caught the eye of Dr. Richard Lehman, who writes the wonderful journal review blog for The BMJ.
First, an excerpt from the JAMA piece to give you a sense of what it’s about:
“The term conflict of interest is pejorative. It is confrontational and presumptive of inappropriate behavior. Rather, the focus should be on the objective, which is to align secondary interests with the primary objective of the endeavor—to benefit patients and society—in a way that minimizes the risk of bias. A better term—indicative of the objective—would be confluence of interest, implying an alignment of primary and secondary interests. In this regard, the individuals and entities liable to bias extend far beyond the investigator and the sponsor; they include departments, research institutes, and universities. The potential for bias also extends to nonprofit funders, such as the National Institutes of Health and foundations, as well as to journals that might, for example, generate advertising revenue from sponsors.”
Lehman called this article “disingenuous denial.” He wrote:
“I think it marks a low point for JAMA. It aligns the journal with the disingenuous deniers who pretend that conflicts of interest don’t arise when authors and investigators write about work that they have a vested interest in promoting. It joins together JAMA with the New England Journal of Medicine which took a similar stance in a series of opinion papers earlier this year. This is a sort of Republican Tea Party of the soul, where you know you are saying something false and daring people to contradict you, knowing that their very engagement is a form of legitimation.”
We wrote about the New England Journal of Medicine series earlier this year.
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Comments (3)
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Tim Church
November 10, 2015 at 10:38 amNon-monetary conflicts of interest are real and everyone has them. To conflate such conflicts with the economic conflicts that are at the heart of COI policies is totally disingenuous and an attempt to blunt the perception that economic conflicts are undesirable. As Upton Sinclair said, “It is difficult to get a man to understand something, when his salary depends upon his not understanding it!”
Thomas Concannon
November 17, 2015 at 7:25 amI read this opinion piece differently. Rather than promoting a denial of conflict, it recommends we expand the search for bias-inducing relationships. This notion is presented in the following quote: “In this regard, the individuals and entities liable to bias extend far beyond the investigator and the sponsor; they include departments, research institutes, and universities.” I, for one, consider the current rules on COI as disingenuous, amounting to little more than academics pointing their fingers at the biases induced by relationships outside of academia. Current rules allow academics to ignore bias induced through their own relationships with teaching hospitals. These behemoths, though not for profit, are just as hungry for revenue as the instituitions that manufacture healthcare products. How else can you explain an $87 charge for aspirin? In full disclosure, I have a financial relationship with a hospital and it amounts to more than $5000.
jerome schofferman
November 17, 2015 at 1:41 pmI fully agree with the comments of Dr Lehman. The opinion that conflict of interest should be replaced by confluence was the consensus of a two-day conference. The entire conference is available for viewing and listening. The conference was primarily focused on medical research. Many if not most participants had direct or indirect ties to industry including some venture capitalists. There was minimal to no discussion of how COI might affect patient care. despite the stated intention of their meeting, the most cynical part of me might call it collusion of interest.
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