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Academy News: September 2006Conflicts of interest: how much information should be disclosed? We read the latest research article and see that the authors have declared that they have no potential conflicts of interest. Is this true? Does our current system of required disclosures adequately protect the biomedical literature or the latest educational program? Perhaps the system does not work as well as we might think—if current events at the Journal of the American Medical Association (JAMA) are any indication. Recently, JAMA published a study examining the biological association between migraines and cardiovascular disease.1 The authors of this study declared no conflicts; however, it soon came to light that all of the authors had received financial support from pharmaceutical companies who made migraine or heart-related treatments.2 However, the study involved examining a link between two disease states, not an examination of therapeutics in the diseases, and the authors stated that they did not report the ties because “they did not believe they were relevant to the study.”2 This brings up an important question. Who is responsible in determining what is considered a potential conflict of interest? Is it the author, the presenter, the editor, the program chair or the audience? The American Medical Association (AMA) Code of Medical Ethics makes it quite clear in the case of studying a specific drug or product that a disclosure should be made, but provides no useful guidance regarding disease states and ties to the industry that provides therapeutics for these disease state.3 Surely the answer is to have authors disclose all of the financial ties they have. While this approach has supporters, it would lead to disclosure of a great deal of irrelevant information and might lead to information overload—so many disclosures by everyone, that the real conflicts would be diluted or hidden. Would you read through a page or more of disclosures on each article? Catherine DeAngelis, MD, the editor-in-chief of JAMA, had a different approach. She would “decide what’s pertinent or not.”2 Maybe this is somewhat of a middle ground, but it leaves much to a single person to make a decision on what is a relevant conflict. This may work for JAMA, but what about smaller journals? Perhaps what we really need is a system of peer-review, similar to the way in which biomedical research papers are scrutinized for scientific accuracy. Allowing several people to look at the authors’ full disclosures and then make a judgment on what is relevant, might lead to a more fair and useful way to determine and report potential conflicts. However revelation of potential conflicts of interest is handled, it is important that the reader (i.e. the audience) is aware of how these disclosures were determined. In this manner, the reader will be able to better judge any potential bias that might lurk in the publication. As with educational programs, the caveat “buyer beware” remains. The biggest problem lies in making sure the reader has all of the pertinent information to make an educated decision on the research being presented. References
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