Conflicts of interest in government-funded studies

Do Editorialists With Industry-Related Conflicts of Interest Write Unduly Favorable Editorials for Cancer Drugs in Top Journals?

BACKGROUND

Editorials accompanying the publication of trials in major oncology journals can have a substantial influence on clinical practice. We describe the prevalence of financial conflicts of interest (FCOIs) of authors writing such editorials and the extent to which FCOIs may shape the interpretation of clinical trials.

METHODS

We examined editorials published in 2018 alongside trial reports in the top 5 journals that publish cancer drug trials (New England Journal of Medicine, Lancet, Lancet Oncology, JAMA Oncology, and Journal of Clinical Oncology). An editorial was considered to have an FCOI if at least one of the editorialists had any disclosed FCOI. An FCOI with the same company whose drug was being discussed in the editorial was classified as a direct FCOI. Editorials were reviewed for their content and classified as being unduly favorable (defined as the presence of a positive spin without discussion of limitations) or not. Association of an FCOI and a direct FCOI with writing an unduly favorable editorial was assessed.

RESULTS

Of the 90 editorials assessed, 74% (n=67) were classified as having an FCOI with the pharmaceutical industry, and 39% (n=35) had an FCOI with the same company whose product was being discussed in the editorial (direct FCOI). Editorials were classified as being unduly favorable toward the study drug in 12% (8 of 67) and 13% (3 of 23) (P=1.0) of those with and without FCOIs, respectively; corresponding rates with and without direct FCOI were 23% (8 of 35) and 5% (3 of 55), respectively (P=.009).

CONCLUSIONS

Editorials in top oncology journals were frequently authored by experts with FCOIs, including direct FCOIs. Authoring an unduly favorable editorial for a new cancer drug was significantly associated with the author having a direct FCOI with the same company. These findings support the call for journals to ensure that authors of editorials have no direct FCOIs.

Evidence Regarding the Impact of Conflicts of Interest on Environmental and Occupational Health Research

PURPOSE OF REVIEW

This review describes published literature providing evidence for financial conflicts of interest in environmental and occupational health research. Secondary goals were to describe evidence that (a) utilized quantitative methods to evaluate the association of conflicts with study outcomes, and (b) assessed undisclosed as well as disclosed conflicts of interest.

RECENT FINDINGS

Forty-three studies were identified which contained descriptions of the impact of financial conflicts of interest on research results; 11 of these conducted quantitative analyses to demonstrate these relationships. All 11 articles which quantified associations identified significant associations of the presence of financial conflicts of interest with study findings. In studies which measured undisclosed conflicts, these comprised a substantial proportion of all conflicts. Suggestions for improving understanding and interpretation of research results are presented.

Conflicts of interest, smoke and mirrors

Commercial funding of research studies may potentially influence or bias the findings and interpretation of results. An editorial on conflicts of interest suggested that funding from non-commercial sources, such as government agencies, may also represent a conflict of interest, and uses the Women's Health Initiative (WHI) as an example of how this might be. Two WHI investigators responded by claiming that the arguments put forward in the editorial were largely 'red herrings' and were aimed at disparaging the WHI results. But there is evidence of bias in the presentation and interpretation of WHI findings by some investigators which may be due to conflicts of interest. It is probably wise to declare all sources of external research funding, including industries, governments and charities, as conflicts of interest so that reviewers of such research studies are alerted to give them full scrutiny for evidence of external influences.

Of conflicts, conspiracies, red herrings, and black swans

The impact of the findings from the Women's Health Initiative trial of estrogen plus progestin cannot be attributed to any real or imagined conflicts of interest between government, researchers, and journals. Rather, the findings overturned decades of dogma in part promoted by the pharmaceutical industry, and the reaction to these unexpected findings was in direct proportion to their importance in reversing a misguided practice of prescribing the drug for chronic disease prevention. The findings have been widely accepted, as shown by the sustained subsequent reduction in prescriptions. However, conflicts of interest may influence a minority unwilling to accept the findings. The decrease in the use of a drug with an adverse risk profile for prevention of chronic disease is a public good.