Governance of conflicts of interest in the publication of health research – perspectives on ways forward from a journal

Identifying corporate influence and biases in the publication of academic research is fraught with difficulty, as this presentation explores. Journals often rely on authors' own disclosures of interests, which may intentionally or unintentionally omit relevant conflicts. Financial conflicts of interests may be easier for authors and editors to identify, allowing some mitigation, but non-financial conflicts of interest and corporate influence can be harder to tease out. Both authors and journals make multiple judgements on which interests are relevant and it is easy for opaque conflicts to slip through the cracks.

Even if these conflicts of interests are declared, moreover, many journals rely on transparency to inform their policy on publishing research by authors with links to industry; this transparency assumes that readers are able to discern the potential bias arising from these relationships. However - while we know that readers consider research papers written by authors with declared financial links to industry to be less important, relevant, rigorous, and believable - this may lead readers to place unwarranted trust in research from authors whose conflicts are less clearly visible. For example, from authors aligned with academic institutions whose departments may experience corporate influence, but in a manner too indirect to be declared.

In order to consider these issues in context, delegates will be asked to make judgements on whether particular conflicts of interest statements would exclude authors from publishing with one leading journal, the British Medical Journal. They will hear how journals are now moving beyond transparency in order to better engage with these themes: via such initiatives as, for example, registries of interests; the re-definition of competing interests as relationships; and increasingly widespread policies that entirely exclude authors with financial ties to industry from publishing.

Rapid full-length genomic sequencing of two cytopathically heterogeneous Australian primary HIV-1 isolates

Two Australian HIV-1 isolates, derived from patient blood (HIV(MBC200)) and cerebrospinal fluid (HIV(MBC925)), were characterized after in vitro culture in peripheral blood mononuclear cells (PBMC). Although virus replication was similar, as measured by cell-free reverse transcriptase activity, only one of the two isolates (HIV-1(MCB200)) consistently induced cell syncytia and depleted the PBMC population of CD4+ cells by cell killing. A novel technique, devised for rapidly obtaining high-quality viral sequence data and the full-length genomic sequence of these two isolates, is presented. Analysis of the predicted sequence of the viral Env proteins provides correlates of the observed phenotypes. Phylogenetic analysis derived using near full-length sequence of these and other HIV-1 subtype B genomic sequences (including two other Australian isolates) shows a star-shaped phylogeny with each member having a similar genetic diversity. These data expand the database of genomic sequence available from well-characterized primary clinical isolates of HIV-1 using a novel rapid technique.

Autoimmune haemolytic anaemia in infancy with anti-Kpb specificity

Autoimmune haemolytic anaemia (AIHA) in infancy is rare. We report a case of AIHA in a male infant whose serum contained an antibody with apparent anti-Kpb specificity. Autoantibody with anti-Kpb specificity has been described in adults; to our knowledge, this is the first case of this kind described in infancy with AIHA. Clinical course and response to red cell transfusion are described.

Genomic structure of an attenuated quasi species of HIV-1 from a blood transfusion donor and recipients

A blood donor infected with human immunodeficiency virus-type 1 (HIV-1) and a cohort of six blood or blood product recipients infected from this donor remain free of HIV-1-related disease with stable and normal CD4 lymphocyte counts 10 to 14 years after infection. HIV-1 sequences from either virus isolates or patient peripheral blood mononuclear cells had similar deletions in the nef gene and in the region of overlap of nef and the U3 region of the long terminal repeat (LTR). Full-length sequencing of one isolate genome and amplification of selected HIV-1 genome regions from other cohort members revealed no other abnormalities of obvious functional significance. These data show that survival after HIV infection can be determined by the HIV genome and support the importance of nef or the U3 region of the LTR in determining the pathogenicity of HIV-1.

Otorrhoea in children with middle ear ventilation tubes: a comparison of different types of tubes

Otorrhoea is a troublesome complication of middle ear ventilation tubes. This investigation of children with various ventilation tubes shows that the incidence of this complication varies with the type of tube used. In particular, Paparella type 2 tubes are associated with a higher rate of otorrhoea, and should be reserved for use when long-term ventilation is necessary.