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extreme weather events
flooding 2011
global health
NHS
NZ Election 2017
WHO
health
Healthcare and health reform
abortion
adverse events
aged care
allied health care
Australian Medical Association
cancer
cardiovascular disease
child health
Choosing Wisely
chronic diseases
co-payments
Cochrane Collaboration
complementary medicines
conflicts of interest
death and dying
diabetes
digital technology
disabilities
e-health
emergency departments and care
Equally Well
euthanasia
evidence-based issues
general practice
genetics
health & medical marketing
health and medical education
health and medical research
Health Care Homes
health ethics
health financing and costs
health reform
health regulation
health workforce
HIV/AIDS
hospitals
HRT
infectious diseases
influenza
international medical graduates
journal articles
LGBTIQ
medical marijuana
Medicare Locals
men's health
mental health
MyHospitals website
National Commission of Audit 2014
National Health Performance Authority
naturopathy
NDIS
NHMRC
non communicable diseases
nurses and nursing
oral health
organ transplants
out of pocket costs
pain
palliative care
paramedics
pathology
Pharmaceutical Benefits Scheme
pharmaceutical industry
pharmacy
Pregnancy and childbirth
primary health care
Primary Health Networks
private health insurance
quality and safety of health care
rural and remote health
screening
sexual health
social media and healthcare
suicide
surgery
swine flu
telehealth
tests
TGA
trauma
women's health
youth health
Indigenous health
#CTG10
#NTRC
Acknowledgement
cultural safety
Indigenous education
Lowitja Institute
NT Intervention
social and emotional wellbeing
Uluru Statement
WA community closures
News about Croakey
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Public health and population health
#PreventiveHealthStrategy
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alcohol
consumer health matters
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food and nutrition
gambling
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health communications
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legal issues
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media-related issues
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Croakey and conflicts of interest: what do you think?

As regular readers may have guessed, Croakey takes a keen interest in conflict of interest issues, as indicated by the Crikey Register of Influence and our regular coverage of related stories.

Of course, it’s not only Croakey who follows such matters – conflict of interest has been one of the big and important ongoing stories of health and medical research, practice and policy for some years now. Much more detail is available from the Institute of Medicine in the US which has recently published a landmark report addressing these issues.

But Croakey has been living in something of a glass-house. We haven’t had a formal policy to help readers assess the conflicts of our contributors and also of the Coakey moderator (that’s me, Melissa Sweet).

So if you’ve time to have a quick read of the draft Croakey Conflict of Interest Policy below, your feedback would be appreciated. Much of the material has been adapted from the World Association of Medical Editors (WAME) statement on this topic.

Draft Croakey Conflict of Interest policy

Why do conflicts of interest matter?

The World Association of Medical Editors notes that everyone has conflicts of interest of some sort, and that this does not, in itself, imply wrongdoing. But if these are not managed effectively, they can cause authors and editors to make decisions that, consciously or unconsciously, tend to serve their competing interests.

What are conflicts of interests?

The World Association of Medical Editors notes that there are many kinds of competing interests.

These include:

• Financial ties

Examples of financial ties to industry include payment for research, ownership of stock and stock options, as well as honoraria for advice or public speaking, consultation, service on advisory boards or medical education companies, and receipt of patents or patents pending.  Also included are having a research or clinical position that is funded by companies that sell drugs or devices. Competing interests can be associated with other sources of research funding including government agencies, charities (not-for-profit organizations), and professional and civic organizations.  Clinicians have a financial competing interest if they are paid for clinical services related to their research —for example, if they write, review, or edit an article about the comparative advantage of a procedure that they themselves provide for income. Financial competing interests may exist not just on the basis of past activities but also on the expectation of future rewards, such as a pending grant or patent application.

• Academic commitments

Participants in the publications process may have strong beliefs (“intellectual passion”) that commit them to a particular explanation, method, or idea.  They may, as a result, be biased in conducting research that tests the commitment or in reviewing the work of others that is in favor or at odds with their beliefs.

• Personal relationships

Personal relationships with family, friends, enemies, competitors, or colleagues can pose COIs.  For example, a reviewer may have difficulty providing an unbiased review of articles by investigators who have been working colleagues.

• Political or religious beliefs

Strong commitment to a particular political view (eg, political position, agenda, or party) or having a strong religious conviction may pose a COI for a given publication if those political or religious issues are affirmed or challenged in the publication.

• Institutional affiliations

A COI exists when a participant in the publication process is directly affiliated with an institution that on the face of it may have a position or an interest in a publication.  An obvious concern is being affiliated with or employed by a company that manufactures the drug or device (or a competing one) described in the publication.  However, apparently neutral institutions such as universities, hospitals, and research institutes may also have an interest in the results of research. Professional or civic organisations may also have competing interests because of their special interests or advocacy positions.

How does Croakey manage conflicts of interests?

• Contributors to Croakey are expected to declare any potential conflicts of interests at the bottom of their posts. Ideally, these should also be declared on comments but we acknowledge that this is difficult to enforce, given that many comments are anonymous.

• If you are not sure whether to declare something, please ask. You may wish to consider the World Medical Association of Editors prompt that, “if my competing interest becomes known to others later, would I feel defensive or would others in the publication process, readers or the public think I was hiding my other interests or could they feel I misled or deceived them?”

• If Croakey subsequently discovers that relevant conflicts of interest have not been declared, they shall be published at a later stage.

The Croakey moderator Melissa Sweet has many conflicts of interests, including:
• contributor to Australian Rural Doctor and Pharmacy News(Reed Business), Australian Nursing Journal, British Medical Journal, The Worker (published by ACP for The Worker magazine), Inside Story (Swinburne University), and the Medical Journal of Australia. She has had books published by Pan MacMillan, Allen & Unwin, and ABC Books. She is occasionally asked to review articles for the Medical Journal of Australia and the Australian and New Zealand Journal of Public Health. She is a founding member of the Foundation for Public Interest Journalism, based at the Institute for Social Research at Swinburne University.
• she has honorary appointments with the University of Sydney School of Public Health and the University of Notre Dame’s medical school (Sydney campus). She is not paid for these appointments but the networks and information she obtains through these appointments do have an influence upon her thinking and work.
• she does occasional paid work for not-for-profit organisations, writing and editing reports. Clients have included the Canadian Health Services Research Foundation, the Milbank Memorial Fund in the US, the Sax Institute, the NHMRC, Research Australia, VicHealth, and the Centre for Primary Health Care and Equity at the University of NSW.
• she is a member of the Media, Entertainment and Arts Alliance, and the Australasian Medical Writers Association, and has an ongoing association with the Dart Centre for Journalism and Trauma. More details about her affiliations and associations are available here.

Comments 5

  1. Margaret Simons says:

    Extraordinarily thorough. Good stuff.

  2. William Parsonage says:

    Well about time to.

    The much maligned medical profession is way ahead of the journalists game here. Journals and meetings for several years have required mandatory declarations of conflicts of interest for all publications and presentations. In contrast, the public media (and that includes Crikey, of which I am an avid follower and subscriber) is able to publish and broadcast widely and with ‘authority’ without a policy at all.

    Your so called register of interests is a nonsense – as pointed out eloquently by the couple of colleagues who could be bothered to respond. The implications of the list are clear – despite your qualifying statement.

    This links very nicely to your current ‘campaign’ regarding involvement of the pharmaceutical industry in education and research. Whilst accepting that this is an area that is ripe for reform there is a dire need for some balance in the argument, not least recognition of the fact that successive governments (globally) have increasingly abrogated their responsibility to support these areas adequately for years now.

    The health system in Australia could surely be better, but is probably second to few. Someone has been investing in it. Have you??

    Conflicts of interest: Several, but none that are directly linked to these comments

  3. Trevor Kerr says:

    It’s only about the money, and the difference between a $10 sandwich and $10,000 worth of shares. All the other interests may be listed, but they cannot be weighted.
    We see the NHMRC is talking about smartening up its own COI guidelines.
    http://nhmrc.gov.au/media/media/rel09/091002-conflict-of-interest.htm
    What may we expect? Something gentle, like the usual practice of the chair asking around at each meeting? Maybe a confidential off-the-record chat with the Minister?
    How about the NHMRC does a global scan, seeking out how other bodies do it?
    Would it be too much to expect that partners/spouses of NHMRC Council members put their assets and appropriations up for declaration, too?
    Australia’s research future may be on a sounder footing if there was less risk of reputable investors being undercut by competitors who are prepared to support slack standards of disclosure.

  4. Trevor Kerr says:

    Bob Williamson (AAS) just on ABC radio crowing about Liz Blackburn. Well, yes, will tighter COI standards at the highest levels promote more, or less, involvement in, say, international clinical trials for cancer treatments? Who knows? Who cares? Why not flog off access to punters for trials to the lowest bidders?
    Do any of our notable clinical researchers insist that *all* results are published, not just the ones with positive outcomes? Or are there incentives to bury the “unhelpful” results? Why should these questions be aired in public, when there are delicate reputations to uphold?
    [I will disclose my pecuniary interests (49 tanking shares in Bluescope Steel) when the Chief Medical Officer does likewise.]

  5. Steve Lambert says:

    Melissa Sweet’s statement of interests is welcome and timely, but there are subtleties that are missed with any such listing.

    Journalists are inherently conflicted by the need to have their articles read. Controversy attracts readers. How is this conflict to be captured in a list? Sweet has moderated, written, or overseen a large volume of commentary on Crikey that has been, in my opinion, unreasonably critical of the Commonwealth Government’s H1N1 vaccination program using the CSL Ltd produced, TGA licensed vaccine. This commentary has focussed on rare, mild, or theoretical adverse effects of vaccination whilst almost universally ignoring the now 183 people who have died from H1N1 infection, and the 4,806 people hospitalised this flu season. In this last week alone, according to the Commonwealth’s most recent report, there have been 36 people hospitalised, 10 into intensive care, with H1N1.

    For a thematic discussion allegedly on the merits of the vaccination program, the coverage has been extremely unbalanced. As Editors of the Lancet learned following the publication of Andrew Wakefield’s 1998 paper suggesting a link between measles-mumps-rubella vaccine and autism, you need to be careful and sure of your facts when raising safety issues about vaccines.

    But back to declarations of interest. Blog posts and articles with titles that imply the Minister is covering up facts, that there is real reason to be concerned about severe vaccine adverse events, will draw more readers than neutral or positive titles. Becoming known for promoting such controversial views will generate interest from other media outlets: radio interviews, guest articles and the like, all improving the journalist’s profile. How is any of this captured in a declaration of interest? I don’t think it can be. And whilst it may be good copy for the media outlet and journalist involved, we have no way of measuring the damage it may do in terms of generating irrational, non-evidence based fear of vaccination in the broader community.

    Stephen Lambert

    Declaration of interest: I am a public health physician and medical epidemiologist. I have a primary interest in the epidemiology of vaccine preventable and other infectious diseases. I have been a co-investigator on numerous industry sponsored vaccine trials since 1999 (including the current CSL Ltd sponsored H1N1 paediatric trial), received fees as a member of industry advisory panels relating to vaccines, and received travel support to attend and present at international conferences by pharma companies.

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