Tuesday, November 18, 2008

Conflict of Interest: Resolved? What does that mean?

I just posted on the reently published guidelines for antidepressants in the treatment of depression - carefully phrased to indicate the qualifier IF you are gonna use meds, while not bringing too much attention to the IF issue (successful, as headliens seem to indicate).

The article is: Qaseem et al. Using Second Generation Antidepressants ... Annals of Internal Medicine 2008;149:725-733.

Wondering (OK, actually, "suspecting") a conflict of interest, I looked for a COI statement. One conflict is noted: One author, Snow, has received pharmaceutical funding. Fair enough. Just let us know so we can include a grain of salt when flavoring the findings.

But that statement is followed by the curious statement:
"Any conflict of interest of the group members was declared, discussed, and resolved."

Resolved?

There is no such thing.

One of the challenges of science is to minimize any and all sources of bias, so as to test, as purely as possible, the specific hypothesis at hand.

There are many kinds of bias. One area of bias is "experimenter bias." Simply put: as long as an experimenter has some vested interest in an outcome, SCIENCE itself declares that, whether any bias is involved or not, that the result is to be considered suspect to some degree. The theoretical possibility of experimenter bias is enough to taint the study. That is all that is necessary to have a theoretical conflict of interest: to have any degre of care regarding the outcome. Done. Degree of nobility has nothing to do with it.

If any author has in recent history had any financial relation with any of the involved pharma companies, the taint is there.

It cannot be "resolved." It just is.

So: I have no idea what "resolved" means.

Something is fishy.

Being skeptical, as we scientists should be, I start thinking abt who has bankrolled this endeavor: it has apparently been paid for by the "American College of Physicians' operating budget."

which should seem to put the study "above" the spectre of bias or COI.

But let's think abt thia bit more.

Who bankrolls the ACP?

So, I google.
ACP publishes several journals, including Annals of Internal Medicine, that make money by selling ads for: first on their list of acceptable ads: FDA-approved prescription meds.

OK, so the journal itself, exercising its editorial control, has a vested interest in the livelihood of pharmaceutical companies.

In the words of Thurgood Marshall, "Those companies willing to pay for advertising space got it."

Lead author, Qaseem: google: OK he has been funded by Endo, a company testing SSRIs for pain. As luck would have it, this was one of the sub-topics of the article!

So, now lead author Qaseem, and the Annals itself, have COI / have a vested interest in the results but with no disclosure. Snow has "resolved" conflict, whatever that means.

Well, that's enough for me to see the spectre of conflict and bias, "resolved" or not.

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