Researchers examining the effect of financial conflicts of interest have found a strong association with authors' published positions on the safety of a type of heart medication and their financial relationships with pharmaceutical manufacturers. The results of the study are published in the Jan. 8 issue of the New England Journal of Medicine.
"The pharmaceutical industry provides substantial financial support for research and medical education," says lead investigator Professor Allan Detsky of the departments of health administration and medicine at the University of Toronto, physician-in-chief at Mount Sinai Hospital and the department of medicine at The Toronto Hospital. "The debate about the use of calcium-channel blockers, a medication used to treat high blood pressure and coronary artery disease, provided an opportunity to study financial conflicts of interest in medicine."
The researchers examined the positions of authors in 70 articles published from March 1995 to September 1996 about the safety of calcium-channel blockers and manufacturers of competing products. The articles were independently assessed by two of the investigators and assigned a classification of supportive, neutral or critical. Of the 70 articles, 30 were classified as supportive, 17 as neutral and 23 as critical.
Questionnaires were then sent to 86 of the 89 authors to obtain their reported financial relationship with pharmaceutical manufacturers. This enabled researchers to compare the authors' positions on the safety of calcium-channel blockers with their financial relationships with pharmaceutical companies. Eighty-three percent of the authors responded to the questionnaire.
The investigators found that 96 percent of the supportive authors had financial relationships with manufacturers of calcium-channel antagonists, as compared with 60 percent of the neutral authors and 37 percent of the critical authors. The researchers also found that supportive and neutral authors were more likely than critical authors to have financial interactions with manufacturers of competing products (87 percent and 53 percent, respectively, versus 37 percent). In addition, 100 percent of the supportive authors, as compared with 67 percent of the neutral authors and 43 percent of the critical authors, were found to have financial interactions with at least one pharmaceutical manufacturer. Each of these results were statistically significant.
"This study emphasizes why it is important for physicians to clearly disclose their financial relationships with manufacturers to ensure that readers and journalists can determine for themselves if there is any potential bias in an author's position," says Detsky. "Editors of journals also need to be more specific in their determination of any potential bias when requesting editorial material," he adds, suggesting editors provide potential authors a questionnaire to help disclose any conflicts and avoid any ambiguity and accidentally missed conflicts.
"Medical journals would risk limiting their pool of experts available to debate medical issues if they were to exclude the publication of articles by physicians with financial relationships with manufacturers," Detsky explains. "Physicians and researchers simply need to disclose their financial relationships."
Detsky conducted the study together with investigators Dr. Henry Thomas Stelfox, a medical resident at the University of Toronto, Dr. Grace Chua, a staff cardiologist at York Central Hospital, and Keith O'Rourke, a statistician at The Toronto Hospital and the department of public health sciences at the University of Toronto. This investigation did not receive financial support from the pharmaceutical industry.
Journal
New England Journal of Medicine