Ethics, morality, and conflicting interests: how questionable professional integrity in some scientists supports global corporate influence in public health

Toolkit for detecting misused epidemiological methods

BACKGROUND

Critical knowledge of what we know about health and disease, risk factors, causation, prevention, and treatment, derives from epidemiology. Unfortunately, its methods and language can be misused and improperly applied. A repertoire of methods, techniques, arguments, and tactics are used by some people to manipulate science, usually in the service of powerful interests, and particularly those with a financial stake related to toxic agents. Such interests work to foment uncertainty, cast doubt, and mislead decision makers by seeding confusion about cause-and-effect relating to population health. We have compiled a toolkit of the methods used by those whose interests are not aligned with the public health sciences. Professional epidemiologists, as well as those who rely on their work, will thereby be more readily equipped to detect bias and flaws resulting from financial conflict-of-interest, improper study design, data collection, analysis, or interpretation, bringing greater clarity-not only to the advancement of knowledge, but, more immediately, to policy debates.

METHODS

The summary of techniques used to manipulate epidemiological findings, compiled as part of the 2020 Position Statement of the International Network for Epidemiology in Policy (INEP) entitled Conflict-of-Interest and Disclosure in Epidemiology, has been expanded and further elucidated in this commentary.

RESULTS

Some level of uncertainty is inherent in science. However, corrupted and incomplete literature contributes to confuse, foment further uncertainty, and cast doubt about the evidence under consideration. Confusion delays scientific advancement and leads to the inability of policymakers to make changes that, if enacted, would-supported by the body of valid evidence-protect, maintain, and improve public health. An accessible toolkit is provided that brings attention to the misuse of the methods of epidemiology. Its usefulness is as a compendium of what those trained in epidemiology, as well as those reviewing epidemiological studies, should identify methodologically when assessing the transparency and validity of any epidemiological inquiry, evaluation, or argument. The problems resulting from financial conflicting interests and the misuse of scientific methods, in conjunction with the strategies that can be used to safeguard public health against them, apply not only to epidemiologists, but also to other public health professionals.

CONCLUSIONS

This novel toolkit is for use in protecting the public. It is provided to assist public health professionals as gatekeepers of their respective specialty and subspecialty disciplines whose mission includes protecting, maintaining, and improving the public's health. It is intended to serve our roles as educators, reviewers, and researchers.

Association Between Financial Conflicts of Interest and ILO Classifications for Black Lung Disease

RATIONALE

The US Department of Labor administers the Federal Black Lung Program (FBLP), an administrative system charged with managing claims by coal miners for workers' compensation for totally disabling coal mine dust lung disease. Specific case reports have raised concern that financial conflicts of interest (COI) may systematically bias physicians when they are classifying chest x-rays (CXRs) for the absence, presence and severity of pneumoconiosis.

OBJECTIVE

To evaluate the direction and magnitude of association between financial COI of physicians participating in the FBLP and international standards for the classification of radiographs of pneumoconiosis.

METHODS

An epidemiologic assessment of black lung claims filed to the FBLP, 2000-2013, was conducted to determine physician classifications of radiographs. FBLP court decisions for years 2002-2019 (n=7,656) were used to evaluate financial COI of each physician. The main outcome measures used were classifications of radiographs for the absence of pneumoconiosis (small opacity classifications of 0/0 or 0/1), simple pneumoconiosis (small opacity classifications of 1/0 through 3/+) and Progressive Massive Fibrosis (PMF; large opacities with classifications of A, B or C).

RESULTS

Out of 63,780 radiograph classifications made by 264 physicians, 31.4% were read positive for simple pneumoconiosis and 3.6% were read as having progressive massive fibrosis (PMF). There were 52 physicians who classified CXRs as having no evidence of pneumoconiosis in 99%+ of their readings, and 18 physicians who classified CXRs as positive for simple pneumoconiosis in 99%+ of their readings. The adjusted odds of a negative classification of pneumoconiosis was 1.46 (CI95%: 1.44, 1.47) per 10% increase in the proportion of court records demonstrating that a physician was hired by the employer. Per 10% increase in court records indicating a physician was hired by the miner-claimant, the adjusted odds ratio for classifying simple pneumoconiosis was 1.51 (CI95%: 1.49, 1.52) and for finding PMF was 1.28 (CI95%: 1.26, 1.30).

CONCLUSIONS

There was a strong association between source of payment and radiograph classification suggesting the importance of eliminating financial COI in what should be an objective determination of eligibility for Black Lung workers' compensation benefits.

Ongoing downplaying of the carcinogenicity of chrysotile asbestos by vested interests

Industries that mine, manufacture and sell asbestos or asbestos-containing products have a long tradition of promoting the use of asbestos, while placing the burden of economic and health costs on workers and society. This has been successfully done in recent years and decades in spite of the overwhelming evidence that all asbestos types are carcinogenic and cause asbestosis. In doing so, the asbestos industry has undermined the WHO campaign to reach a worldwide ban of asbestos and to eliminate asbestos-related diseases. Even worse, in recent years they succeeded in continuing asbestos mining and consuming in the range of about 1.3 million tons annually. Nowadays, production takes place predominantly in Russia, Kazakhstan and China. Chrysotile is the only asbestos type still sold and represents 95% of asbestos traded over the last century.The asbestos industry, especially its PR agency, the International Chrysotile Association, ICA, financed by asbestos mining companies in Russia, Kazakhstan and Zimbabwe and asbestos industrialists in India and Mexico, continues to be extremely active by using slogans such as chrysotile can be used safely.Another approach of the asbestos industry and of some of its insurance agencies is to broadly defeat liability claims of asbestos victims.In doing so they systematically use inappropriate science produced by their own and/or by industry-affiliated researchers. Some of the latter were also engaged in producing defense material for other industries including the tobacco industry. Frequent examples of distributing such disinformation include questioning or denying established scientific knowledge about adverse health effects of asbestos. False evidence continues to be published in scientific journals and books.The persisting strong influence of vested asbestos-related interests in workers and public health issues including regulations and compensation necessitate ongoing alertness, corrections and appropriate reactions in scientific as well as public media and policy advisory bodies.

Rethinking Environmental Carcinogenesis

The 2010 report of the President's Cancer Panel concluded that the burden of cancer from chemical exposures is substantial, while the programs for testing and regulation of carcinogens remain inadequate. New research on the role of early life exposures and the ability of chemicals to act via multiple biological pathways, including immunosuppression, inflammation, and endocrine disruption as well as mutagenesis, further supports the potential for chemicals and chemical mixtures to influence disease. Epidemiologic observations, such as higher leukemia incidence in children living near roadways and industrial sources of air pollution, and new in vitro technologies that decode carcinogenesis at the molecular level, illustrate the diverse evidence that primary prevention of some cancers may be achieved by reducing harmful chemical exposures. The path forward requires cross-disciplinary approaches, increased environmental research investment, system-wide collaboration to develop safer economic alternatives, and community engagement to support evidence-informed action. Engagement by cancer researchers to integrate environmental risk factors into prevention initiatives holds tremendous promise for reducing the rates of disease.See all articles in this CEBP Focus section, "Environmental Carcinogenesis: Pathways to Prevention."

How can the integrity of occupational and environmental health research be maintained in the presence of conflicting interests?

BACKGROUND

The sciences, and especially the research subspecialties of occupational and environmental health, are being misused. The misuse serves to interfere with the advancement of policies that depend on rational evidence needed for policies to protect public health.

METHODS

We selectively surveyed the independent scientific literature. In addition, the efforts of respected international professional organizations of scientists whose focus is on maintaining and improving public health have been considered. This commentary is unique in assembling not only the factual basis for sounding alarms about significant bias in occupational and environmental health research, but also about the manipulative mechanisms used, and, in turn, the methods needed to keep science honest.

RESULTS

Scientific integrity is based on the principle that research is conducted as objectively as possible; it cannot be compromised by special interests whose primary goals are neither to seek truth nor to protect human health. Evidence demonstrates a significant risk of bias in research reports sponsored by financial interests. Practices of corporate malfeasance include the orchestrated contamination of editorial boards of peer-reviewed scientific journals with industry apologists; interference with activities of national regulatory bodies and international review panels engaged in safeguarding occupational and public health; constructing roadblocks by capitalizing on uncertainty to undermine scientific consensus for much-needed government regulation of carcinogenic, endocrine-disrupting and/or immunotoxic agents; promoting "causation" criteria that lack foundation and effectively block workers' access to legal remedies for harms from occupational exposures resulting in morbidity and premature mortality; and, violating standards of professional conduct by seducing reputable scientists with financial incentives that make them beholden to corporate agendas.

CONCLUSIONS

Well-orchestrated assaults on science continue unabated and must now be met head-on. Success could be achieved by promoting and protecting the integrity of research. Furthermore, avoiding influence by conflicted corporate affiliates in occupational and public health regulations is needed. Identifying, managing and, ideally, eliminating corporate influence on science and science policy are needed to protect research integrity. Protecting the public's health, preventing disease, and promoting well-being must be the unambiguous goals of research in occupational and environmental health.

Asbestos in Colombia: Industry versus science and health

The usefulness of an industrial product must be measured both in economic profitability and product safety terms, and the social benefit it represents. In the case of asbestos, due to its harmful effects on human health, its use, handling and production has been banned in high-income countries thanks to the efforts carried out by their oversight bodies. Worldwide, the industrial use of this mineral has been associated with high morbidity and mortality rates, hence the importance of denouncing the health effects of asbestos.Asbestos is a term used to refer to six naturally occurring silicate minerals that are used in the manufacture of building materials, such as asbestos–cement, and automotive components, including brake linings and brake pads; however, it has been proved that inhaling asbestos microscopic fibers can lead to the development of lung diseases (pneumoconioses) and cancer. In many cases, these diseases are caused by a short occupational or environmental exposure to it, but their clinical manifestation occurs several years after the first time of exposure.The main objective of this paper is to reflect on the hazards related to the use of asbestos and to influence public health policies addressing this problem in Colombia, so that by means of the newly adopted law banning the use of this mineral in our country, significant progress is made in aspects such as the identification and the monitoring of people who were exposed to it, and the handling, removal and final disposal of materials containing asbestos.

Conflicts of interest and the (in)dependence of experts advising government on immunization policies

There has been increasing attention to financial conflicts of interest (COI) in public health research and policy making, with concerns that some decisions are not in the public interest. One notable problematic area is expert advisory committee (EAC). While COI management has focused on disclosure, it could go further and assess experts' degree of (in)dependence with commercial interests. We analyzed COI disclosures of members of Québec's immunization EAC (in Canada) using (In)DepScale, a tool we developed for assessing experts' level of (in)dependence. We found great variability of independence with industry and that companies with the highest vaccine sales were predominantly associated with disclosed COIs. We argue that EACs can use the (In)DepScale to better assess and disclose the COIs that affect their experts. Going forward our scale could help manage risk and select members who are less conflicted to foster a culture of transparency and trust in advisors and policy-makers.

Financial Conflicts of Interest and Study Results in Environmental and Occupational Health Research

OBJECTIVES

To date, there is no comprehensive analysis of the relationship between financial conflict of interest (COI) and a potential publication bias in environmental and occupational health studies.

METHODS

We analyzed original research articles published in 2012 in 17 peer-reviewed journals. Multivariable ordinal logistic regression models were developed to evaluate the relationship between financial COI and the study outcome.

RESULTS

Of the 373 studies included in the analysis, 17.2% had a financial COI associated with organizations involved with the processing, use, or disposal of industrial and commercial products, and studies with this type of COI were more likely to report negative results (Adjusted Odds Ratio = 4.31), as were studies with any COI associated with the military (employment or funding; Adjusted Odds Ratio = 9.15).

CONCLUSIONS

Our findings show a clear relationship between direction of reported findings and specific types of financial COI.

The export of hazardous industries in 2015

In the 1970s, there were many reports of toxic hazards at corporate subsidiaries in the developing world that were no longer tolerated in the corporations' "home" countries. Following the chemical disaster in Bhopal, India, in 1984, leading corporations then announced that they applied uniform standards of worker and environmental protection worldwide. With globalization, corporations should also be obliged to take responsibility for their separate supplier, contractor and distributor companies, and licensees of their technology.The asbestos industry today consists of national corporations. Individual countries must overcome the influence of the asbestos-exporting countries and asbestos companies and stop building with asbestos, as recommended by WHO, ILO, and World Bank. WHO precautions for limiting governmental interaction with the tobacco industry should be applied in dealing with the asbestos industry.