Conflict of interest reporting by authors involved in promotion of off-label drug use: an analysis of journal disclosures

Smoke and mirrors? Conflict of interest declarations in tobacco and e-cigarette-related academic publications

OBJECTIVE

This research explored international tobacco control experts' level of satisfaction with conflict of interest (COI) declaration processes; and the transparency of COI declarations of identified authors publishing in the tobacco, e-cigarette, and related novel products academic literature.

METHODS

This case study profiled 10 authors' (identified by expert panel) COIs pertaining to the tobacco industry; identified the 10 authors' publications (2010-2021); and assessed the transparency of the COI declarations within the publications.

RESULTS

All authors received indirect or direct funding from the tobacco industry. On review of the authors' 553 publications, 61% of COI and funding declarations were accessible, 33% were partially accessible and 6% were inaccessible. Overall, 33% of authors provided complete COI declarations, 51% provided incomplete declarations, and 16% provided no declaration.

CONCLUSION

This research demonstrates existing guidelines and recommendations for reporting COI declarations are not sufficiently robust to ensure transparency in reporting of COI declarations within the field.

IMPLICATIONS FOR PUBLIC HEALTH

Research outcomes have the potential to define public health discourse and influence public opinion, practices, and policy. It is critical that research remains independent and protected from the influence of the tobacco industry. Processes for monitoring and enforcing accurate reporting of COI declarations are needed.

Evaluating the reproducibility of research in obstetrics and gynecology

OBJECTIVE

Reproducibility is a core tenet of scientific research. A reproducible study is one where the results can be recreated by using the same methodology and materials as the original researchers. Unfortunately, reproducibility is not a standard to which the majority of research is currently adherent.

METHODS

Our cross-sectional survey evaluated 300 trials in the field of Obstetrics and Gynecology. Our primary objective was to identify nine indicators of reproducibility and transparency. These indicators include availability of data, analysis scripts, pre-registration information, study protocols, funding source, conflict of interest statements and whether or not the study was available via Open Access.

RESULTS

Of the 300 trials in our sample, 208 contained empirical data that could be assessed for reproducibility. None of the trials in our sample provided a link to their protocols or provided a statement on availability of materials. None were replication studies. Just 10.58% provided a statement regarding their data availability, while only 5.82% provided a statement on preregistration. 25.85% failed to report the presence or absence of conflicts of interest and 54.08% did not state the origin of their funding.

CONCLUSION

In the studies we examined, research in the field of Obstetrics and Gynecology is not consistently reproducible and frequently lacks conflict of interest disclosure. Consequences of this could be far-reaching and include increased research waste, widespread acceptance of misleading results and erroneous conclusions guiding clinical decision-making.

Discrepancies in self-reported financial conflicts of interest disclosures by physicians: a systematic review

Background

There is a high prevalence of financial conflicts of interest (COI) between physicians and industry.

Objectives

To conduct a systematic review with meta-analysis examining the completeness of self-reported financial COI disclosures by physicians, and identify factors associated with non-disclosure.

Data sources

MEDLINE, Embase and PsycINFO were searched for eligible studies up to April 2020 and supplemented with material identified in the references and citing articles.

Data extraction and synthesis

Data were independently abstracted by two authors. Data synthesis was performed via systematic review of eligible studies and random-effects meta-analysis.

Main outcomes and measures

The proportion of discrepancies between physician self-reported disclosures and objective payment data was the main outcome. The proportion of discrepant funds and factors associated with non-disclosure were also examined.

Results

40 studies were included. The pooled proportion of COI discrepancies at the article level was 81% (range: 54%–98%; 95% CI 72% to 89%), 79% at the payment level (range: 71%–89%; 95% CI 67% to 89%), 93% at the authorship level (range: 71%–100%; 95% CI 79% to 100%) and 66% at the author level (range: 8%–99%; 95% CI 48% to 78%). The proportion of funds discrepant was 33% (range: 2%–77%; 95% CI 12% to 58%). There was high heterogeneity between studies across all five analyses (I²=94%–99%). Most undisclosed COI were related to food and beverage, or travel and lodging. While the most common explanation for failure to disclose was perceived irrelevance, a median of 45% of non-disclosed payments were directly or indirectly related to the work. A smaller monetary amount was the most common factor associated with nondisclosure.

Conclusions

Physician self-reports of financial COI are highly discrepant with objective data sources reporting payments from industry. Stronger policies are required to reduce reliance on physician self-reporting of financial COI and address non-compliance.

Under-reported relationship: a comparative study of pharmaceutical industry and patient organisation payment disclosures in the UK (2012-2016)

OBJECTIVES

To examine the under-reporting of pharmaceutical company payments to patient organisations by donors and recipients.

DESIGN

Comparative descriptive analysis of payments disclosed on drug company and charity regulator websites.

SETTING

UK.

PARTICIPANTS

87 donors (drug companies) and 425 recipients (patient organisations) reporting payments in 2012-2016.

MAIN OUTCOME MEASURES

Number and value of payments reported by donors and recipients; differences in reported payments from/to the same donors and recipients; payments reported in either dataset but not the other one; agreement between donor-recipient ties established by payments; overlap between donor and recipient lists and, respectively, industry and patient organisation data.

RESULTS

Of 87 donors, 63 (72.4%) reported payments but 84 (96.6%) were mentioned by recipients. Although donors listed 425 recipients, only 200 (47.1%) reported payments. The number and value of payments reported by donors were 259.8% and 163.7% greater than those reported by recipients, respectively. The number of donors with matching payment numbers and values in both datasets were 3.4% and 0.0%, respectively; for recipients these figures were 7.8% and 1.9%. There were 24 and 3 donors missing from industry and patient organisation data during the entire study period, representing 38.1% and 3.6% of those in the respective datasets. The share of donor-recipient ties in which industry and patient organisation data agreed about donors and recipients was 38.9% and 68.4% in each dataset, respectively. Of 63 donors reporting payments, only 3 (4.8%) had their recipient lists fully overlapping with patient organisation data. Of 200 recipients reporting industry funding, 102 (51.0%) had their donor lists fully overlapping with industry data.

CONCLUSIONS

Both donors and recipients under-reported payments. Existing donor and recipient disclosure systems cannot manage potential conflicts of interest associated with industry payments. Increased standardisation could limit the under-reporting by each side but only an integrated donor-recipient database could eliminate it.

Relationship Between Declarations of Conflict of Interests and Reporting Positive Outcomes in Iranian Dental Journals

Conflict of interests is a situation when someone is in need of other people's trust on one the hand and has personal or general interests on the other hand, resulting in conflict with the given responsibility. In this research work, an attempt was made to find the relation between declarations of conflict of interests and reporting positive outcomes in the dental journals in Iran (2000-2016). In this analytical/cross-sectional study, first Health and Biomedical Information was searched and all the Persian and English dental journals published in Iran were collected. Then, all the papers published in the journals from December 2000 to December 2016 were collected and categorized in terms of the year of publication, author or authors' affiliations, Persian and English journal, type of the substance or the drug used (including the manufacturing company), declarations of conflict of interests and the positive or negative conclusion of the report. Data were analyzed with the Fisher's exact test and Chi squared test, using the program SPSS 18. In numerical analysis, the significance was set at P < 0.05. Seventeen dental journals in Persian and English were analyzed: 10 in English and 7 in Persian. Reviewing these studies showed that of 1021 articles in Persian, in 128 cases there was no mention of a declaration of conflict of interests and in 11 cases, the COI had been stated. In addition, from 1220 articles in English, in 825 cases there was no mention of declarations of conflict of interests and in 45 cases, the declarations of COI had been mentioned. There was no significant relation between the COI and 'no' COI and the reporting of positive outcomes in papers in Iranian dental journals in terms of the journal type, year of publication and the journals' guarantee form (P = 0.25, P = 0.41 and P = 0.09). A total of 83% of studies with declarations of COI had one positive outcome, with a significant relationship in this field; however, in 73% of studies with no COI, there was one positive outcome, too. In general, the society expects that doctors would not consider any incentives except the health of the patients in the efforts made by them. The severity of the consequences of COI is of higher value when the patients' health is endangered due to it. In addition, COI might change the attitude and approach of other doctors and peers.

Conflicts of interest of editors of medical journals

BACKGROUND

Almost all medical journals now require authors to publicly disclose conflicts of interests (COI). The same standard and scrutiny is rarely employed for the editors of the journals although COI may affect editorial decisions.

METHODS

We conducted a retrospective observational study to determine the prevalence and magnitude of financial relationships among editors of 60 influential US medical journals (10 each for internal medicine and five subspecialties: cardiology, gastroenterology, neurology, dermatology and allergy & immunology). Open Payments database was reviewed to determine the percentage of physician editors receiving payments and the nature and amount of these payments.

FINDINGS

703 unique physician editors were included in our analysis. 320/703 (46%) received 8659 general payments totaling $8,120,562. The median number of payments per editor was 9 (IQR 3-26) and the median amount per payment was $91 (IQR $21-441). The median total payment received by each editor in one year was $4,364 (IQR $319-23,143). 152 (48%) editors received payments more than $5,000 in a year, a threshold considered significant by the National Institutes of Health. COI policies for editors were available for 34/60 (57%) journals but only 7/34 (21%) publicly reported the disclosures and only 2 (3.%) reported the dollar amount received.

INTERPRETATION

A significant number of editors of internal medicine and subspecialty medical journals have financial COI and very few are publicly disclosed. Specialty journal editors have more COI compared to general medicine journal editors. Current policies for disclosing COI for editors are inconsistent and do not comply with the recommended standards.

Self-declared stock ownership and association with positive trial outcome in randomized controlled trials with binary outcomes published in general medical journals: a cross-sectional study

Background

Describe the prevalence and types of conflicts of interest (COI) in published randomized controlled trials (RCTs) in general medical journals with a binary primary outcome and assess the association between conflicts of interest and favorable outcome.

Methods

Parallel-group RCTs with a binary primary outcome published in three general medical journals during 2013–2015 were identified. COI type, funding source, and outcome were extracted. Binomial logistic regression model was performed to assess association between COI and funding source with outcome.

Results

A total of 509 consecutive parallel-group RCTs were included in the study. COI was reported in 74% in mixed funded RCTs and in 99% in for-profit funded RCTs. Stock ownership was reported in none of the non-profit RCTs, in 7% of mixed funded RCTs, and in 50% of for-profit funded RCTs. Mixed-funded RCTs had employees from the funding company in 11% and for-profit RCTs in 76%. Multivariable logistic regression revealed that stock ownership in the funding company among any of the authors was associated with a favorable outcome (odds ratio = 3.53; 95% confidence interval = 1.59–7.86; p < 0.01).

Conclusion

COI in for-profit funded RCTs is extensive, because the factors related to COI are not fully independent, a multivariable analysis should be cautiously interpreted. However, after multivariable adjustment only stock ownership from the funding company among authors is associated with a favorable outcome.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-2108-z) contains supplementary material, which is available to authorized users.

Discordance of conflict of interest self-disclosure and the Centers of Medicare and Medicaid Services

BACKGROUND

The Open Payments Database (OPD) discloses financial transactions between manufacturers and physicians. The concordance of OPD versus self-reported conflicts of interest (COI) is unknown.

MATERIALS AND METHODS

Our objectives were to compare (1) industry and self-disclosed COI in clinical literature, (2) payments within each disclosure level, and (3) industry- and self-disclosed COI and payments by specialty. This was an observational study. PubMed was searched for clinical studies accepted for publication from January 2014 to June 2016. Author and OPD-disclosed COIs were compared. Articles and authors were divided into full disclosure, incomplete industry disclosure, incomplete self-disclosure, and no COI. Primary outcome (differences in reported COI per article) was assessed using McNemar's test. Payment differences were compared using Kruskal-Wallis test.

RESULTS

OPD- and self-disclosed COI differed (65.0% discordance rate by article, P < 0.001). Percentages of authors within each disclosure category differed between specialties (P < 0.001). Hematology articles exhibited the highest discordance rate (79.0%) and received the highest median payment for incomplete self-disclosure ($30,812).

CONCLUSIONS

Significant discordance exists between self- and OPD-reported COI. Additional research is needed to determine reasons for these differences.

Conflict of interest disclosure in biomedical research: A review of current practices, biases, and the role of public registries in improving transparency

Conflicts of interest held by researchers remain a focus of attention in clinical research. Biases related to these relationships have the potential to directly impact the quality of healthcare by influencing decision-making, yet conflicts of interest remain underreported, inconsistently described, and difficult to access. Initiatives aimed at improving the disclosure of researcher conflicts of interest are still in their infancy but represent a vital reform that must be addressed before potential biases associated with conflicts of interest can be mitigated and trust in the impartiality of clinical evidence restored. In this review, we examine the prevalence of conflicts of interest, evidence of the effects that disclosed and undisclosed conflicts of interest have had on the reporting of clinical evidence, and the emerging approaches for improving the completeness and consistency of disclosures. Through this review of emerging technologies, we recognize a growing interest in publicly accessible registries for researcher conflicts of interest and propose five desiderata aimed at maximizing the value of such registries: mandates for ensuring that researchers keep their records up to date; transparent records that are made available to the public; interoperability to allow researchers, bibliographic databases, and institutions to interact with the registry; a consistent taxonomy for describing different classes of conflicts of interest; and the ability to automatically generate conflicts of interest statements for use in published articles.

Conflict of interests for radiation oncologists: Harnessing disclosures from policy to reality

PURPOSE

An increasing attention is being paid to disclosures of conflicts of interests in the field of oncology. The purpose of this study was to examine how radiation oncologists report their conflicts of interests with pharmaceutical or technology industries.

MATERIALS AND METHODS

We collected the data of conflicts of interests disclosures in the abstract books from the annual 2012 and 2013 meetings of the American Society for Radiation Oncology (ASTRO) in Miami (FL, USA), and in Atlanta (GA, USA), respectively. Geographic origins of abstracts as well other factors were examined.

RESULTS

We identified a total of 4219 abstracts published in the past two years. The total number of involved authors was of 28,283. All of the published abstracts had conflicts of interests disclosures. Amongst them, 563 abstracts (13.4%) reported at least one potential conflict of interests, in which 1264 (4.5%) declared a potential conflict of interests in their disclosures. Geographic distribution of abstracts with financial relationship was as following: 67.9%, 15.5%, 7.7% and 7.7% for USA, Europe, Asia/Pacifica, and Canada, respectively. Abstracts with conflict of interest originated from North America in 75.6% of cases. USA distribution was 70.6% and 29.4% for Eastern and Western, respectively.

CONCLUSIONS

The proportion of physicians declaring financial conflicts of interests remains extremely low, whichever geographic area authors are from. In comparison to the rest of the world, the US proved itself better at declaring potential links. Changes in medical culture and education could represent a significant step to improve the process of revealing conflicts of interest in medical journal as well as in international meetings.

Conflicts of interest in research: looking out for number one means keeping the primary interest front and center

Conflicts of interest represent circumstances in which professional judgments or actions regarding a primary interest, such as the responsibilities of a medical researcher, may be at risk of being unduly influenced by a secondary interest, such as financial gain or career advancement. The secondary interest may be financial or non-financial, and the resultant bias may be conscious or unconscious. The presence of conflicts of interest poses a problem for professional, patient, and public trust in research and the research enterprise. Effective means of identifying and managing conflicts are an important element in successfully achieving the goals of research. These strategies typically focus on the investigator and rely upon disclosure, which has substantial limitations. Additional management strategies include process-oriented steps and outcomes-oriented strategies. More attention to identifying and managing non-financial conflicts is needed. Future empirical research will be important for defining which conflicts need to be better addressed and how to achieve this goal.

Conflict of interest reporting in dentistry meta-analyses: A systematic review

Objectives: The issue of reporting conflicts of interest (COI) in medical research has come under scrutiny over the past decade. Absolute transparency is important when dealing with conflicts of interest to provide readers with all essential information required to make an informative decision of the results. The key objective of this study was to examine the prevalence of reporting conflicts of interest in therapeutic dental meta-analyses of Randomized Control Trials (RCTs), and to investigate possible associations with other categorical variables. Study Design: We conducted an extensive literature search across multiple databases to search for relevant review articles for this study. We utilized pre-determined key words, and relied on three reviewers to test and review the use of a data extraction form that was used for the meta-analyses. Data regarding study characteristics, direction of results, and the significance of the results from each meta-analysis were extracted. Results: There were 129 meta-analyses used in this review, and the reporting on conflict of interest was low with only 50 (38.8%) of the articles possessing a conflict of interest statement (either confirming of denying COI). Of these 50 articles, there were only 4 (8%) studies that reported an actual conflict of interest. A statement of conflicts of interest was found in 29 (35.3%) of the papers that reported significant findings, whereas 35% of the papers that reported positive results reported on conflict of interest. Prior to 2009, only 17 (25%) papers reported conflicts of interest, but since 2009, 54.1% of papers collected had a conflict of interest statement. Conclusions: Meta-analyses published in the field of dentistry do not routinely report author conflicts of interest. Although few conflicts appear to exist, the field of dentistry should continue to ensure that best evidence reports provide clear and transparent reporting of potential conflicts of interest in academic journals.

Key words:Dentistry, dentition, meta-analysis, quantitative review.

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BACKGROUND

Honorary and ghost authorship, as well as competing interests, are well documented concerns related to the publication of scientific articles. Guidelines for writing and publishing scientific manuscripts are available, including those of the International Committee of Medical Journal Editors (ICMJE).

OBJECTIVES

The primary objective of this descriptive cross-sectional study was to identify, in the instructions for authors of pharmacy practice journals, guidance on authorship and competing interests. The secondary objective was to suggest suitable corrective measures for more transparent authorship.

METHODS

The first step of the project was to identify journals in the area of pharmacy practice. The instructions for authors of each journal were then reviewed to determine recommendations for avoiding problems related to authorship and competing interests. Finally, the members of the research team formulated potential corrective measures for researchers.

RESULTS

Of 232 pharmacy journals identified, 33 were deemed to focus on pharmacy practice. A total of 24 (73%) of these journals mentioned that they followed ICMJE policies, 14 (42%) asked authors to complete a competing interests disclosure form at the time of submission, 17 (52%) had a formal definition of authorship, and 5 (15%) asked for details of each author's contribution. A list of 40 criteria was developed to define authorship status.

CONCLUSION

Fewer than half of the journals asked authors to provide a competing interests disclosure form upon submission of an article, and only half had a formal definition of authorship. The scientific publication of papers relevant to pharmacy practice is not free from issues related to publication transparency. Publishing articles online and using a checklist to detail each author's contribution may help to limit the associated risks. [Publisher's translation].

The evidence-based medicine paradigm: where are we 20 years later? Part 2

In Part 2, we discuss the challenges of keeping up with the 'literature,' evidence-based medicine (EBM) in emerging economies and the Neurosciences, and two recent approaches to classifying evidence. We conclude by summarizing information from Parts 1 and 2 which suggest the need to critically re-appraise core elements of the EBM paradigm: (1) the hierarchical ranking of evidence, (2) randomized controlled trials or systematic reviews as the gold standard for all clinical questions or situations, (3) the statistical tests that have become integral to the 'measurements' for analyzing evidence, and (4) re-incorporating a role for evidence from basic sciences and pathophysiology. An understanding of how cognitive processes influence clinical decisions is also necessary to improve evidence-based practice. Emerging economies may have to modify the design and conduct of clinical research to their settings. Like all paradigms, EBM must keep improving with input from the grassroots to remain beneficial.

The effect of a conflict of interest disclosure form using closed questions on the number of positive conflicts of interest declared - a controlled study

Objective. While declarations of conflicts of interest (COI) have become an integral part of medical articles, COIs are often not declared completely and accurately. One of several possible reasons for deficient COI declarations is the lack of standardized and comprehensive COI forms. In 2010, the International Committee of Medical Journal Editors (ICMJE) introduced a COI form using clear definitions and closed questions. Deutsches Ärzteblatt (DA), the journal of the German Medical Association, adapted this form and implemented it in early 2011. However, it is unclear whether changing COI forms leads to more positive COI statements.

Material and Methods. In a controlled pre-post design, positive COI statements were analyzed at three German medical journals: one had changed its COI form (DA), two had not: Deutsche Medizinische Wochenschrift (DMW) and Nervenarzt (Ner), both of whom used open questions in their forms. At the levels of both authors and articles, respectively, the proportion of positive COI declarations in orignal and review articles was recorded for volumes 2010 (before implementation of the new COI form at DA) and 2012 (after). The change in positive COI disclosures at the journals was compared. Chi-square tests were used to compare the figures by journal in 2010 versus 2012 and among DA, DMW, and Ner.

Results and Discussion. While positive COI statements more than doubled at DA, there was no meaningful change in either of the control journals: In 2010, 19.1% [95% CI: 15.4–23.2] of all DA-authors submitted positive COI declarations, relative to 39.6% [35.0–44.5] in 2012, a factor of 2.1. At the level of articles, positive COI statements increased from 32.3% [23.7–42.0] to 70.1% [60.5–78.6] (factor 2.2). At DMW, positive declarations rose by a factor of 1.3 to 12.1% [9.7–14.8] in 2012 at author level and by a factor of 1.3 to 19.4 [14.2–25.7] for articles. At Ner, figures fell: to 19.9% for authors [16.9–23.4] and 30.7% for articles [24.0–38.1] (both by a factor of 0.8). P-values for the comparison of positive COI statements between 2010 and 2012 were low at DA (p for both author and article level comparisons <0.00001) and considerably higher at DMW and Ner (all >0.05). Although this is not a randomized controlled study, the findings support the hypothesis that the steep increase in positive COI statements at DA from 2010 to 2012 is the result of its new COI form: Relative to two journals that had not modified their COI forms the effect size of the change was considerably higher at DA. Also, in contrast to DMW and Ner, p-values indicate that chance is unlikely to have played a major role in the change of positive COI statements at DA.

Conclusions. COI forms employing closed questions based on clear definitions of conflicts of interests, such as those recommended by ICMJE and now used by Deutsches Ärzteblatt, seem to be superior to less structured forms. These results require confirmation with other COI forms and at other journals.

Safety of off-label erythropoiesis stimulating agents in critically ill patients: a meta-analysis

PURPOSE

Erythropoiesis stimulating agents (ESAs) are used to treat anemia in critically ill patients. This indication is off-label, because it is not licensed by regulatory authorities. Recently ESAs were suspected to harm critically ill patients. Our objective was to assess the safety of ESAs in off-label indications in critically ill patients.

METHODS

Eleven databases were searched up to April 2012. We considered randomized controlled trials (RCTs) and controlled observational studies in any language that compared off-label ESAs treatment with other effective interventions, placebo or no treatment in critically ill patients. Two authors independently screened and evaluated retrieved records, extracted data and assessed risk of bias and quality of reporting.

RESULTS

We used frequentist and Bayesian models to combine studies, and performed sensitivity and subgroup analyses. From 12,888 citations, we included 48 studies (34 RCTs; 14 observational), involving 944,856 participants. Harm reporting was of medium to low quality. There was no statistically significant increased risk of adverse events in general, serious adverse events, the most frequently reported adverse events, and death in critically ill patients treated with ESAs. These results were robust against risk of bias and analysis methods. There is evidence that ESAs increase the risk of clinically relevant thrombotic vascular events, and there is some less certain evidence that ESAs might increase the risk for venous thromboembolism.

CONCLUSIONS

In critically ill patients, administration of ESAs is associated with a significant increase in clinically relevant thrombotic vascular events but not with other frequently reported adverse events and death.