Introduction
History of the NEJM & COI
“During the decade of the 1990s, when I was editor-in-chief of the New England Journal of Medicine, we rejected anyone who had a conflict of interest from writing an editorial or review article. Sometimes it required going down the list until we found someone who didn't have a conflict, but we never had to compromise and accept someone without sufficient expertise to do a good job. I also think it's often a good idea to get someone who isn't too close to the action: it often avoids “group think” and provides a fresh perspective. But to maintain our 1990s policy takes more work because you can't just accept the first person who pops into your mind. I was disappointed when the journal changed the policy, and said so publicly.”
– Kassirer JP, British Medical Journal 2001
Current media campaign in the NEJM
Industry funding of NEJM
Conflicted nature of medical publishing
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Managing COI: Who should write review articles and guidelines?
Is there a shortage of authors for review articles?
Conclusions
- No, Phramascolds are not worse than the pervasive conflicts of interest they criticize: Larry Husten in Forbes
- Medical journals are an extension of the marketing arm of pharmaceutical companies. Smith R, PLOS Medicine 2005.
Addendum 6/3/2015: Drs. Kassirer and Angell (prior editors of the NEJM referenced above) just published an editorial in the BMJ here. It is a must-read.
- Pulmcrit wee: The cutoff razor - April 15, 2024
- PulmCrit Blogitorial – Use of ECGs for management of (sub)massive PE - March 24, 2024
- PulmCrit Wee: Propofol induced eyelid opening apraxia – the struggle is real - March 20, 2024
Completely agree- need to make trials as pragmatic as possible, need to have a healthy sense of skepticism with anything that is taught, need to understand physiology/pathophysiology, need to understand a guidelines is a 'suggestion' not a rule, etc etc etc.
Still think that if you want to make change (and have people actually follow what you say) you shouldn't be posting as anonymous – takes away credibility in my opinion.
BTW, I am not blaming anyone for the present state. Just explaining what Thomas Kuhn and Karl Popper might teach us about the present state of critical care research.
Read "Structure of Scientific Revolution" T Kuhn (esp. chapter 4)
If we work hard to understand ourselves, and how we think "as a group", we can better prepare ourselves for the inevitable social forces which we face when seeking to operate at the tip of the spear of scientific thought.
I respect and wish all of you well. Science is hard, the politics of science is impossible.
Thy point is simply to open the eyes of those who think they are not conflicted. When the eyes are opened there is power. Ever see a sepsis trial say, at the end in the discussion of the limitations of the trial, "One limitation of this trial was that we used a guessed set of thresholds (guessed over 2 decades ago) as the gold standard for the condition under test" Ever see a professor warn his residents that the "sepsis criteria" or the MEWS are just guesses from a few docs from another era and that naïve reliance on them… Read more »
Not sure if you meant to do this or not but… posting this as 'anonymous' doesn't exactly 'empower young free thinking researchers' or promote 'freedom of academic speech'.
Intrinsic Conflicts of Interest Just as serious (if not more serious) a problem in critical care research is the conflict of interest posed by the social forces described by Thomas Kuhn which we call this an "intrinsic conflict of interest" Kuhn teaches that the thought leaders (who may have long before retired) define the board, the pieces and the rules of the game and the researchers play the game as given to them. We call the present state "the NIH grant system meets Thomas Kuhn" because now there are officials which fund the game as it is expected to be… Read more »
I agree that journal article authors should be unbiased. But there is also a bias AGAINST industry-funded research, particularly in the pharmaceutical industry. Since research particularly in new drug development would likely not exist without pharma, we must somehow support them in that respect until the importance is recognized by academia or another publicly-funded entity. For now, they are the only ones in the game with the pockets big enough to assume the risk. And pharma enjoys considerable profits, but there are many expensive drug “fails” that make it through trial phases only to fail and lose the kind of… Read more »
Pharmaceutical companies are motivated by profit, and there have been situations where this led them to act in ways contrary to the common good, thus leading to a certain level of suspicion/bias against them. However, as you point out they also fund a lot of great research as well. I think we largely agree. These are difficult issues to which there is no simple solution.
I think that academia is as much for-profit as pharma. And anything state or local government funded is inefficient, far more costly, and often kills competitive spirit…seeing what they have done to public education and healthcare, I’d rather have pharma researching and developing drugs…Thanks for considering my view 🙂