Slide Presentation from the AHRQ 2009 Annual Conference
On September 19, 2009, Steve Knickrehm made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (270 KB) (Plugin Software Help).
AHRQ 2009 Annual Conference
Do Ask, Do Tell: Best Practices in Conflict of Interest Policies for Research, Publishing, and Recommendation-Making
Non-Financial Conflicts of Interest
James Bell Associates
AHRQ Project: Best Practices in Conflict of Interest for Comparative Effectiveness Reviews and for Recommendation-Making Panels
James Bell Associates:
- James Bell
- Steve Knickrehm
Eastern Research Group:
- John Eyraud
- Andreas Lord
- Nyssa Ackerley
Definition of Conflict of Interest
"A conflict of interest is a set of conditions in which professional judgment concerning a primary interest (such as a patient's welfare or the validity of research) tends to be unduly influenced by a secondary interest (such as financial gain)."
D. F. Thompson, Understanding Financial Conflicts of Interest, 1993
Emphasis on Financial COI (FCOI)—1993
COI rules focus on financial gain because money is:
- More objective
- More fungible
- Easier to regulate by impartial rules
- Generally useful for more purposes.
"Just because we cannot do much about the other secondary interests, it does not follow that we should do little about financial gain."
- Thompson, 1993
The Two Horns of the Non-Financial COI (NFCOI) Dilemma
- Medical and health care literature is clear that NFCOI can be as damaging to scientific integrity as financial interests.
- Much of the literature assumes nothing can be done to manage nonfinancial interests and ignores its potentially damaging consequences.
Leading Organizations Increase Emphasis on NFCOI
- World Association of Medical Editors (WAME) Policy Statement
- International Committee of Medical Journal Editors (ICMJE) Uniform Requirements
- Implementation Science
- U.K. National Institute for Health and Clinical Excellence (NICE)
Types of NFCOI*
- Political or Ideological Beliefs
- Institutional Affiliations
- Professional Relationships
- Recognition for Professional Achievement
- Favors to Students, Friends, or Family
- Professional Affiliations
- Published Opinions or Advocacy Positions
* Compiled from WAME, ICMJE, JAMA, etc.
NFCOI Example 1—Religious Beliefs
NFCOI Example 2—Personal/Professional Associations
NFCOI Example 3—Published Opinions or Advocacy Positions
- Dietary Approaches to Stop Hypertension (DASH)-Sodium Trial funded by the National Heart, Lung, and Blood Institute (NHLBI)
- Questions were raised about the lack of primary end points for all subgroups in the published results, despite repeated requests.
- "It is plausible to assume that the reluctance of NHLBI may be based in its own conflict of interest in this matter. Dr. Lenfant and his colleagues at NHLBI have spent the better part of the past two decades championing sodium restriction as the most important dietary adjustment for the prevention and treatment of hypertension. Without the data to justify this, we must ask whether the vested interests of the NHLBI might not have a role in apparent efforts to protect this policy."
David A. McCarron, "NHLBI's Conflict of Interest: Why We Need the Data
Quality Act", Editorial, American Journal of Hypertension, 2003
Addressing the NFCOI Dilemma
"As with all competing interests, what's in dispute is not that they exist, but how to manage them. The responsibility of journals and the wider research communities is to safeguard the credibility of the scientific and editorial processes. Three things are needed to start making sense of non-financial competing interests:
- More Policy Development
- More Research"
- PLOS Medicine Editors, 2008
Non-Financial Conflicts of Interest. Slide Presentation from the AHRQ 2009 Annual Conference (Text Version). December 2009.
Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/annualconf09/knickrehm.htm