1. Don’t Show Me The Money*
Non-Financial Conflicts of Interest
CHEST 2012
Atlanta, Georgia
Ivan Oransky, MD
Executive Editor, Reuters Health
Clinical Assistant Professor of Medicine, New York University
Co-Founder, Retraction Watch
*With apologies to Jerry Maguire and TheConversation.edu.au

2. The Hidden Problem
theconversation.edu.au

3. The Hidden Problem
“The discussion has focused
almost exclusively on
pecuniary, or financial,
interests. But these may
play a relatively minor role
in medicine.
Most doctors or researchers
don’t do what they do primarily to increase their
material wealth. If making money was their primary
goal, they could choose more effective ways of doing
so.”

4. The Hidden Problem
“The motivations that
underlie most decisions in
medicine are not financial.
Rather they range from an interest in patient care or
research or public welfare, to a commitment to certain
ideas, principles or values and the desire for personal
advancement in career, reputation or status.”

5. PLoS Editors’ Take
Published: September 30, 2008

6. PLoS Editors’ Take
“Non-financial competing
interests (sometimes called
‘private interests’) can be
personal, political,
academic, ideological, or
religious.
Like financial interests, they can influence professional
judgment. Much as we'd like to believe that the reporting
and evaluation of research are always objective, there is
substantial evidence to the contrary .”

7. PLoS Editors’ Take
“Like all human activity …
research and scientific
publishing are inherently
subjective, imperfect, and
prone to bias, corruption,
and self-interest.
Indeed, because professional affinities and rivalries,
nepotism, scientific or technological competition, religious
beliefs, and political or ideological views are often the fuels
for [passions and careers], private competing interests are
perhaps even more potent than financial ones.”

8. Non-Financial COIs in Grant Review
Published: April 9, 2012

9. Non-Financial COIs in Grant Review
“Most participants
(73/98) spontaneously
reported that non-
financial COIs
predominated over
financial COIs.
Non-financial COIs mainly involved rivalry among
disciplines, cronyism, and geographic and academic
biases.”

10. Non-Financial COIs in Grant Review
“However, none of the
participants challenged
the validity of peer
review.
Reviewers who felt they might be affected by CoIs said
they reacted in a variety of ways: routine refusal to
review, routine attempt to conduct an impartial review,
or decision on a case-by-case basis.”

11. Competition vs. Cronyism
• Turf battles between disciplines/specialties
• Geographic biases
• Anticipating peer review
• How to manage: Would open peer review help?

12. Protectionism

13. Protectionism
“Policies regarding
retraction announcements
vary widely among
journals, and some, such
as the Journal of Biological
Chemistry, routinely decline to provide any explanation
for retraction. These factors have contributed to the
systematic underestimation of the role of misconduct
and the overestimation of the role of error in retractions
(3, 4), and speak to the need for uniform standards
regarding retraction notices (5).”
-- Fang F et al. PNAS 2012.

14. Protectionism
How to manage:
Embrace transparency
(e.g., detailed retraction notices)

15. Conflicts between Roles
Patient Care vs. Clinical Research
How to manage:
Separation of staff

16. Religious and Political Beliefs
Abortion
Stem cells
End-of-life care
How to manage:
Tricky!

17. Positive Publication Bias
• Inherent human optimism
• Need to publish quantity for tenure, grants
How to manage:
Journals could publish percentage of studies
showing positive results

18. Messy and Imprecise – But Worth It
Published: September 30, 2008

19. Messy and Imprecise – But Worth It
“Despite the messy and
imprecise nature of
private interests,
researchers and editors
must persist in
establishing a better
understanding of their extent and impact. Any
assumption that non-financial competing interests are
less common or influential than financial incentives is
probably misguided.”

20. Messy and Imprecise – But Worth It
“It's accepted that
political interference in
science is dangerous,
that governments and
funders do not make
decisions on the basis
of science alone,
and that intellectual and professional commitments
often lead to strong personal views. When it comes to
making sense of non-financial competing interests, why
shouldn't we be interested?”

21. Contact Info/Acknowledgements
ivan-oransky@erols.com
Twitter: @ivanoransky
Thanks to Nancy Lapid