Managing or maintaining bias? Examining the conceptualisation of conflicts of interest in medical journal publishing
View/ Open
Date
05/07/2017Item status
Restricted AccessAuthor
Hendrick, Rachel A.
Metadata
Abstract
BACKGROUND: It has been claimed that the involvement of commercial
companies in medical and health research poses risks relating to potential
conflicts of interest. In response, many journals have developed conflict of
interest policies, and there has been a proliferation of related guidance from
publishers, professional associations and commercial companies, mostly
centred on processes of voluntary disclosure. Studies and commentaries on
these have raised concerns regarding the adequacy of such practices, but there
has been limited analysis of the underlying context – how and why policies have
been constructed in this way – or exploration of alternative approaches.
AIM: This thesis examines how actors within medical journal publishing
conceptualise conflicts of interest. It analyses their understandings of conflicts
of interest: which types of interest are deemed most significant; which actor
groups are seen as conflicted; and how conflicts are managed. Through doing so,
it explores the barriers to, and possibilities of, change.
METHODS: The study draws on two distinct sets of data. The first is a sample
of conflict of interest policies and guidance. The second is 48 semi-structured
interviews with actors working in a range of roles related to medical journal
publishing. These data were thematically analysed to illustrate how medical
journal publishing conceptualises and manages conflicts of interest, to identify
perceived strengths and weaknesses of current approaches, and to identify
potential opportunities for improvement.
RESULTS: There appears to be an established discourse around conflicts of
interest, which emphasises particular stakeholders, while others, who also have
opportunities to influence journal content, are frequently absent from the
debate. Financial interests are readily highlighted, while non-financial ones
receive less attention and are thus often unregulated (Chapter 5). High levels of
consistency characterise the ways in which actors discussed the management of
conflicts of interest: for example, self-disclosure was regularly highlighted,
despite the acknowledged weaknesses of this approach (Chapter 6). The
existence of further mechanisms that offer the potential to assist in managing
conflicts of interest were identified, though findings suggest that, in practice,
these currently have limited uptake (Chapter 7). Interviewees’ suggestions of
how conflicts of interest might be better managed (e.g. through greater data
transparency) are also analysed. Overall, narrow interpretations of conflicts of
interest and their management appear to have become institutionalised in ways
that serve to limit the uptake of alternative approaches.
DISCUSSION: Given the substantive importance that medical research can have
on health policies and treatments, robust processes are required to protect the
integrity and legitimacy of journals. This research shows that existing,
institutionalised understandings of conflicts of interest have critical limitations,
which leaves medical publishing open to potentially unethical practices that may
be a source of bias in published evidence. This poses a significant threat to the
desire to attain ethically robust, peer-reviewed medical/health research that can
be used to inform policy and practice. Drawing on the interview data, the thesis
explores some possible alternatives that may warrant further consideration.