It is a bad day for news, thanks to the oh so pretty wedding of the heir to the system that made Old Europe the source of most of the worst bloodshed the world experienced for about half a millennium. (For anyone who is interested in my further anti-royalist snark – not that you should be – see my comment on this post.) So, lacking news, today I will do a meta – instead of writing about health research and reporting, I am writing about something that affects health research and reporting. It is something that comes up so often, and is pretty clearly even less well understood than confounding. Several commentaries that bring up the concept of highly adamant opinions and how they relate to conflict of interest have crossed my screen this week, so I will concentrate on those. I have written a lot on this topic, so I am picking just a few themes, continuing this post in UN121, and planning to revisit the topic later series.
The most important thing to understand is that the phrase “conflict of interest” is not just jargon. It has its natural language meaning: Someone has two different interests and they create conflicting motives. One interest is about worldly outcomes, and is venal or is a narrow special interest that is not universally shared, and the other is the ideal of presenting disinterested and dispassionate scientific analysis. It is actually often the case that someone is not really motivated by the latter of these at all, feeling no hesitation to unabashedly serve their worldly goals, in which case the phrase refers to the conflict between their actual interest and the interest they are supposed to have.
So, someone doing a study to figure out whether “Big Food” is really causing children to eat badly has an obligation to try to report what the data shows, shooting for the ideal of being a disinterested scientist. (The term “objective” often gets used, but that is actually a very bad choice of words – objective science cannot exist, while disinterested science is rare in worldly sciences, but theoretically possible.) But if a researcher is a dedicated activist against Big Food, already convinced that there is problem, it will be quite the challenge to not let that influence the interpretation. Even when someone in that situation does their best to be unbiased there are blind spots (to borrow a phrase from this recent NYT op-ed that looked at ethical questions related to COI).
On the other hand, not every adamant opinion leads to a conflict of interest. Jacob Sullum just posted this observation about how two anti-Big Food activist academics published a call-for-papers at a journal, looking for “articles considering how to change the behavior of the food industry”. Sullum slams the authors for portraying their particular personal morality on this controversial topic as if it were a matter of science or the only possible view of the public interest. At this point, it might be tempting to accuse such advocates-cum-scientists of having a COI, as some authors (not Sullum) have done. But I would argue that they neither exhibit much COI nor are creating it with their call for papers. They are not calling for studies that support the claim that the food industry’s behavior should be changed – that would clearly create a terrible COI (of the type that is typical in anti-tobacco and other areas that are more politicized than food). Rather, they lead with their goal and look for support for how to pursue that change; so long as their premises, motives, and goal are not secret (it would be hard for them to avoid disclosing those even if they wanted to), there is no COI or disclosure problem. The legitimate criticism, then, takes forms like Sullum’s, about the adamance itself and how it is directing the science priorities, not that it is corrupting the science.
Being an advocate for a particular worldly goal and writing an advocacy piece in favor of it is not a conflict of interest. It is a perfect alignment of interests – no conflict there. Moreover, being a paid advocate for a particular position is no more a conflict of interest than is being an unpaid advocate. Why would it matter? In theory, a paid advocate might not really believe in the cause they are advocating, unlike an unpaid advocate, but it is difficult to see why this would matter when interpreting their claims. A conflict does arise if, instead of trying to make the case for one’s side of an argument, an advocate-author claims to be presenting a balanced analysis of the dispute or claims to be speaking for the “public” or the only possible goal someone could have.
Money matters occasionally, and under a few circumstances is arguably the strongest source of COI, though it is not the most common source as is generally implied. Money is primarily a problem when someone is employed by an entity with a particular position. A rarer but potentially far more problematic case is when someone has a major financial investment (e.g., owning relevant intellectual property) that is affected by the outcome of a study. In both of these cases, it is difficult to imagine the author being able to completely overcome the COI if writing about whether a particular scientific conclusion or view (the one that they are employed to support, or stand to make a lot of money from) is justified. If they were studying something based on the assumption that their preferred view is true (e.g., why it is true; how to act, given that it is true, as in the case of the food advocates; etc.), then they should be fine. Someone who is employed in “tobacco control” can be trusted to make the best arguments in favor of more tobacco control policies (more’s the pity that the published arguments are so lame). But vanishingly few tobacco control advocates have the intellectual discipline and honesty to analyze whether, all things considered, tobacco control efforts are improving the world (I cannot recall ever seeing a respectable example of that).
Anti-tobacco activists recently became agitated upon learning that British American Tobacco quietly provided financial support for UK retailers’ campaign to fight the proposed ban on all in-store displays of tobacco products. But for activists to portray this as some improper “conflict of interest” debases the term, changing its meaning to simply “there is financial support for a position I and my friends personally disagree with”. If a tobacco company (or an anti-tobacco advocacy group, private or governmental; or a retail lobbying group) expends resources to support a particular goal, they are simply acting in their interests – no conflict. It is only COI if they claim to be acting for the common good or disinterested science that they start promising scientific disinterestedness. If BAT, hypothetically, commissioned a study about the effects of display bans, there would be a challenging COI to deal with. Similarly, when activists who are intent on demonizing tobacco use claim there is scientific support that display bans have a public health benefit, their obvious COI must be considered in interpreting their claims (and their persistent failure to disclose that COI needs to be recognized as reflecting their overall level of honesty). Their interest in the demonization creates the incentive for them to misrepresent the health science.
In short, adamantly believing in a position, for whatever reason, whether one’s salary depends on it or not, does not create a COI for many analyses related to the position, and certainly not with explicit advocacy for the position. However, the COI is a challenge for analyses of whether the position is valid. Interestingly, the adamance itself may create more credibility problems for honest readers than the COI. I will take that up in Part 2.