Research findings have the ability to influence decisions – with regard to practice, policy and funding directions. It’s what makes the work of researchers satisfying – the thought that it may actually make a difference! But with this warm fuzzy feeling comes responsibility and the need to check our good intentions at the door – not necessarily to leave them there, but to submit ourselves to an open and honest conflict scan.
My work involves managing the editorial steps leading to the publication of public health research, and includes assessing the appropriateness of the composition of research teams as well as allocation of editorial advisors and peer referees to provide feedback on the research. In doing so I am very conscious of the conundrum that can arise, in identifying individuals with sound understanding of a topic to undertake the research (or review the research) yet free of any vested interest in the outcomes of that research.
There are rules and policies to identify, declare and manage potential conflicts of interest (COI), to “provide guidance to ensure that there is clarity and transparency in the declaration of any interests, a balance of perspectives, and guidance on disclosing and managing interests” (NHMRC 2012) around research committees and working groups developing guidelines, and for researchers and peer referees of researchers’ work.
The tricky part is that declaration statements often rely on the objectivity of the individual closest to the work – the researcher, the research committee member, the guidelines developer, the content expert chosen to peer referee the research. I hazard to guess that a failure to declare a potential conflict of interest associated with a particular task is usually not due to an underhanded intent of the researcher or research advisor, but due more to a lack of understanding of what might be perceived as a conflict. Most are clear about declaring any financial interest in the subject at hand or funds received by parties with an interest in the findings of a research work. But what of other influences that might openly or inadvertently influence the judgements and decisions of the researcher or research advisor? And can these influences coexist in a team without compromising the integrity and outcomes of a research task?
In noting my area of work, as Managing editor of the Cochrane Public Health Group, I also declare an interest (conflicting?) in this topic for authors, editors and advisory group members and peer referees of systematic reviews – of public health topics specifically. A recent report, prepared for the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services, contended that whilst the importance of attention to financial conflicts of interest has been addressed, there has been little guidance on how to manage the risk of bias for systematic reviews systematic reviews from nonfinancial conflicts of interest. The paper outlines definitions and examples of non-financial COI, and how these can be managed and assessed for their potential to bias their involvement in the review. It also confirms that authors may not be identifying themselves as having potential conflicts.
Non-financial COI in the AHRQ report was defined as “a set of circumstances that creates a risk that the primary interest—the quality and integrity of the systematic review—will be unduly influenced by a secondary or competing interest that is not mainly financial.” They include interests relating to the individual (intellectual, professional, career advancement), persons with whom the individual has a close personal relationship (e.g., family members, friends, colleagues), and interests held by the employer or organization with which the person is affiliated (e.g., employer, academic institution, specialty organizations, other professional organizations, and community interests).
Getting the authorship team right on a systematic review is important – with a need to include content expertise, methods knowledge and experience, as well as statistical and searching expertise. Bringing together a systematic review team that adequately balances essential content expertise with independence of judgment can be tough and requires open and deliberate choices for the lead author.
What is important to understand is that the identification and declaration of a potential COI and the management of that COI are two very different things. It is the latter that can ease the struggle between the need to be close to, knowledgeable, and dare we admit, passionate about a subject or content area, and the need to make objective decisions based purely on the information presented or available to the team. Once the risk of potential conflicts of interest is identified, based on the context of the topic, there are a range of options to managing the conflicts of interests within a research team. These range from disclosure followed by no change in the research team or activities, inclusion on the team along with other members with differing viewpoints to ensure a range of perspectives, exclusion from certain research activities (such as assessment of risk of bias in individual studies in the case of a systematic review), to exclusion from the authorship team entirely.
Not all conflicts of interest, once identified and acknowledged, lead to a compromised research project. Being upfront and declaring all potential conflicts, to the editorial team and in any associated publications, allows the reader to make an informed judgement about the trustworthiness of the research process and findings.
Written by Jodie Doyle
Managing Editor, Cochrane Public Health Group