Wednesday, January 22, 2014

Why Did Surgeon General's Report Violate Well-Accepted Ethical Guidelines for Disclosing Conflicts of Interest?

Yesterday, I revealed that the 2014 Surgeon General's report, released last Friday, failed to disclose the financial conflicts of interest of many of its authors. Specifically, the report is hiding the fact that many of its authors have or had financial conflicts of interest with pharmaceutical companies that manufacture the smoking cessation products about which the report provides a misleadingly positive review.

The Rest of the Story

The failure of the report to disclose financial conflicts of interests of its authors is problematic for several reasons.

First, disclosure of conflicts of interest has become a widely accepted guideline for ethical practice in medicine and public health. Most, if not all, reputable public health and medical journals require authors to disclose any relevant conflicts of interest and most journals publish any conflicts that are disclosed.

Second, disclosure of conflicts of interest is essential to achieve the public health ethical principle of transparency. Readers have the right to know if there are any relevant conflicts that could be perceived as influencing the objectivity of scientific reports.

Third, the Surgeon General's report comes across as a project of massive hypocrisy, as the report itself complains about how tobacco-funded scientists failed to disclose their conflicts of interest. The report emphasizes that in the 50 years since the release of the report, disclosure of financial conflicts has become the "norm." It bemoans the fact that in the past, tobacco-funded scientists did not disclose their conflicts of interest, which left readers unaware of these important financial relationships.

According to the Surgeon General's report: 

"Engagement with the industry became increasingly unacceptable for researchers whose reputations were tarnished by their industry activities. At the same time, concerns about potential conflicts of interest among scientists increased, and disclosure of consulting activities to universities became the norm, making it more difficult for researchers to maintain secret ties to the tobacco industry. By contrast, when the 1964 report was released, there was little concern that scientists’ results would be influenced by their funding source." ...

While disclosure of consulting activities may have become the norm, it certainly has not become the norm for the Surgeon General's report!

The report goes on to state:

"It is difficult to estimate the extent to which industry-generated research activities have influenced scientific thinking regarding the effects of nicotine on cognitive performance and on nicotine’s therapeutic applications. Authors’ industry affiliations and potential conflicts of interest reported in publications may go unnoticed by readers, may be difficult to identify, or may not be disclosed at all. Reviews and other articles citing industry-affiliated studies generally did not include author affiliations or potential conflicts of interest at all, leaving the readers unaware of possible industry influences."

Unfortunately, the 2014 Surgeon General's report has left readers unaware of possible industry influences, as it has failed to disclose the pharmaceutical industry ties of many of its authors. And it is not difficult to estimate the extent to which pharmaceutical industry-generated research activities have influenced scientific thinking regarding the effects of smoking cessation drugs and nicotine's therapeutic (cessation) applications.

The rest of the story is that the 2014 Surgeon General's report is violating the very ethical principles that it attacks the tobacco company for violating in the past. While there has been substantial progress in the past 50 years in the area of disclosure of conflicts of interest, somehow that progress has evaded the producers of the Surgeon General's report itself.

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