Correspondence
Editorials and Conflicts of Interest
N Engl J Med 1997; 336:728-729March 6, 1997
- Article
To the Editor:
Regarding the editorial on editorials and conflicts of interest (Oct. 3 issue),1 in which you extend the definition of a conflict of interest for editorialists to include one-time consulting fees, as well as ongoing financial associations, I wonder whether you aren't setting a standard that is too extreme. As a primary care physician who is often invited to dinner lectures sponsored by pharmaceutical companies, I wonder why the fees for the speakers on such occasions wouldn't fall into the same category. Why is it less compromising to accept such fees for repeated lectures to physicians on therapeutics than to accept money (as Dr. Manson did) for a one-time presentation to the Food and Drug Administration (FDA)? I suspect that many of your editorialists have been paid by pharmaceutical companies for speaking on the subjects they discuss in their editorials.
1 ReferencesRobert Salzman, M.D.
340 Wood Rd., Braintree, MA 021841
Angell M ,Kassirer JP . Editorials and conflicts of interest. N Engl J Med 1996;335:1055-1056
Full Text | Web of Science | Medline
To the Editor:
I was very pleased to hear from experts such as Drs. Manson and Faich about the risks and benefits of pharmacotherapy for obesity (Aug. 29 issue).1 I was surprised by your editorial implying a conflict of interest. After reading the letter by Manson and Faich (Oct. 3 issue),2 I thought it was clear that the consultancy, at least on Manson's part, was limited to making a presentation to an FDA advisory committee on the health risks of obesity — the area of her research and expertise.
Where was the opportunity for financial gain in writing an editorial or testifying before the FDA? You call it a “gray area,” but it seems clear that there was no current financial association, let alone a past one or a relevant one.
2 ReferencesLance R. Stone, D.O.
San Diego Rehabilitation Institute, San Diego, CA 921201
Manson JE ,Faich GA . Pharmacotherapy for obesity -- do the benefits outweigh the risks? N Engl J Med 1996;335:659-660
Full Text | Web of Science | Medline2
Manson JE ,Faich GA . Conflicts of interest -- editorialists respond. N Engl J Med 1996;335:1064-1065
Full Text | Web of Science | Medline
To the Editor:
On the basis of the facts you cite in your editorial, Dr. Manson had informed you that she and her colleague had “participated in the FDA review of dexfenfluramine [Redux] as scientific consultants.” On the basis of Manson and Faich's reply, they appear to have specifically requested that a disclosure statement appear with their editorial. Finally, as you admit, Manson had previously disclosed her work with the company in question in a separate article in the Journal.
Despite the apparent attempts at full disclosure on the part of Manson and Faich, you proceeded as though no disclosure were necessary. It was only after the potential conflict had been revealed elsewhere that you noticed. And then you blamed Manson and Faich for the problem. The irony is that in pinning the blame on the physicians, rather than on your own editorial oversights, you may have lost more credibility with your audience than if you had simply admitted the misunderstanding.
Eric F. Douglas
BMR Associates, Corte Madera, CA 94925To the Editor:
Manson and Faich unconvincingly attempt to justify their incomplete disclosure of a potential conflict of interest by using legalistic interpretations. Furthermore, they try to deflect the blame for the misunderstandings back to you. You might have been duped, but your stiff-upper-lip approach of letting the “excuses” be read and interpreted by your readers only enhances your prestige and credibility.
Nathan K. Blank, M.D.
Allegheny University of the Health Sciences, Philadelphia, PA 19102To the Editor:
Although I understand the intent of your conflict-of-interest policy, I am struck by your failure to acknowledge that the academic experts who are most likely to be solicited as editorialists are the very same people who are sought by industry as consultants, for obvious reasons.
Michael D. Erisman, Ph.D.
2497 Caminito Ocean Cove, Cardiff, CA 92007Author/Editor Response
The editors reply:
It is exceedingly difficult to devise a conflict-of-interest policy that will be fair and reasonable in all cases. For nearly every possible rule, there is an exception. That is why authors must be forthcoming and editors must temper their policies with common sense. One-time consultancies would not necessarily violate our policy; it would depend on a number of factors, including how recent the consultancy was and whether it concerned a product to be discussed in the editorial or a quite different product made by the same company. Thus, we have not extended our policy, as Dr. Salzman infers, and we have never exempted speakers' fees. The important point is the reason for the policy. If that is understood, the details can be clarified on a case-by-case basis.
We disagree with Dr. Stone that Dr. Manson's consultancy was not relevant. The benefits of an appetite suppressant, such as dexfenfluramine, depend crucially on the risks of obesity. Dr. Manson was paid by Interneuron Pharmaceuticals to testify before the FDA about those risks, and that was not stated in her written disclosure. She thought that she had made the nature of the consultancy clear to an editor in a telephone conversation, but it was not clearly understood. We acknowledge that there was a misunderstanding during that conversation.
Mr. Douglas implies that the editors should remember past disclosures made in different contexts. That is quite unrealistic, given the number of such disclosures, and if authors are forthcoming it is unnecessary. He also mistakenly implies that we require authors of editorials to disclose conflicts of interest. As stated in our editorial, a financial conflict of interest disqualifies someone from writing an editorial for the Journal.
Dr. Erisman is correct that we often seek out the very people who are attractive to industry, but fortunately many distinguished experts in academic medicine choose not to have financial arrangements with the manufacturers of products they are studying.
We are aware that Dr. Manson's consultancy was not ongoing at the time the editorial was written, but Dr. Faich's consultancy with Wyeth–Ayerst was ongoing. He coauthored the editorial, and his violation of our conflict-of-interest policy is unarguable.
Marcia Angell, M.D.
Jerome P. Kassirer, M.D.
