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"Conflicts of interest dont always involve money"

Discussion in 'Other Health News and Research' started by Dolphin, Feb 15, 2012.

  1. Dolphin

    Dolphin Senior Member

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    I think the idea of intellectual conflicts of interest is interesting

    Full article at: http://www.kevinmd.com/blog/2012/02/conflicts-interest-involve-money.html
     
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  2. Sean

    Sean Senior Member

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    So true.

    It goes way past a bit of cash. Career, ideology and pet theories, power games, egos, etc, are all important in determining undue influence, often much more important than mere money.
     
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  3. alex3619

    alex3619 Senior Member

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    Hi, I agree. Its why I used "doggie treats" instead of money in one of my blogs. Its about reward, and reward could be something like prestige or influence, cash has preeminance only because its easy to count the dollars - how do you do book-keeping on influence? Bye, Alex
     
  4. Dolphin

    Dolphin Senior Member

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    I think intellectual conflicts of interest can also involve cash directly and indirectly e.g. a regular researcher in the ME/CFS field who feels there would be less place for them, and less chance of them to get funding, if a certain finding is accepted/somebody that is a central tenet of their work is shown to be false.
     
  5. WillowJ

    WillowJ Senior Member

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    I thought this was interesting
    (this concept actually has implications beyond medicine, but it's the medicine that I'm interested in here)

    There's a link to the full text of a scholarly paper produced by the American Thoracic Society and published in the American Journal of Respiratory and Critical Care Medicine, which I didn't notice the first time I read the blog post. It's 17 pages, counting references. I haven't read it yet)

    Quote from the ATS paper:

    COI=Conflict of Interest
     
  6. Snow Leopard

    Snow Leopard Senior Member

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    What about research report from patients or former patients? ;)
     
  7. biophile

    biophile Places I'd rather be.

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    On the PACE Trial, it was irritating how Richard Horton of the Lancet portrayed a skeptical ME/CFS community as having ideological conflicts of interest while presenting the researchers (with careers and reputations on the line and known COI stated in the paper itself) as "utterly impartial".
     
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  8. Dolphin

    Dolphin Senior Member

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    (I'm not exactly sure what you are saying but will reply using one interpretation)
    Patients may have cognitive biases like everyone else, but I think it can be argued that's not the same as a conflict of interest.
    If you're a researcher or offer a therapy, you and your family's income could rely on a treatment/therapy being prompted/not being discredited - you may even keep prompting it even though you believe there are problems, because of this conflict of interest (and not simply pride).
    A patient's aim will be what they hope will best bring about progress in a field - they may be biased in what they see, but I think it can be argued that's not by a conflicting (separate) interest.
     
  9. alex3619

    alex3619 Senior Member

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    Hi WillowJ (post 5), your comment on intellectual conflicts is part of what I am looking at: confirmation bias, cognitive dissonance, and dogmatism. Do you have a reference for that paper discussing intellectual conflicts that you cited? If you are also interested in this area, maybe I should compile a list of interesting papers and send them to you.

    To biophile (post 7), the Horton controversy isn't just irritating. If the real state of affairs in this research becomes widely known his comments will come back to haunt him.

    Bye, Alex
     
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  10. Dolphin

    Dolphin Senior Member

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    I'm interesting in that area anyway so feel free to send me anything if you're sending them to others.
     
  11. Esther12

    Esther12 Senior Member

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    Post it up Alex! I've only been able to have a quick look at your recent blogs, due to PC troubles, and now pressing real world issues, but they looked interesting and have been added to my growing list of stuff to read when I'm able.

    re cognitive biases: I try to prioritise the identification of my own biases, as I think the mine is the mind I have the most knowledge of and control over. It can be a little too easy to read about some common distortion of thought and think "So that's why other people disagree with me! They're deluded." While there are some very broad themes (instinctive faith in authority, just world hypothesis, desire to protect ego) which are likely to play some role in almost all people's thinking, trying to diagnose ones opponents with particular cognitive distortions can lead to a smug intellectual laziness (see Simon Wessely).

    (Even I'm not sure if that was a deliberate joke).
     
  12. Dolphin

    Dolphin Senior Member

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    I think it might be worth pointing out that "conflicts of interests" reported now tend to be rather narrowly defined.

    So, for example, CBT therapists, physiotherapists, psychiatrists or others who make a living offering particular nonpharmacological treatments to ME/CFS patients don't report these as conflicts of interest even though many might not find a place in the ME/CFS field, or at least, they might be more side-lined if things changed. Or, alternatively, certain guidelines or papers might help cement their career.

    Conflicts of interest tend to be associated with the private sector money e.g. pharmaceutical companies or certain types of insurance work e.g. if an insurance company regularly sends patients for you to assess, this often isn't reported - it's seen as more part of normal life. It tends only to come up if somebody has a role a bit higher up.
     
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  13. Esther12

    Esther12 Senior Member

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    Oh yeah - I didn't mean to sound critical of the initial post. In many way, this seems to be more of a problem in 'science' now.

    In the social sciences, it's widely recognised that different researchers will view the evidence according to different biases and ideological commitments, and this awareness helps mitigate the harm done. With some science it could be that there is less room for the biases of researchers to affect results, but with much psychological work, it is closer in nature to most of the social sciences than something like chemistry. An instinctive faith in someone's clarity of thought just because they happen to be working as a researcher leads to the sort of laziness biophile pointed out in Horton.
     
  14. alex3619

    alex3619 Senior Member

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    Hi Esther12 i will work on a reading list as you suggested, I have to go back and find the material but it shouldn't take long when I have a chance. One in a particularly is a recent study that clearly shows how entrenched confirmation bias is with doctors.

    Science is indeed subject to bias. Methodologies like RCTs are supposed to avoid this, but sadly don't. They only avoid some of it.

    Its ironic that the BPS approach has been so badly mangled. As you point out these conflicts have been seen so clearly in the social sciences. My own background in systems theory overlaps a little with the social sciences, and perspective (world view) is very much a part of that: we recognize that how someone has learnt to see the world very much colours their thinking. Indeed, I suspect if BPS were rebalanced a lot, with an emphasis on multidisciplinary teams (NOT just psychiatrists) it would be a far more successful approach, though other problems with methodology would remain that I hope to discuss at some point.

    The other thing that will help a lot is an end to ivory tower publication. Open access journals open up the debate, and while that will lead to more conflict in the short and medium term I suspect, in the long run it will make research more transparent and accountable.

    Bye, Alex
     
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  15. WillowJ

    WillowJ Senior Member

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    Sure, Alex, I would like that. Thank you. :Retro smile: I don't promise to read them anytime soon, though! But I'll keep them for when I'm able to read them.

    There are actually 4 full text references and one abstract in the blog post Dolphin cited. The ATS paper I mentioned in post 5 is at http://171.66.122.149/content/180/6/564.full.pdf html

    The "one recent study" from post 1 is http://www.bmj.com/highwire/filestream/447600/field_highwire_article_pdf/0.pdf

    Paper is here: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60787-X/fulltext#article_upsell

    Papers here: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61816-X/fulltext
    and here: http://www.annals.org/content/153/6/421.2.extract
     
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  16. alex3619

    alex3619 Senior Member

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    Confirmation bias

    http://dspace.library.drexel.edu/bitstream/1860/1164/1/Parmley_Meagan.pdf

    This is a thesis on confirmation bias, I am only part way through it.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1126323/pdf/3261453.pdf

    I havent read this recently, I am including this for completeness.

    http://www.scribd.com/doc/73420955/...iatrists-Stick-to-Wrong-Preliminary-Diagnoses

    This is the formal study that shows bias. Its very hard to pretend the problem is not real after this one.

    I think I have posted two of these before on other threads. As I find more papers I will post them if I remember to. I do have other papers but I am not really organized just yet and don't necessarily have references. In particular many sources I have read over the last month within philosophy of science discuss dogmatic and confirmation bias.

    Bye, Alex
     
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  17. Snow Leopard

    Snow Leopard Senior Member

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    Indeed. A BPS approach is the only comprehensive scientific approach. The problem is that for many, they don't practice what they preach. As soon as you hear them saying stuff like "evidence based" (as opposed to "science based medicine"), you know they have started to make their retreat.
     
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  18. WillowJ

    WillowJ Senior Member

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  19. alex3619

    alex3619 Senior Member

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    As an historical side bar, the first name proposed for EBM was Science Based Medicine. It was rejected as it implied that medicine up to then wasn't about the science. Bye, Alex
     
  20. Snow Leopard

    Snow Leopard Senior Member

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    It certainly makes you wonder doesn't it... :thumbsup:
     
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