Unmasking Special Interest Groups: The Key to Addressing Conflicts of Interest in Medicine (2010)

[Dolphin]

Unmasking Special Interest Groups: The Key to Addressing Conflicts of Interest in Medicine

Giovanni A. Fava

There is no abstract to this, I'm afraid.

I've underlined some bits I thought were interesting.

When our journal published the first investigation which gave an idea of the extent and dangerousness of conflict of interest in science [6], this took place in a stage of massive denial by major medical journals [7]. The issue was whether specific episodes that emerged were the unavoidable drawbacks of a scientific system that functioned in a substantially independent way, or whether they were simply the tip of the iceberg. What iceberg? Corporate interest which results in self-selected academic oligarchies (special interest groups) that influence clinical and scientific information [7]. Members of special interest groups, by virtue of their financial power and close ties with other members of the group, have the task of systematically preventing dissemination of data which may be in conflict with their interests.

I think CBT/GET proponents might fit in such a description

The first target is to undermine the critical individual judgment of the physicians. George Engel [8] differentiated between ‘scientific physicians’ (clinicians who fully apply the scientific method in their care of patients and in their understanding of the disease) and ‘physician- scientists’ (physicians whose primary commitment is to scientific research pertaining to medicine, with no obligation to be involved with patients). Clinical practice is the source of fundamental scientific challenges for scientific physicians, whereas the application of basic (including pharmaceutical) research is the preferred focus of physician-scientists. The intellectual freedom portrayed by scientific physicians is the worst enemy of special interest groups, and thus requires massive doses of censorship. Censorship may take different forms: direct suppression of information by special interest groups who act as editors and reviewers or make choices in scientific pro- grams, careful selection of the literature in a biased direction and manipulated interpretation of clinical trials (including those supported by public sources), and self-censorship (when an investigator omits raising questions and criticism for the fear of retaliation) [9].

Other instrumental methods are the substitution of critical reviews with meta-analyses whose data could be easily manipulated by excluding censored (unpublished) studies [10], the emphasis on clinical guidelines by experts with major conflicts of interest [11], full control of medical societies, their journals and their meetings [12], and keeping medical literature as distant as possible from the clinical problems of daily practice.

 

[Dolphin]

Chomsky’s [13] mechanisms of propaganda may apply to what has occurred in medicine in the past two decades.

provides the appropriate degree of retaliation to outliers (marginalizing dissident cultures).

Prescribers may claim to be following the evidence, but are primarily influenced by the eminence of the authorities they listen to in meetings and read in journals [21] or by the framing of the risk of medication side effects by the pharmaceutical industry [22]. This occurs also because of the control of special interest groups over diagnostic classification [23] and clinical guidelines committees.

Mario Maj [26] has recently summarized several issues concerned with non-financial conflicts of interest and has expanded the notion of ‘special interest groups’ to academic, political and personal ties. Table 3 outlines Several steps to address non-financial conflicts of interest in medical research, as discussed in detail elsewhere [27]. The rationale behind this strategy is to increase and sup- port the reservoir of disinterested experts who can be called upon to advise government policy makers and physicians on the safety and efficacy of treatments and on the hazards of chemicals [6] and the dangers of restrictive ideology leading to ‘trivial variations on tired themes' in grant and journal selections [28].

I think the latter is an issue with a lot of government-funded research in the UK and the Netherlands, for example, where there are lots and lots of studies on various CBT/GET/rehab studies and related studies by proponents of CBT/GET/rehab studies.

 

[SilverbladeTE]

as always, it's about control
see same kind of crap with of course linked ot this, pharmaceuticals, but also, oil, power generation, food and information
he who controls these, has you by the balls.
currently this massive intertwining lust for control is dragging the entire structure of the Human system down

 

[alex3619]

These issues are why I started looking into Zombie Science (old name, same principle) several years ago. Its not just academic researchers, or physician researchers and influence over reviews. Its also about corporate sponsorship, bureaucratic support and sponsorship, influencing grant bodies etc.

Under this kind of thing you don't need an overarching conspiracy, this climate works against science and the public good without any centralized directive.

 

[Dolphin]

I thought it was interesting how patient organisations got a couple of mentions as part of the solution, given how CBT/GET proponents like to criticise them.

Table 3. Steps to addressing non-financial conflicts of interest in medical research

[..]

5. Increased input from the general public, patients’ associations and scientists whose main field is outside of the one which is the target of grant applications

Table 4. Agenda for fostering creativity and independence in PMAs [PMAs=Professional Medical Associations]

1. PMAs should reformulate their missions and goals with the help of the general public and patients’ associations