Wednesday, August 23, 2006
The Dog Ate My Disclosure
BY ADRIANE FUGH-BERMAN

The Center for Science in the Public Interest, one of a handful of consumer advocacy groups that takes no industry money, has called for medical journals to levy a three-year publishing ban on authors who omit declarations of conflicts of interest. Environmental Health Perspectives has imposed just such a ban.

In the August 7 issue of the Journal of the American Medical Association, however, editor Catherine DeAngelis favors education over punishment, arguing that medical journals cannot be responsible for ferreting out failures of disclosure and punishing miscreant authors. She makes the point that “it cleans our house by messing others,” meaning that an author punished by one journal would merely divert manuscripts elsewhere - although if journal editors shared information about cheaters this problem goes away. DeAngelis also writes that “those who suggest this approach have not considered the risk of an antitrust suit.” This seems far-fetched; antitrust litigation usually involves plotting for profits, not unpaid publications. Litigation paranoia aside, a secret blacklist of authors would be problematic because malicious, misleading, or mistaken entries could not easily be corrected.

So… don’t make it secret. Let’s out the perpetrators in public, where the merely naïve can apologize, the falsely accused can rescue their reputations, and the lying curs can bluster self-incriminating excuses. A forum where medical editors can describe nondisclosure incidents, and where others, including the implicated, can respond, would be a great service not only to editors, but to colleagues, the media, and consumers. Anyone receiving information from a source who stands to profit from that information deserves to know about conflicts of interest.

Without sanctions, a requirement is demoted to an easily-ignored request. If there is no downside to omitting conflicts of interest from an article submission, many authors will continue to omit information that could invite additional scrutiny of a manuscript.

CSPI’s proposal deserves support. A medical journal that identifies nondisclosure should ban an author from publishing in that journal for three years and should publish that information. And repeat offenders should receive the same sanction from the International Committee of Medical Journal Editors and the World Association of Medical Editors. Medical journals have an ethical obligation to their readers - and to the public - to expose misdeeds.

This commentary appears by arrangement with the American Society for Law, Medicine, and Ethics.

Comment on this essay.

Comments are sent to the forum moderator. Select responses may be posted.

The Luxurious Growth
David Brooks, NY Times
“There seems to be a general feeling, as a Hastings Center working group put it, that ‘behavioral genetics will never explain as much of human behavior as was once promised.’”

Mind-Altering Drugs and the Problem Child
Claudia Meininger Gold, Boston Globe
“If we can listen differently to parents of young children who have ‘behavior problems,’ we can intervene early, before there is even a question of medication, and may be able to change these developing brains.”

Cash for Kidneys? Scheme Won't Work
Art Caplan, MSNBC
“A default donation plan could bring a boost in organs for transplant without creating the headaches, fears and misdistribution of a financial market.”

'Blade Runner' ruling subverts nature of sport
Art Caplan, MSNBC
“It may be fascinating to see who can go the fastest on rocket-powered legs or throw a heavy weight the farthest using performance-enhancing drugs, or genetically engineered muscles. But what you have then is an exhibition or a show, not a sport.”

A Phony 'War on Science'
Michael Gerson, Washington Post
“In their talk of a Republican war on science, liberals may be blinding themselves to a very different kind of modern war in which their own ideals are deeply implicated: a war on equality.”

It’s Not Immoral to Want to be Immortal
Arthur Caplan, MSNBC
“Despite a lot of hand-wringing and finger-pointing, it is not obvious that wanting to live a lot longer is evil or immoral.”

Science Is Leading Us to More Answers, but It's Also Misleading Us
David A. Shaywitz, Washington Post
“Consumers of scientific information must balance the hope we place in global biology with the skepticism this field has surely earned.”

Taking the Scary out of Breast Cancer Stats
Carol Tavris and Avrum Bluming, LA Times
“The media understand how deeply women fear breast cancer, and the result is that every study that seems to find a link between some new risk factor and the disease makes headlines everywhere.”

Dollars to Doughnuts Diagnosis
Albert Fuchs, LA Times
“Insurance doesn't make routine care affordable; it makes it more expensive by adding a middleman.”

Tainted Medicine
Jerome P. Kassirer, LA Times
“Disclosure of financial ties may give a scientist or researcher a clean conscience, but that doesn't erase the possibility of a conflict.”

Children's health can't be left to faith alone
Arthur Caplan, MSNBC
“Parents do not have the right to watch a child wither away while they pray.”

Transplant List Numbers Raise Doubts
Arthur Caplan, MSNBC
“The American people have a right to expect absolute honesty about the number of people waiting for a transplant at any time.”

An Epidemic No One Wants to Talk About
Robert E. Fullilove et al., Washington Post
“Simply put, we will never rid the United States of HIV and other STDs if our only weapon is medical treatment.”

Making Cells Like Computers
Erik Parens, Boston Globe
“Conceivably, we are on the verge of installing synthetic genomes in bacterial cells to create products we want. But we are still a long, long way from doing what most people mean by ‘synthesizing life.’”

Miracle Workers?
David Rieff, New York Times Magazine
“Even today, the oldest of all relations between patient and physician — that of supplicant to shaman — continues to exert its authority.”

Overselling Overmedication
Judith Warner, NYTimes.com
“Most of the critics decrying the over-medicalization of the American mind rest their arguments upon the bedrock assumption that people who have nothing wrong with them are being medicated for largely fictitious concerns.”

Ads Spur Urge for Drugs
David Lazarus, LA Times
“DTC advertising has turned prescription drugs into just another gotta-have-it consumer product.”