ScienceWriters2010: Sorting out conflicts of interest
UPDATE: See Mayberg’s response to Bass’s post.
Alison Bass posted an interesting item on her eponymous blog regarding Helen Mayberg’s Sunday morning talk at ScienceWriters2010. The talk was on the use of deep-brain stimulation to treat depression–a potentially breakthrough technology (and I don’t use that word lightly) that is in its earliest tests.
In her item–headlined “Keynote scientist at ScienceWriters conference dances around the truth”–Bass says Mayberg’s talk was too anecdotal, left out “a few salient details,” and failed to disclose conflicts of interest. I was the person who invited Mayberg to talk at the meeting, and I tried to explain that decision in a comment on Bass’s post. I won’t say any more about that.
What I do want to address, however, is the notion of conflict of interest, which applies, in similar ways, to both scientific research and to journalism. “Conflict of interest” is used by science journalists to cover all manner of sins, and I fear that it is losing its meaning. That’s a bad thing, because this is a very important notion that we all need to understand and keep in mind.
Bass acknowledges that Mayberg, in her talk at Yale last Sunday, disclosed that she was a consultant for St. Jude Medical, a company that makes, among other things, the probes that Mayberg uses for deep-brain stimulation. Bass thought Mayberg should have explained that she was not referring to a non-profit hospital with a similar name, but the more interesting question, to me, was that Bass thought Mayberg was wrong to be associated with St. Jude Medical which, Bass wrote, “has a less than stellar reputation.”
For that reason, she concluded that “if I were a chronically depressed patient being recruited for the company’s ongoing clinical trials, I might think twice about participating.”
The question I’m interested in is this: Does Mayberg’s inolvement with this device-maker raise questions about the integrity of her research? And does this relationship pose a conflict of interest?
As many Tracker readers know, large-scale clinical trials of procedures such as deep-brain stimulation can cost tens of millions of dollars, a sum out of the reach of most researchers, hospitals and universities. To do those studies, researchers routinely partner with drug and device makers. There is, indeed, a conflict of interest in these arrangements. Industry’s interest in making money conflicts with the researcher’s presumed interest in helping patients. Public funding of publicly minded researchers would subvert this conflict of interest, because all parties would, at least theoretically, have the patients foremost in mind. But even government cannot afford to replace the billions of dollars that drug and device makers spend on research.
Journalists face the same kind of conflict of interest when they write for sponsored publications. The journalist’s interest in serving readers can conflict with the publication’s interest in serving its institution. It doesn’t matter who the publisher is–a distinguished university, a drug company in trouble with the FDA, or a pawn broker–the conflict exists.
The issue with Mayberg is not whether St. Jude Medical is a good company or a bad company, as Bass suggests. There is an inherent conflict of interest there, regardless of the company’s reputation. But, I would argue, it’s an unavoidable one, given the available means of financing hugely expensive clinical research.
The issue with journalists is whether we serve our readers’ interests, or whether we occasionally serve somebody else’s, as most freelancers (including this one) have done, at least on occasion.
Conflict of interest is easy to understand. It’s devilishly hard to get rid of.
And if I were a chronically depressed patient being recruited for a company’s ongoing clinical trials, I think I’d grasp at anything.
- Paul Raeburn
November 10th, 2010 at 5:46 pm
I’d guess that Mayberg’s hope that a technique she devised might, might actually help hopelessly depressed people would be at least as powerful a distortion field as any financial conflict of interest that shehas. Both should be recognized by journalists.
As an audience member with no previous awareness of this technique, I thought that Mayberg did a pretty good job of tamping down expectations, saying quite explictly that it was unlikely to work as well as the anecdotes might suggest.
November 10th, 2010 at 5:49 pm
I’d guess that Mayberg’s hope that a technique she devised might, might actually help hopelessly depressed people would be at least as powerful a distortion field as any financial conflict of interest that she has. Both should be recognized by journalists.
As an audience member with no previous awareness of this technique, I thought that Mayberg did a pretty good job of tamping down expectations, saying quite explictly that it was unlikely to work as well as the anecdotes might suggest.
November 10th, 2010 at 8:19 pm
It sounds on the face of it to be a conflict of interest. On the other hand, the small numbers involved and the anecdotal evidence were manifest, and the speaker did say it’ll take a lot more testing to get anywhere close to application.
If she acknowledged being a consultant to St. Jude Medical, but did not make it clear the this is not a hospital but a for-profit medical device manufacturer that provided the electrodes, that also is misleading. I was in and out of that session, so did not note those remarks. This really is a situation full of on-the-other-hands. It’s also true there is no surprise or sure sign of ethical compromise in the connection – as Paul says in his post – to a company involved in the field under test. It is difficult to see how one can demand that every company consult with competent people in a given field so it has good science advice in developing products, and also to assume that other competent people with which it has not consulted will step up and do the peer-reviewed, open testing of the product for journals and meetings (and submissions to the FDA). Sometimes the pool of competence makes that hard to do.
A plainer disclosure wouldn’t have changed the presentation’s impact by much. It was dramatic, curious, worth following, but not persuasive yet that it merits big coverage. It was at the New Horizons meeting, and this is just one of the things on the horizon that’s worth following.
More to the point, Bass in her blog post refers to a letter from the FDA to the company warning that the manufacturing practices of a different device is under scrutiny. That seems itself, if that’s all we have, thin and anecdotal evidence on which to hang an assertion the company has a “less than stellar reputation.” I’m not defending the company, but this doesn’t make the case it has an odor about itself. Even five star restaurants get dinged once in a while after a health dept. inspection.
November 11th, 2010 at 7:39 am
Don, Charlie–
Thanks for the thoughtful comments. Mayberg has responded in an email to me, and you can see my new post above with her responses. She reviewed her slides, and she says that the disclosure was far plainer than Alison or any of us remember.
November 11th, 2010 at 2:46 pm
The conflict of interest is definitely something to look at for she developed the instrument and then doing the research which manipulation can be involved so she can make the results better than they may be so she can sell her product to other hospitals to make a significant amount of money and hopefully she doesn’t gear the results in the way she wants it too but what the actual results really are. This can affect the clients drastically. When people are depressed it is not in there best interest to try something or even be in research for they just want to feel better.
Phil Milnamow, MSW
Owner or http://H-Bond.com