NEJM: Editors Admit Conflict-of-Interest Slips
The editors of the New England Journal of Medicine apologized yesterday for violating its financial conflict-of- interest policy 19 times since 1997 in "choosing experts to review drug therapies," the New York Times reports. In a written apology printed in the journal's latest issue, the editors acknowledged that they had "failed to disqualify authors of the 19 reviews even though the authors had told them about their financial ties to drug companies that marketed therapies described in the articles." Intended to "avoid bias in reporting information about drugs that doctors prescribe for their patients," the journal's policy requires it to select authors who have no ties to the manufacturers of the medicines mentioned in the articles. Although the journal did disqualify authors of reviews and editorials who had received "significant research funds from companies making the drugs discussed in an article," those whose institutions received grants or those who served as drug company consultants were not disqualified. Editor-in-Chief Dr. Marcia Angell said, "This is the most serious mistake for which we have had to apologize" (Altman, 2/24). NEJM conducted audits after the Los Angeles Times uncovered eight articles that violated the policy (Monmaney, Los Angeles Times, 2/24).
Pinpointing the Problem
Angell attributed the lapse to "poor coordination among the editors and carelessness within the office," adding, "It was a mistake, to put it as bluntly as possible" (New York Times, 2/24). Angell "blamed the most recent violations largely on misunderstandings between" Dr. Alastair Wood, a Vanderbilt University pharmacology professor, and the main editorial office in Boston. She added that "one or more editors may have told prospective authors that it was all right to provide a misleading answer on the journal's mandatory financial disclosure statement." Such appears to be the case with Dr. Vera Price, a University of California-San Francisco professor who wrote a favorable review of hair-loss treatments, despite receiving $1.7 million in research funding between 1994 and 1999 from Merck & Co. and Pharmacia Upjohn, manufacturers of hair-loss treatments Propecia and Rogaine. Price had signed the standard disclaimer statement that read: "I/we have no current, recent past or planned future financial associations (such as equity interest, consultancies or major research support) with a company that stands to gain from the use of a product (or its competitor) discussed in the editorial or review article." Despite the ethics violations, Angell said that the articles in question were not deficient, adding, "These articles all passed painstaking peer review. If any bias had been detected, we wouldn't have published them. But that doesn't mean there isn't a bias. That's why we have the policy in the first place" (Los Angeles Times, 2/24).
In the apology letter, the editors said "they had taken steps to prevent a recurrence." Angell said improving communication among the editors and tightening the policy would be the first steps. The disclosure statement will be amended to require authors to disclose who paid their grants during the two years preceding the request for the article and then what percent of the total grant comes from industry (New York Times, 2/24). However, Kenneth Rothman, editor of the journal Epidemiology, said that NEJM's unique policy is reflective of its current troubles. Rothman said that the policy hinders scientific debate, adding, "That policy would prevent Thomas Edison from writing an editorial about the future of electricity" (Los Angeles Times, 2/24).