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‘Unduly Positive’ Editorials and Financial Conflict of Interest

For a large proportion of editorials published in top oncology journals, the authors have industry-related financial conflicts of interest (FCOIs), and in many cases, the relationship is with the company that produces the drug being discussed in the editorial.

Moreover, “unduly favorable” commentaries for new cancer drugs are significantly associated with editorialists having direct conflicts of interest with the companies producing those drugs.

These findings come from a first-of-its-kind analysis published online July 29 in the Journal of the National Comprehensive Cancer Network.

“Many clinical decisions in oncology need to be made in the absence of level I evidence; the voices of editorialists can therefore have a major influence on practice and policy,” say the researchers, with senior author Bishal Gyawali, MD, PhD, Cancer Research Institute, Queen’s University, Kingston, Ontario, Canada.

“Our study demonstrates that not only is FCOI pervasive among the authors of oncology editorials but also these authors are more likely to present the results of clinical trials in a manner that may be unduly favorable for the drug,” they conclude.

Analysis of Top Five Oncology Journals

For their analysis, the team evaluated 90 editorials published in 2018 in the following five top oncology journals: The New England Journal of Medicine; The Lancet; The Lancet Oncology; JAMA Oncology; and the Journal of Clinical Oncology.

The investigators assessed whether or not the authors disclosed any conflicts of interest with industry and judged whether or not the commentary was “unduly favorable.”

“Unduly favorable” editorials were defined as those in which a positive spin was given or a clinical recommendation was made without discussing the limitations of a nonrandomized controlled trial; a positive spin was given in the editorial despite the randomized controlled trial’s yielding negative results; or an excessively positive interpretation of the findings was given with no discussion of the study’s limitations.

The analysis revealed that 74% of the editorials were written by at least one author with a minimum of one disclosed conflict of interest with the pharmaceutical industry.

More importantly, 39% of the editorials were authored by at least one editorialist who had disclosed a conflict of interest with the company whose product was being discussed — what the investigators call a “direct FCOI.”

Some 12% of the editorials or commentaries reviewed were judged to be “unduly favorable” to the product being discussed. Of those, 73% had been authored by at least one editorialist with an FCOI — “all of whom also had a direct FCOI with the same industry,” the authors note.

Somewhat in contrast, some 12% of the editorials that were deemed as unduly favorable were written by authors who had at least one FCOI, compared with 13% of those authored by editorialists who did not have an FCOI, they point out.

On the other hand, 23% of the editorials that were judged as unduly favorable for the study drug under discussion were written by authors who had a direct conflict of interest, compared to only 5% of editorials authored by those who did not have a direct conflict of interest (P = .009).

“Our data demonstrate that this is not just a problem with optics; editorialists with direct FCOIs were more likely to author an unduly favorable editorial for the drug,” the authors emphasize.

The team suggests that the problem is bigger in oncology than in medicine generally. They point out that a prior analysis of three high-impact general medicine journals found a direct FCOI rate of about 18%, whereas in their study of oncology editorials, the direct FCOI rate was 39%.

Other studies have also suggested that oncology is particularly affected: an analysis of 100 of the largest US medical societies found that the American Society of Clinical Oncology topped the list for both payments to individuals and research, as previously reported by Medscape Medical News

Relevance of the FCOI

The authors acknowledge that the type, extent, and relevance of the FCOIs are important. For example, principal investigators of major clinical trials are likely to have some conflict of interest because they are on the steering committee of the study. This type of conflict of interest is not the same as a conflict of interest that includes honoraria for serving on an advisory board or owning stock in a company, they comment.

“A way to address this would be to consider a minimum threshold of FCOI over which the conflict would be considered substantial enough not to allow the researcher to write an editorial in the journal,” the researchers suggest. “Journals should take proactive steps to exclude experts with substantial direct FCOIs from authoring editorialist,” they reemphasize.

However, as has been noted in a Medscape Oncology panel discussion, the real problem when it comes to an author declaring a direct conflict of interest is that readers are not able to judge whether a recommendation made by an author has been influenced by that conflict of interest or not. One solution suggested by the panelists would be to stipulate that any investigator running a trial for a company not be allowed to hold stock in that company or to receive substantial funding from the company — ie, they should be free of any direct FCOI.

These panelists also suggested that $10,000 be set as the threshold for defining a significant conflict of interest ― which is much lower than the $25,000 threshold that the US Food and Drug Administration and the National Cancer Institute set as the threshold in their definition of substantial funding.

Gyawali and co-authors have disclosed no relevant financial relationships.

J Natl Compr Canc Netw. Published online July 29, 2021. Full text

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